Articles related to BREAST CANCER

A conversation with Sayeh Lavasani, MD, MS, a medical oncologist specializing in breast cancer at the City of Hope Comprehensive Cancer Cente, in Duarte, California, who discusses how clinical pathways are developed and used at the cancer center, how the pathways for patients with HER2-low breast cancer are utilized, recent updates in the HER2-low treatment landscape, the challenges and level of evidence needed to incorporate new therapeutic approaches into the clinical pathway, and the challenges and crafty balancing that’s needed between standardizing treatment decisions across the population and optimizing care for individual patients.

The approval is based on the findings of the DESTINY-Breast04 Phase III trial and follows the Committee for Medicinal Products for Human Use’s favorable recommendation. In the trial, Enhertu (trastuzumab deruxtecan) significantly decreased the risk of disease progression or death in patients with HER2-low metastatic breast cancer with hormone receptor (HR)-positive or HR-negative disease by 50% compared to the physician’s choice of chemotherapy. According to a blinded independent central evaluation, Enhertu had a median progression-free survival (PFS) of 9.9 months compared to chemotherapy patients’ PFS of 5.1 months (BICR). When compared to chemotherapy, Enhertu showed a 36% reduction in the risk of death, with a median overall survival (OS) of 23.4 months as opposed to 16.8 months.

Adjuvant olaparib (Lynparza) was linked with significantly longer life free of invasive or distant illness compared to placebo among patients with high-risk, HER2-negative early breast cancer and germline BRCA1 or BRCA2 pathogenic or possibly pathogenic mutations. Global patient-reported quality of life was not significantly impacted by olaparib.

In his discussion of the subject, Adam M. Brufsky, MD, PhD, FACP, of the University of Pittsburgh School of Medicine notes that about 50% of breast cancers categorized as HER2-negative exhibit low HER2 expression, and preliminary data suggest that new antibody-drug conjugates may be effective in treating tumors with low HER2 expression; clinical trials are currently underway. Trastuzumab should not be added to treatment plans for women with low HER2 expression, according to Dr. Brufsky, because it does not assist those with IHC 3+ or ISH-amplified breast cancer or those without those conditions. Finally, compared to triple-negative tumors, hormone receptor-positive (HR+)/HER2-negative cancers seem to have low HER2 expression more commonly.

The majority of the decrease in the risk of local recurrence was seen in the first decade, according to the researchers’ observations of a differential effect over time. With or without irradiation, the risk of recurrence is not significantly different in the second decade. However, others pointed out that the goal of radiotherapy is not to increase overall survival but rather to lower the risk of local recurrence, which is a crucial aspect of breast-conserving therapy.

The median PFS and overall survival in the hormone receptor-positive cohort (494; 88.7%) were 23.9 months and 17.5 months, respectively, for the trastuzumab deruxtecan group and 10.1 months and 5.4 months, respectively, for the physician’s choice group. Overall survival was 23.4 months and 16.8 months, respectively, while the median PFS for all patients was 9.9 months for the trastuzumab deruxtecan group and 5.1 months for the physician’s choice group.