Clinical evidence is interpreted based on clinical studies and personal experience which can lead to different interpretations of data. This makes the opinions issued by panels of experts such as the Advanced Breast Cancer Panel which convened in November 2023 for the seventh time (ABC7) particularly important. At the conference, current issues around advanced breast cancer were evaluated by an international team of experts.
In 2023 the data on CDK4/6 inhibitors was so extensive that the answers to questions about the sequencing of therapy and the potential use of chemotherapy as an alternative therapy were relatively clear. Moreover, data on antibody drug conjugates which provides a good overview of their uses is available for all molecular subtypes.
Some therapeutic settings, including patients with brain metastases or leptomeningeal disease, older patients, locally advanced breast cancer and visceral crises, continue to be particularly important and were discussed in structured sessions. The scientific context of some of the topics discussed at ABC7 is presented and assessed here.
Background
The optimal adjuvant endocrine treatment in premenopausal patients with hormone receptor-positive, HER2-negative (HRpos/HER2neg) early breast cancer (eBC) remains debated, particularly the choice between aromatase inhibitors plus ovarian function suppression (AI + OFS) or tamoxifen (TAM) with or without additional OFS. This study assessed the use of adjuvant endocrine therapies for premenopausal patients with intermediate/high-risk HRpos/HER2neg eBC.
Methods
CLEAR-B (AGO-B-059; NCT05870813) was a retrospective study analyzing data, collected from January 2016 to June 2019 and from January 2022 to December 2023 during the certification process of breast centers in Germany. Premenopausal patients with HRpos/HER2neg intermediate/high-risk eBC were eligible. Patient and disease characteristics, in addition to recommended and received adjuvant treatments, were evaluated.
Results
The number of registered patients was 3137, of whom 2789 had complete information on endocrine treatments (1717 for 2016–2019 and 1072 for 2022–2023). In 2016–2019, 8.4 % of the patients were recommended to be treated with AI + OFS, whereas in 2022–2023, the proportion of patients with a treatment recommendation for AI + OFS rose to 42.1 %. In 2016–2019, TAM monotherapy was most frequently recommended (80.8 %). Conversely, TAM + OFS was not commonly recommended (9.3 % in 2016–2019 and 16.5 % in 2022–2023). While no clear association between tumor stage and chosen endocrine therapy was found in 2016–2019, most patients with ≥stage IIA were recommended to be treated with AI + OFS in 2022–2023.
Conclusion
This analysis shows that treatment recommendation for AI + OFS in premenopausal patients with HRpos/HER2neg eBC increased relevantly in the past years, reflecting latest guideline recommendations.
The use of CDK4/6 inhibitors, the new PI3K/AKT-kinase inhib-
itors, selective estrogen receptor-degraders (SERDs), anti-
body-drug conjugates, immune therapies and PARP inhibitors
in recent years has resulted in a marked change in the therapy
landscape for patients with advanced stage breast cancer.
CDK4/6 inhibitors, trastuzumab deruxtecan, and sacituzumab
govitecan have all been shown to provide significant overall
survival benefits compared to conventional chemotherapy.
Other substances are also showing promising results and hold
out the hope that further analysis of the overall survival bene-
fits will be available in the near future. The speed at which
studies are now being carried out has markedly increased,
and conferences and specialist journals are now constant
sources of new information. This review summarizes the most
recent publications and conference presentations on the
treatment of patients with advanced stage breast cancer
This review summarizes the latest developments for the treatment of patients with early-stage breast cancer. Most of the clinically relevant changes were the result of using immune checkpoint inhibitors to treat patients with triple-negative breast cancer (TNBC) and CDK4/6 inhibitors to treat patients with hormone receptor-positive, HER2-negative (HRpos/HER2neg) tumors and a high risk of recurrence. Recent studies are presenting more and more data with long follow-up times and integrating translational analyses to evaluate new biomarkers such as circulating tumor DNA (ctDNA). This review article summarizes the latest developments published in recent months and puts the findings in context.
