By Susan Siegel
Photo Caption: Thanks to VBCF Volunteer Extraordinaires – Lisa DeFerrari, Susan Siegel, and (ex-Virginian) Debbie Hayes as well as Marylinn Minor (not pictured) for attending the San Antonio Breast Cancer Symposium and bringing this cutting-edge scientific knowledge back to our state!
I am always excited to be able to attend the San Antonio Breast Cancer Symposium as I always learn so much. This is the largest breast cancer conference in the world and is attended by doctors, researchers and patient advocates from around the world.
This year’s most exciting news was regarding treatment for metastatic HER2-positive cancer. The HER2CLIMB trial studied the use of tucatinib in patients with HER2+ metastatic breast cancer (MBC) whose cancers had progressed after at least two rounds of previous therapy. Additionally, the trial included patients with metastases to the brain.
Researchers hoped that this medicine would cross the blood-brain barrier, which many cancer medicines can’t cross, and get to the cancer in the brain. This is especially important in HER2-positive cancers since brain metastases are common in HER2+ MBC.
The results were quite significant. Tucatinib significantly improved both the overall survival and progression-free survival rates of those who received the drug. Additionally, at the one-year mark, a quarter of the women who had brain metastases were alive with no further progression of the cancer. Tucatinib is fairly well tolerated, and only a small percentage of patients dropped out of the study due to adverse side effects.
It was really exciting to see that this clinical trial included the people who most needed the treatment. This was the first randomized trial completed in patients with HER2+ MBC that included patients with untreated or previously treated, progressing brain metastases.
Since I recently began taking an aromatase inhibitor, I was anxious to hear the results of the NASABP-2 trial, which looked at the results of extending the use of aromatase inhibitors beyond five years. Aromatase inhibitors are a type of hormone therapy for postmenopausal women with hormone-dependent therapy. Since hormone receptor-positive breast cancers can recur well past 5 years after initial treatment ends, it is not clear how long people should take these drugs.
This study looked at the use of the aromatase inhibitor letrozole for 10 years vs. 5 years. While there was some improvement in disease-free survival, there was no significant difference in overall survival.
So what does this mean? We all want to lower our risk of recurrence whenever possible, but the risks and benefits of extending the use of aromatase inhibitors must be carefully evaluated to determine who would benefit from taking the medication longer. This includes tumor characteristics, the patient’s other existing illnesses and conditions, and tolerance of the aromatase inhibitor during the initial 5 years. There are also new tools, genomic tests, that can help to make this determination. These tests can predict who is likely to benefit from additional hormonal therapy.
Another interesting study compared the use of the taxane chemotherapy paclitaxel given as a pill instead of by infusion, in metastatic breast cancer. Taxanes are a class of chemotherapy medicine that is given by infusion to the vein. This is done at a hospital or infusion center and takes about 3 hours.
Oral administration of chemotherapy drugs has advantages, as most people would rather take a pill than travel to a center for a lengthy treatment. In this study, they used encequidar to help the body absorb the paclitaxel. The study showed that the oral paclitaxel with encequidar improved response rates and overall survival, and resulted in less neuropathy and hair loss, although there was a higher incidence of gastrointestinal adverse reactions. A downside is a patient would need to take a lot of pills; an average weight woman would need to take 11 pills. And these are taken for 3 consecutive days every week.
One last thing that I was happy to see was a paradigm shift away from maximum tolerated dose to optimal biological dose for clinical trials and drug approval. One study in particular looked at a lower dose of tamoxifen, called “baby tam.” This study showed that 10mg of tamoxifen every other day was as beneficial as 20mg every day. This is an exciting way to reduce side effects without sacrificing benefits.
I have attended this conference many times over the years and always enjoy connecting with other advocates from around the world. I was especially anxious to attend this time, after having a second breast cancer diagnosis earlier this year, and wanting to hear what was new on the horizon that I might benefit from. While it feels as if we know a lot more than we did in 2007 when I was diagnosed the first time, we still have a long way to go. While there is hope for better, less toxic treatments in the future, we still have no effective means of prevention, and my fears of a recurrence or new cancer are still here. It means my advocacy work is not over, and I invite all of you to join us in our advocacy efforts.
Susan Siegel is a breast cancer survivor and volunteer extraordinaire. She has served in numerous VBCF leadership roles including former Immediate Past President, President, and Vice President as well as a former co-chairperson of our Advocacy Committee. She remains an active VBCF volunteer advocate and educator at community events across Virginia. She has also served as a Team Leader for Virginia’s delegation for the National Breast Cancer Coalition (NBCC)’s Lobby Day and is a former member of NBCC’s 501c4 Board of Directors. Susan is a graduate of NBCC’s Project LEAD national patient advocate reviewer training program and has served as a reviewer for the DOD BCRP for many years. She received VBCF’s Karin Decker Noss Scholarship funding to attend this year’s SABCS conference.
