The 2020 San Antonio Breast Cancer Symposium may have been virtual, but the scientific advances at the country’s preeminent breast cancer conference were real.
The conference kicked off with a session dedicated to health equity and collaboration presented in partnership with a Black patient advocate, Maimah Karmo. Both the high-profile commitment to discussing health equity and the decision to have a patient advocate co-chair the session were important firsts, showcasing the American Association of Cancer Research’s (AACR) leadership and values. (The AACR is the organizer of the San Antonio Breast Cancer Symposium). Health equity and patient voice are core values for us at the Dr. Susan Love Foundation, and it was exciting to see those commitments embraced at a meeting of the scope and scale of San Antonio.
The most discussed presentation from the symposium was the RxPonder trial. The trial evaluated the role of a 21-gene recurrence score (Oncotype-DX®) for persons with hormone receptor-positive breast cancer and one to three positive lymph nodes. We currently use the Oncotype-DX test to predict which persons with lymph node-negative, hormone-receptor-positive breast cancer will do as well with hormone therapy alone and which should have hormone therapy and chemotherapy. The RxPonder trial showed that for post-menopausal women with one to three positive lymph nodes, the recurrence score predicted who would benefit from chemotherapy. But in premenopausal women, a benefit was seen from chemotherapy, regardless of their recurrence score. Whether premenopausal women who will also be treated with ovarian suppression therapy still benefit from chemotherapy remains unclear.
New data also was presented about the online calculator, RSClinTM. This research showed that for people with lymph node-negative breast cancer, adding certain clinical and pathologic features to the 21-gene recurrence score adds additional prognostic and predictive information alone that can be helpful to women and their doctors.
Take home message? We have great tools to help “right-size” breast cancer treatment. Many persons with hormone receptor-positive breast cancer can safely skip chemotherapy and each patient’s care team should be able to offer personalized risk discussions with these modern tools.
Other high-profile trials presented included:
CONTESSA: Patients received low dose capecitabine (an oral chemotherapy pill) + tesetaxel (a new oral chemotherapy pill) vs. standard full dose capecitabine. The oral combination improved progression-free survival (longer time to cancer growth). While the trial earned some criticism for using combination chemotherapy and demonstrating only modest benefit, exploring how oral chemotherapy regimens can improve patient experience or decrease time in infusion centers, particularly as the COVID-19 pandemic rolls on, remains vital.
Take home message? Oral chemotherapies are getting more effective and new options are on the horizon.
MonarchE: Patients with early-stage, hormone-receptor-positive, high-risk breast cancer (Stage 2 or Stage 3) received either standard hormone therapy (anastrozole, letrozole, exemestane, tamoxifen) for 5 to 10 years or standard hormone therapy for 5 to 10 years plus abemaciclib for two years. The group that received abemaciclib had a 28.7% lower risk of an invasive recurrence than the group that received hormone therapy alone.
Penelope-B: Patients who received neoadjuvant chemotherapy (chemotherapy before surgery) for hormone receptor-positive breast cancer and who still had some of their tumor remaining at the time of surgery (no pathologic complete response) were randomized to palbociclib vs. placebo for 1 year. Both arms received the standard of care endocrine therapy (anastrozole, letrozole, exemestane, tamoxifen) for 5 to 10 years. Penelope-B showed no improvement in outcome for persons receiving palbociclib.
Take-home messages? The CDK4/6 inhibitors (abemaciclib, palbociclib, ribociclib) have shown different responses in early-stage high-risk breast cancer. We are trying to understand if the difference is from different patient selection, different medication effects, or both.
KEYNOTE-355 randomized persons with previously untreated metastatic triple-negative breast cancer to chemotherapy with or without pembrolizumab, a form of immunotherapy. The addition of pembrolizumab improved outcomes. We also saw in an update from IMpassion031 (chemotherapy with or without atezolizumab, another immunotherapy) that the addition of immunotherapy did not negatively impact health-related quality of life.
Take home message: Immunotherapy has arrived for certain types of breast cancer! Although both approved drugs are still given with chemotherapy, patient-reported quality of life is still good.
Other interesting trials found an association between a low glycemic index diet and breast cancer risk, and that mindfulness/meditation education improved depression symptoms in breast cancer survivors. There were also updates showing good outcomes for women pursuing pregnancy after breast cancer treatment.
I left San Antonio (virtually) with the same sense of hope that the symposium fills me with every year. Trial participant by trial participant, donation by donation, teams of committed scientists and physicians continue to move us closer to ending breast cancer and reducing the side effects of treatment. Despite the challenges the pandemic has dealt, the breast cancer community remains united.
I am thankful you are here with us, too. Part of our virtual community at the Dr. Susan Love Foundation – learning, volunteering, spreading the word, making a difference. That difference is also very real.
Learn more about our virtual education series, ImPatient Science, here.
Note: Dr. Graff served as a principal investigator in the CONTESSA, MonarchE, and Impassion031 trials.
