Welcome to Season 2!
Dr. Adam Brufsky shares findings from the recent San Antonio Breast Cancer Symposium and the important role of precision medicine
In this episode of the Precision Medicine Podcast, Dr. Adam Brufsky, Medical Director for the Women’s Cancer Program at the UPMC Hillman Cancer Center shares the newest findings presented in December 2019 at the San Antonio Breast Cancer Symposium (SABCS) and discusses the important role of precision medicine in breast cancer care.
SABCS was founded over thirty years ago by Chuck Coltman, whose goal was to gather together researchers from around the world to discuss topics related to breast cancer. Both translational and clinical research is presented with 10,000-15,000 attendees expected each year. Dr. Brufsky, a long-time attendee, highlights three main points from this year’s Symposium.
The first is the research on HER2-positive early stage and metastatic breast cancer. He calls this year’s findings “practice-changing.” Over the last twenty years, the treatment of HER2-positive metastatic breast cancer has improved exponentially. Now, women with this diagnosis can live up to five years or more. This year at SABCS, Seattle Genetics presented a new drug called Tucatinib. In the trial, not only was there a progression-free survival improvement, but there was also an overall survival benefit — a very rare result in cancer research. Tucatinib, which created a lot of buzz at SABCS, is now under review by the FDA with approval expected in the next 4-6 months.
Another drug made an appearance in the HER2-positive space: Enhertu (also called DS-8201). A recent trial included women who had progressed through at least three anti-HER2 therapies in the metastatic setting. The response rate was 60-70%, which suggests that the natural history of the disease may be changed by the drug. As a result, Enhertu received accelerated approval from the FDA, and is becoming the standard care for third-line and beyond.
Dr. Brufsky’s second takeaway from SABCS was the data on liquid biopsy. There was a presentation of a trial done in England called plasmaMATCH. Though the trial was not hugely successful, the researchers did find a few mutations that are clinically actionable, and that a circulating tumor DNA test may help. There is now proof that therapy can affect the disease. Dr. Brufsky also details an abstract from the University of Indiana which studied mutations in women who were undergoing adjuvant therapy or neoadjuvant therapy for triple negative breast cancer.
The third major development at SABSC19 was the research on hormone replacement therapy and its relationship to breast cancer. Since 2002, it has been widely accepted that hormone replacement increases the risk of breast cancer. A few years ago, the Women's Health Initiative did a study that stated that there was no increased risk of breast cancer in the estrogen-only hormone replacement – the risk was only in the combined estrogen-progestin hormone replacement.
At SABCS19, the Women’s Health Initiative presented a new study, which said that patients who had estrogen-only hormone replacement had a reduced risk of breast cancer, and survival in the case of breast cancer was improved. The study also showed the reverse: if a patient had estrogen-progestin combined hormone replacement, breast cancer incidence was increased and survival was decreased.
Overall, Dr. Brufsky felt that SABCS19 presented intriguing new data in the field of breast cancer. He ends by saying that though breast cancer initially led in the precision medicine approach to treating tumors, with the first targeted therapy Tamoxifin, lung cancer has now taken the lead. Dr. Brufsky believes that breast cancer will catch up again. There are now four mutations that are clinically actionable that weren’t considered 3-4 years ago. As more and more steps are taken in the field of precision medicine, doctors will learn more about the nuances of cancer and continue to save more lives.
Tune in to the full episode above.
01:32 - The background and significance of the San Antonio Breast Cancer Symposium.
02:44 - The major topics discussed at the 2019 SABCS.
04:27 - The practice-changing data findings on the treatment of HER2-positive metastatic breast cancer.
06:00 - How Neratinib was compared to Lapatinic at the 2018 SABC Symposium.
06:52 - The science behind Tucatinib, a new drug developed by Seattle Genetics.
09:10 - The development and testing of Enhertu (DS-8201).
14:39 - How the payers slow down the release of new drugs, and how the process can be improved.
16:58 - The Eastern Oncology Cooperative Group’s study on circulating tumor cells.
18:24 - The UK trial on mutations called plasmaMATCH.
21:01 - A study from the University of Indiana on different types of mutations.
23:20 - Hormone replacement and its effect on breast cancer incidence and survival.
27:03 - Breast cancer’s place in the precision medicine field.
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About Our Guest
Adam Brufsky, MD, PhD, is professor of medicine at the University of Pittsburgh School of Medicine, PA. He serves as the associate division chief for the Division of Hematology/Oncology in the University of Pittsburgh School of Medicine, Department of Medicine. He is associate director for clinical investigation at the University of Pittsburgh Cancer Institute and co-director of the Comprehensive Breast Cancer Center Magee Women’s Hospital of the University of Pittsburgh Medical Center.
Dr Brufsky is board certified in internal medicine and medical oncology. He earned his medical degree and doctorate of philosophy from the University of Connecticut School of Medicine in Farmington. He then completed a residency in internal medicine at Brigham and Women’s Hospital/Harvard Medical School and a fellowship in medical oncology at Dana-Farber Cancer Institute, both located in Boston, MA.
Dr Brufsky is a member of several professional organizations, such as the American College of Physicians, the American Society of Clinical Oncology, and the American Association for Cancer Research. He has published over 250 abstracts, review articles, and research articles in leading journals such as the Journal of Clinical Oncology and the New England Journal of Medicine. He is currently an investigator on research grants funded by the National Institutes of Health, Susan G. Komen Foundation, and US Army-Breast Cancer Research Program.
On Twitter at @BreastOncDoc