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BCC 2021 | Escalation of adjuvant therapy in HR+ breast cancer

Nicolò Battisti, MD, The Royal Marsden NHS Foundation Trust, London, UK, shares his thoughts on exciting areas of breast cancer research likely to grow in the coming years. Dr Battisti highlights investigations into escalation of adjuvant systemic therapy in HR+ breast cancer as a key focus. Varying findings from recent large clinical trials of CDK4/6 inhibitors in addition to standard endocrine therapy have emphasized the need for longer-term follow-up results. Dr Battisti also talks on the use of ctDNA to predict who would benefit from treatment escalation, as well as advancing the management of triple negative breast cancer. This interview took place during the 17th St. Gallen International Breast Cancer Conference.

Transcript (edited for clarity)

Personally, I think one of the most exciting areas of research at the moment is the escalation of systemic treatment for hormone receptor-positive HER2-negative breast cancer in the adjuvant setting.

We actually got the results of three different trials last year, investigating the use of CDK4/6 inhibitors, obviously monarchE, PENELOPE-B, and PALLAS with very different results which to me simply suggests two things...

Personally, I think one of the most exciting areas of research at the moment is the escalation of systemic treatment for hormone receptor-positive HER2-negative breast cancer in the adjuvant setting.

We actually got the results of three different trials last year, investigating the use of CDK4/6 inhibitors, obviously monarchE, PENELOPE-B, and PALLAS with very different results which to me simply suggests two things. First, that enrolling different population of patients really counts, matters and second, that probably in this specific population of patient that can unfortunately relapse also many years after the initial diagnosis, longer follow-ups also count.

Another area of research that I find extremely interesting is also the management of triple receptor negative disease again in the curative setting. As I said, we have data supporting the use of different systemic treatment options in the post-neoadjuvant setting in this population of patients but this is now also a population of patients where we are increasingly using platinum compounds as well preoperatively. So, we know that the findings of CREATE-X do not necessarily apply to this subset of patients. So I’m really interested to find out the results of other studies that are being conducted in this setting. And also perhaps with the help of other techniques, for example, like the surveillance with circulating tumor DNA to actually, let’s say, find out who are those patients with the high risk, the highest risk of relapse and actually do require treatment escalation in this setting.

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Disclosures

N. Battisti reports travel grants: Pfizer, Lilly, Genomic Health; speaker fees: Pfizer, AbbVie