Women with breast cancer often face an overwhelming amount of information to sort through and decisions to make. Whether newly diagnosed or starting a next step in treatment, they may wonder: What does the latest research say about my type of breast cancer? Should I enroll in a clinical trial? How do I know if I’m receiving my best-possible treatment?
Every day, Cancer Commons helps patients and caregivers find clarity on those questions. And on March 2, 2022, we presented a live webinar to equip even more patients, survivors, caregivers, and medical professionals with the latest and most essential insights on advanced breast cancer treatment.
Featuring our Chief Scientist Emma Shtivelman, PhD, in conversation with Editor in Chief George Lundberg, MD, this was the inaugural event in the Pat Looney Educational Series for Client Empowerment, a series of webinars that provide critically needed education and highly-requested information to people dealing with cancer.
“Cancer Commons armed my mom with not only a second opinion throughout her treatment plan, but best-in-class knowledge and information to ask smarter questions and take action,” said Caitlin Looney Landesberg, whose family sponsors the series, in her opening remarks for the webinar.
Here, we are pleased to share the top highlights from the event, which drew more than 120 live participants from across the U.S. and several countries. We hope this information will help other women navigate their own treatment.
A recording of the entire webinar, Breast Cancer Treatment Trends for 2022: Cutting Edge Options You Should Know About, is also available to view and share with anyone facing breast cancer.
How does testing influence treatment choices?
In his introduction, Dr. Lundberg noted that breast cancer “is the most frequently diagnosed, potentially lethal cancer in women in the United States, with about 290,000 such diagnoses per year. But the good news is that 250,000 of those, or 85%, won’t die of their cancer.”
Key to those hopeful survival statistics is the availability of diagnostic testing to guide treatment. As Dr. Shtivelman outlined, treatment can be influenced by several types of testing:
- Routine testing: This type of testing is essential for detecting genetic changes, or “mutations,” in key genes that determine the main subtype of breast cancer—estrogen receptor (ER)-positive, HER2-positive, triple-negative, or other. It also determines the grade of the cancer, including the Ki67 index, which indicates how quickly the cancer is growing.
- Genetic testing: This determines whether a patient has inherited a mutation (such as in the BRCA1/2 gene) that predisposes them to breast cancer—most often the triple-negative subtype.
- Mutational testing: Mostly done for people with advanced and metastatic cancer, mutational testing uses “next-generation sequencing” to identify mutations in genes that may cause cancer growth, other than the major drivers like ER and HER2. It is very important because, as Dr. Shtivelman said, “we are now in the era of targeted drugs that are designed to attack cancers with specific mutations.”
- Predictive and prognostic testing for early stages: Women with early-stage ER+ cancer can use tests like OncotypeDx to determine whether they can forgo chemotherapy and receive a type of medication known as endocrine therapy, also known as hormonal therapy. Other tests can also monitor how well a patient’s cancer is responding to treatment.
Most importantly, given the immense benefits of mutational testing in breast cancer, Dr. Shtivelman noted that, “it is now time to test all women with advanced or metastatic cancer,” to ensure they receive optimal treatment.
Treatment options for breast cancer subtypes
Next, Drs. Shtivelman and Lundberg discussed the latest treatment options for ER+, HER2+, and triple-negative breast cancer.
ER+ breast cancer: ER+ tumors are fueled by the hormone estrogen, and they can be treated with endocrine drugs that inhibit that process. The first such drug, tamoxifen, has saved the lives of “probably hundreds of thousands of women, if not more,” since its introduction in 1977, Dr. Shtivelman said.
Over the years, an array of related medications has arisen, including aromatase inhibitors, ER degraders (such as Faslodex), ER modifiers, and gonadotropin-releasing hormone agonists. Notably, drugs known as CDK4/6 inhibitors have hit the scene in the past decade, including palbociclib, ribociclib, and abemaciclib; in combination with aromatase inhibitors, these can prolong survival and prevent recurrence far more effectively than aromatase inhibitors alone.
Still, many ER+ tumors eventually develop resistance to those combinations. Fortunately, they can now be treated with yet another class of drugs known as PI3K inhibitors, and additional drugs are continuously introduced in clinical trials. “That means that even not only in early breast cancer, but in metastatic breast cancer, there is an option of going without chemotherapy for a very long time, for years,” Dr. Shtivelman said.
HER2+ breast cancer: These tumors test positive for the presence of the protein HER2, which can be targeted with certain drugs, including Herceptin, Perjeta, and Kadcyla. Each of these medications may work well for a while, before tumors develop resistance and new drugs must be introduced.
The latest HER2-targeted drug is known as Enhertu; “this is the drug about which oncologists say words like ‘amazing’ and ‘magnificent’ and so on,” Dr. Shtivelman said. Referring to a chart of striking clinical trial results, she said, “You can see that one year after treatment started, more than 80% of women who received the new drug Enhertu have no progression of cancer versus less than 40% with the old drug, Kadcyla. And that difference continues for a long time, well over two years.”
Currently, the five-year survival rate for people with metastatic HER2+ cancer is 30%, but Dr. Shtivelman said she expects that to improve with increased use of Enhertu and other drugs currently in development.
Triple-negative breast cancer: These tumors test negative for the presence of HER2, ER, and another protein known as progesterone receptor. Triple-negative breast cancer is especially challenging to treat because, Dr. Shtivelman said, “it doesn’t have a clear target.”
Chemotherapy remains the main option for people with triple-negative breast cancer, but a small number of women can now benefit from the drug Kadcyla. Kadcyla is a type of treatment known as immunotherapy, which boosts the immune system to fight cancer. Combined with chemotherapy, it can prolong survival, but to qualify, a patient’s cancer must express a protein called PD-L1. Two similar drugs, Trodelvy and Dato-DXd, have also shown some benefit for these patients.
Empowering patients with answers
Throughout the webinar, Dr. Lundberg shared questions submitted by the audience via live chat. In response, Dr. Shtivelman discussed additional information on several topics, including tests known as liquid biopsies, additional new approaches to HER2+ breast cancer treatment—including CAR T-cell therapy and natural killer cells, and the potential benefits of the drug pembrolizumab for triple-negative breast cancer.
Every participant who submitted a question received an answer either during the webinar or subsequently via email, thanks to the efforts of our Director of Patient Services Deb Christensen, MSN, APRN, AOCNS, OCN.
“Our hope is that the webinar helped women facing breast cancer, as well as let people know that Cancer Commons is here to help,” says Cancer Commons Chief Operating Officer Shelley Frisbie. “We are deeply grateful to the family of Pat Looney for sponsoring this series.”
The next webinar will focus on challenges, strategies, and resources for loved ones of people with any type of cancer. Led by Deb Christensen, it will feature interviews with experienced caregivers and include opportunities for Q&A. We invite everyone to register for You’re Not Alone—Validating the Caregiver Experience, which will take place on May 18.
And as always, we invite anyone facing advanced cancer to sign up to receive one-on-one help from our compassionate experts. We are here for you.