Dr Hope Rugo explores how evolving endocrine strategies and targeted therapies are enhancing outcomes in hormone receptor-positive early-stage breast cancer.
, Medscape spoke with Hope S. Rugo, MD, FASCO, division chief of breast medical oncology and a professor of medical oncology and therapeutics research at City of Hope Comprehensive Cancer Center, Duarte, California, and professor emeritus at the University of California San Francisco.
Read on for her insights. of determining appropriate treatment and extent of treatment, and we are still learning more about how to appropriately stratify based on clinicopathologic and genomic characteristics. tests are used widely to understand prognosis and benefit from chemotherapy, but there are ongoing issues in HR+ disease including disease heterogeneity and how to optimally treat very young women with HR+ disease. We use clinicopathologic data in combination with gene expression tests to stratify risk, but this approach doesn’t always provide us with the necessary information for determining the optimal adjuvant or neoadjuvant treatment. The adjuvantAdditionally, newer predictors, such as gene expression signatures that may estimate the benefit from immunotherapy, are also being evaluated. What factors influence your choice between endocrine therapy and chemotherapy for HR+ early-stage breast cancer? , but it is clear that these are insufficient, even within the context of age and tumor burden. Additional markers that help to identify up-front or emerging resistance to endocrine therapy are critical. Data from the CDK4/6 inhibitor adjuvant trials has further complicated this question — as now the issue is where optimal outcome can be achieved in less. Disease burden is of course our first consideration, but sensitivity to endocrine therapy, development of resistance, and response to chemotherapy in appropriate cases need to be taken into consideration. Interestingly, several analyses have suggested that patients with low proliferative and genomic risk, but a higher disease burden, might be most likely to benefit from duration endocrine therapy due to the long natural history of this disease. We are now exploring the use of switching the type of endocrine therapy in the high-risk adjuvant setting and the use of included a diverse population, including an intermediate-risk group to evaluate the role of the with 5-year follow-up. Even 3 years after completing treatment with abemaciclib, the data showed an increasing impact on disease-free survival and distant disease-free survival. Although there has been no overall survival impact yet, fewer patients with abemaciclib in monarchE are living with metastatic disease. What are the most critical research gaps or upcoming trials that could reshape how we manage HR+ early-stage breast cancer in the upcoming years? A few main things to address are improving risk stratification, how to use ctDNA to improve outcome, and understanding if use of So far, studies using ctDNA to assess risk and guide therapy changes have been challenging due to the low number of positive ctDNA results. Moreover, has sometimes coincided with metastatic disease already visible on scans in case of several aggressive cancers. We still don’t know the in the early stage setting for the treatment of high-risk disease. While these trials will also collect ctDNA, patient eligibility is not based on these tests. , where tumors seem to behave poorly — particularly in women under the age of 40 — even when patients are treated with optimal therapy. Understanding optimal therapy is a key research focus, and further investigation of biological drivers in both ductal and lobular cancers is warranted. trial aims to determine the value of adjuvant chemotherapy vs ovarian function suppression in conjunction with standard endocrine therapy and CDK4/6 inhibitors as indicated. However, this study is challenging to enroll in.Received research grant from: AstraZeneca; Daiichi Sankyo, Inc.; F. Hoffmann-La Roche AG/Genentech, Inc.; Gilead Sciences, Inc.; Lilly; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Pfizer; Stemline Therapeutics; OBI Pharma; Ambrx Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication. Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see ourSkill Checkup: New-Onset Upper Chest Pain in 61-Year-Old Breast Cancer Survivor
Breast Cancer Center Of Excellence Breast Cancer Malignant Breast Neoplasm Breast Carcinoma Biologic Therapy Biologics Cancer Malignant Neoplasia Carcinoma Malignant Neoplasm Targeted Therapy Targeted Cancer Therapy Breast Mammary Gland Genomics Genomic Medicine Lobular Cancer Lobular Carcinoma Endocrine Therapy Tumor Chemotherapy Fellowship Fellows Residency
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