I am tasked with discussing four excellent presentations this afternoon. They are all about long-term results of endocrine treatment for pre-menopausal breast cancer patients with hormone receptor-positive breast cancer. The combined analysis of SOFT and TEXT will be presented by Dr. Francis. 15-year results that’s pretty remarkable. In luminal breast cancer we need these long follow-up periods and what they show is that escalation of that treatment beyond Tamoxifen is valuable...
I am tasked with discussing four excellent presentations this afternoon. They are all about long-term results of endocrine treatment for pre-menopausal breast cancer patients with hormone receptor-positive breast cancer. The combined analysis of SOFT and TEXT will be presented by Dr. Francis. 15-year results that’s pretty remarkable. In luminal breast cancer we need these long follow-up periods and what they show is that escalation of that treatment beyond Tamoxifen is valuable. However, that benefit is driven by the subgroup of patients at increased risk. So for low-risk patients the traditional Tamoxifen tablet is really good enough. No reason to switch to an aromatase inhibitor or add ovarian function suppression. For high-risk patients, however, they can confirm that at 15 years there is a relevant and statistically significant benefit also in terms of overall survival. And this provides valuable information for clinical consultation of these patients. We have two more abstracts in the same field of interest. Number one is a Korean study that had been presented initially a number of years ago, but they now, the ASTRRA study, they now present 10-year data. And that’s about the clinically also very relevant question, particularly for Asian patients, because we know that the onset of breast cancer in Asian populations is about 10 years earlier than in the US or in Europe. And the question there is after chemotherapy, some of these patients regain their ovarian function, regain their menstruation. And what they did, they randomized these patients in having additional ovarian function suppression with an LHRH agonist or not. And what they also can show is again for high-risk patients, this is a valuable intervention that adds benefit, quite significant benefit, about 10% in terms of breast cancer-free interval at 10 years. The third study I will discuss is about a very large global cohort of patients who are BRCA mutation carriers, breast cancer patients, so they have been diagnosed but they also bear this genetically increased risk. And also for them, it is demonstrated that intensified endocrine treatment with ovarian function suppression provides them with additional benefit for 5% at eight years, which is quite significant in terms of the magnitude. The fourth abstract I’m discussing is a little bit more general on a clinically very important subject, and that is many of our patients really suffer from the side effects of their endocrine treatment. It’s hot flushes, night sweats, menopausal symptoms. And in fact, I think we, as scientists, we sometimes underestimate what kind of burden this means in everyday life of these patients. And it leads to reduced drug adherence. So about estimations are that in the real world, about 10% of patients per year stop the treatment because they cannot cope with these side effects. And we have to admit that so far we have not been able to offer quite a lot. Yes, lifestyle changes, weight loss, but that’s difficult to achieve in real life. The drug interventions have been somewhat limited and the OASIS 4 trial presented by Dr. Cardozo is the first time that in a very proper way a new class of drugs is tested in the breast cancer population taking endocrine treatment. It’s the so-called neurokinin receptor antagonist and OASIS 4 tested a new drug called elinzanetant and that actually really shows very impressive results. So you take this and after one week it starts having a positive effect. They only included patients with severe vasomotor symptoms. And so that’s at least five to seven attacks of such symptoms, hot flushes, sweats per day. And that intervention reduces this by 80%. So when you imagine what this means to the quality of life of our patients every day, this is quite significant. It’s potentially not as sexy as a new drug or something, but in clinical practice I believe this is a breakthrough. And this NK1, NK3 dual receptor antagonist, elinzanetant, is obviously reasonably safe. They have data until one year and they have an extension period of the trial. So I believe this is going to be practice-changing because for the first time now, we as physicians are able to offer those patients, it’s not that many, but a significant proportion of them who are suffering the most from the side effects of our otherwise beneficial treatment, to offer them something that can really help them also to stay on the drugs. And that’s very important. We need to be mindful of drug adherence. A tablet that you are not taking cannot help. So I believe that’s actually a very important piece of progress.
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