William J. Gradishar, MD, of Feinberg School of Medicine and Northwestern Medicine in Chicago, chats with David H. Henry, MD, host of Blood & Cancer, to review some of the top breast cancer research presented at the 2019 annual meeting of the American Society of Clinical Oncology.

Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about dealing with help-seeking and help-rejecting patients.

 

Show notes

This episode discusses three randomized, controlled phase 3 trials that were presented at ASCO 2019: 

• KRISTINE trial (abstract 500)
  • Design: Patients with HER2-positive breast cancer were randomized to receive either neoadjuvant trastuzumab, pertuzumab, and chemotherapy (docetaxel, carboplatin) vs. trastuzumab emtansine plus pertuzumab.
  • Primary endpoint: Pathological complete response rate.
  • Secondary endpoints: Toxicity, event-free survival, invasive disease-free survival.
  • Conclusion: Docetaxel, carboplatin, and trastuzumab plus pertuzumab resulted in a higher rate of pathological complete response than did trastuzumab emtansine plus pertuzumab, but was associated with more serious adverse events.
• PREDIX trial (abstract 501)
  • Design: Patients with HER2 positive and hormone receptor positive breast cancer were randomized to receive either neoadjuvant trastuzumab emtansine monotherapy vs. docetaxel, trastuzumab, and pertuzumab.
  • Primary endpoint: Pathological complete response rate.
  • Secondary endpoints: Toxicity and quality of life.
  • Conclusions: Trastuzumab emtansine monotherapy was better tolerated while maintaining comparable PCR rate as the group which received docetaxel, trastuzumab, and pertuzumab. 
• TAILORx trial (abstract 503)
  • Design: Patients with node-negative, estrogen receptor–positive breast cancer with an Oncotype DX recurrence score of 11-25 were randomized to receive either hormone therapy alone or hormone therapy together with combination chemotherapy.
  • Primary endpoint: Rate of distant recurrence at 9 years. 
  • Conclusions:
    • There was no benefit from chemotherapy for younger women (aged 50 years or younger) with a recurrence score of 16-20 and at low risk clinically (small tumor size and favorable histologic grade).
    • Those age younger than age 50 years with a score of 16-20, but high risk clinically, may benefit from chemotherapy.
    • Much of the benefit derived from chemotherapy was because of ovarian suppression.
    • Using the recurrence score in combination with clinical risk stratification allows clinicians to identify more young women who can be spared chemotherapy, and more young women who may benefit from antiestrogen therapy.

 

Show notes by Sugandha Landy, MD, a resident in the department of internal medicine, University of Pennsylvania, Philadelphia.

 

References

J Clin Oncol 37. 2019 May 20 (suppl; abstr 500). doi: 10.1200/JCO.2019.37.15_suppl.500.

J Clin Oncol 37. 2019 May 20 (suppl; abstr 501). doi: 10.1200/JCO.2019.37.15_suppl.501.

J Clin Oncol 37. 2019 May 20 (suppl; abstr 503). doi: 10.1200/JCO.2019.37.15_suppl.503.

Lancet Oncol. 2018 Jan;19(1):115-26.

N Engl J Med. 2019 Jun 20;380:2395-405. 

 

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