In 2018, several trials in breast cancer have shown efficacy of strategies that rely on novel markers, including gene expression assays or pathological complete response. The relevance of targeted strategies in patient subgroups and of immunotherapy efficacy were demonstrated.
Key advances
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Patients with node-negative luminal early stage breast cancer and a low or intermediate Oncotype DX recurrence score do not benefit from the addition of adjuvant chemotherapy to endocrine therapy1.
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Patients with HER2-positive luminal early stage breast cancer and without a pathological complete response after neoadjuvant chemotherapy would benefit substantially from escalation of adjuvant therapy by switching to T-DM1 (ref.4).
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Results on the efficacy of three cyclin-dependent kinase (CDK)4/6 inhibitors in all major phase III trials in patients with metastatic luminal breast cancer have now been presented, including one showing an overall survival (OS) benefit5,6,7.
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In patients with PIK3CA-mutated metastatic breast cancer, alpelisib substantially improves progression-free survival (PFS) with a manageable toxicity profile8.
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In patients with BRCA-mutated metastatic breast cancer, the addition of talazoparib to standard chemotherapy provided a PFS advantage over chemotherapy alone9.
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In patients with triple-negative metastatic breast cancer, addition of atezolizumab to chemotherapy improved both PFS and OS; the strongest benefit was associated with expression of programmed cell death 1 ligand 1 (PD-L1)11.
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References
Sparano, J. A. et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N. Engl. J. Med. 379, 111–121 (2018).
Nitz, U. et al. Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast Cancer Res. Treat. 165, 573–583 (2017).
Robertson, J. F. R. et al. Peri-operative aromatase inhibitor treatment in determining or predicting longterm outcome in early breast cancer — the POETIC trial (CRUK/07/015). Cancer Res. 78(Suppl. 4), GS1-03 (2018).
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Slamon, D. J. et al. Phase III randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. J. Clin. Oncol. 36, 2465–2472 (2018).
Tripathy, D. et al. Ribociclib plus endocrine therapy for premenopausal women with hormone-receptor-positive, advanced breast cancer (MONALEESA-7): a randomised phase 3 trial. Lancet Oncol. 19, 904–915 (2018).
Turner, N. C. et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N. Engl. J. Med. 379, 1926–1936 (2018).
André, F. et al. LBA3_PR. Alpelisib (ALP) + fulvestrant (FUL) for advanced breast cancer (ABC): results of the phase 3 SOLAR-1 trial. Ann. Oncol. 29 (Suppl. 8), mdy424.010 (2018).
Litton, J. K. et al. Talazoparib in patients with advanced breast cancer and a germline BRCA mutation. N. Engl. J. Med. 379, 753–763 (2018).
Robson, M. E. et al. OlympiAD final overall survival: olaparib versus chemotherapy treatment of physician’s choice (TPC) in patients with HER2-negative metastatic breast cancer (mBC) and a germline BRCA mutation (gBRCAm). Cancer Res. 78 (Suppl.), CT038 (2018).
Schmid, P. et al. Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer. N. Engl. J. Med. 379, 2108–2121 (2018).
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N.H. has received honoraria for lectures and/or consulting from Agendia, Amgen, AstraZeneca, Celgene, Daiichi-Sankyo, Genomic Health, Lilly, MSD, Nanostring, Novartis, Odonate, Pfizer, Roche, Sandoz–Hexal and Seattle Genetics. R.W. has received honoraria for lectures and/or consulting from Agendia, Amgen, AstraZeneca, Boeringer Ingelheim, Carl Zeiss, Celgene, Daiichi-Sankyo, Esai, Genomic Health, GlaxoSmithKline, Lilly, MSD, Nanostring, Novartis, Paxman, Palleos, Pfizer, Pierre Fabre, Puma Biotechnolgogy, Riemser, Roche, Sandoz–Hexal, Tesaro Bio and Teva.
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Harbeck, N., Wuerstlein, R. Truly personalized therapy — an end to the era of one size fits all. Nat Rev Clin Oncol 16, 77–78 (2019). https://doi.org/10.1038/s41571-018-0165-1
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DOI: https://doi.org/10.1038/s41571-018-0165-1
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