Breast Cancer Research Announced at ASCO 2018: Do All Patients Need Chemotherapy?

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Topics include: Treatment

New breast cancer research announced at the 2018 American Society of Clinical Oncology (ASCO) meeting may be challenging the current standard of care. Are conventional chemotherapy methods less recommended for early stage breast cancer patients? Have researchers created a path to positive health outcomes with less treatment? On location at ASCO in Chicago, Patient Power founder Andrew Schorr is joined by expert Julie Gralow, from Seattle Cancer Care Alliance, to discuss the significant impact of more precise testing on breast cancer treatment strategy, and exciting results from clinical trials for recently approved therapies. Julie also touches on things patients can do to take back control in their everyday lives and valuable resources that are often underutilized. Watch now for the latest developments in breast cancer treatment.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome from Chicago, the American Society of Hematology.  I'm with my old friend Dr. Julie Gralow, who is director of the Breast Medical Oncology program at the Seattle Cancer Care Alliance and getting very special recognition here at the humanitarian award.  Congratulations, Julie. 

Dr. Gralow:

Thank you, Andrew. 

Andrew Schorr:

It is well deserved.  There's news related to early breast cancer and whether chemo is needed, right? 

Dr. Gralow:

Big news.  In early-stage breast cancer that expresses estrogen and progesterone receptor, we call it hormone-responsive tumors, we used to say everybody should get chemo along with anti-estrogen therapy.  The big news at this meeting is we finally have the results 15 years in the making, that we can run a profile of 21 genes and we can sort out which of the estrogen receptor positive, lower-risk women whose lymph nodes are negative get no benefit from chemo.  And we can withhold chemo now and reassure our patients that they still have the same benefit, they have no higher risk of recurrence and feel comfortable with that. 

So we're able to for the majority of early-stage breast cancer patients run this assay and now say we're very comfortable.  You don't need chemo, just the anti-estrogen therapy.  And you're going to do really well. 

Andrew Schorr:

So that's a big deal. 

Dr. Gralow:

Huge deal.  Huge deal.  You've been on chemo, you know.  Nobody wants to get chemo.  I don't like to give chemo, but if it's going to increase your odds of surviving, of course, we're going to talk about it and recommend it. 

Andrew Schorr:

Julie, let's go on about HER2-positive women.  Sometimes they have long treatment.  Can that be shortened?  Any data about that? 

Dr. Gralow:

Yeah.  So the theme here is can we give less treatment and get the same benefit.  There's going to be a very important presentation of a trial called the Persephone Trial tomorrow.  The results have already been released, and while the standard of care is a whole year every three weeks of Herceptin, trastuzumab, if you have early stage HER2-positive breast cancer, that one year is being challenged, and this trial is going to show that six months is the same as one year, so we're going to be able to back off.  Treatment will end sooner.  There's less harsh toxicity coming from that. 

And from my standpoint, with my global oncology hat, I also think this might allow some countries that right now can't afford to give all of their women a year of Herceptin or trastuzumab, they're going to be able to reconsider it now because six months.  We even have some data from prior treatments, prior studies suggesting even a little bit less might be just the same. 

Andrew Schorr:

So great news for women who are HER2-positive.  Let's go on to the BRCA area and in some women with triple-negative breast cancer.  What about them? 

Dr. Gralow:

Really cool study, and this was a surprise for me.  I wasn't seeing this one coming.  I didn't know about it.  So this was a trial of early-stage breast cancer patients who had BRCA1 or 2 gene mutations, so they have very high risk of getting breast cancer.  Most of them were BRCA1 and triple negative because that's the most common expression of BRCA1. 

Andrew Schorr:

Just continue, talk about PARP inhibitor. 

Dr. Gralow:

Right.  So these were patients, early-stage breast cancer, BRCA1 and 2 mutations, as soon as they were diagnosed, before surgery, they got started on a PARP inhibitor, talazoparib, and they got it, a pill, for six months.  And at the time of surgery they looked to see what kind of response they had.  Over half had no cancer left at the time of surgery.  They didn't get chemo, just this PARP inhibitor, an oral pill for six months. 

Andrew Schorr:

Wow. 

Dr. Gralow:

Really amazing.  So another drug in this class, olaparib, was just approved in metastatic BRCA1 and 2 breast cancer, and we're trying to figure out if there are other subsets of triple negative breast cancer, not just the BRCA associated, who may have DNA repair defects that go along with these kinds of drugs.  So it's really exciting. 

Andrew Schorr:

Okay.  So you're doing more precise testing.  

Dr. Gralow:

Right. 

Andrew Schorr:

Being able in some cases to have oral therapies, less therapy, shorter therapy, and still effective therapy. 

Dr. Gralow:

Right.  And that is amazing, isn't it? 

Andrew Schorr:

Yeah, it is.  And we've been dealing a lot with the cost of care, and, as you mentioned, if we can have shorter therapy, less therapy but what's right for you less--you were saying. 

Dr. Gralow:

If we could translate what we know and do right now in our high resource countries to the rest of the world, we would save hundreds of thousands of lives tomorrow.  So we need to figure out ways that are feasible and cost effective that can be translated to the rest of the world, and I think we've made some small steps at this meeting. 

Andrew Schorr:

Wow.  Well, it sounds like certainly significant steps.  So when you put it all together for women and family members watching, a variety of different breast cancer situations but taken together certainly we're talking about serious illness, but people can are be more hopeful and there are some things they can do with their doctors right now. 

Dr. Gralow:

So I think, you know, we underplay what the importance of lifestyle modifications, the whole physical and emotional health piece that goes along with it, mind-body.  We had fascinating presentations on like acupuncture for insomnia, we know, hot flashes and joint aches.  We can do things that can make us feel a lot better.  We can manage the symptoms and treatments.  We can get out there and get a little more physical activity and manage our body weight and reduce our chance of breast cancer recurring, chance of getting the next cancer.  Take charge of the things you can control, right? 

Andrew Schorr:

Right.  So there you are.  There are things you can do and things you can do with your doctor and take advantage of some of the progress being made.  Congratulations again on your award and your devotion over many years.  You and I have been doing this a long time. 

Dr. Gralow:

Long time. 

Andrew Schorr:

Yeah, so thank you so much.  Congratulations. 

Dr. Gralow:

Thank you, Andrew. 

Andrew Schorr:

And keep helping pave the way with better treatments in support of women.  Dr. Julie Gralow here at ASCO and winning a humanitarian award, tremendous record.  Craziness at ASCO.  Sorry for the internet craziness but anyway we just want to thank you.  Dr. Julie Gralow and Andrew Schorr telling you knowledge can be the best medicine of all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on November 30, 2018