Denise Yardley, MD, senior investigator, Sarah Cannon Research Institute, discusses the importance of tailoring treatment approaches to the different subtypes of patients with breast cancer.

This past year saw significant advancements made across breast cancer histologies in terms of creating a more precise approach for patients, Yardley says. In early-stage breast cancer, an important questions for research included identifying which patients would benefit from chemotherapy versus those who could avoid it, as well as determining which patients should receive extended endocrine therapy. She adds that conversations between clinicians and patients regarding treatment decisions have become longer, as the latest data is discussed and therapy is tailored to each case.

In the metastatic setting, as more and more niche trials are underway, researchers are beginning to understand the importance of genomic testing in these patients. Yardley says this holds true in terms of frontline treatment, later lines of therapy, and even for hormone receptor—positive patients. The recently presented SOLAR-1 trial is a perfect example of the role of genomic testing, Yardley adds, which was the first to show benefit in a genomic subgroup of patients with the rare mutation 

Additionally, immunotherapy is starting to make headway in breast cancer. This treatment approach has traditionally lagged in breast cancer compared with other solid tumors, but checkpoint inhibitors are now showing benefit in patients with triple negative disease and those whose tumors express PD-L1.

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Dr. Yardley on Importance of Tailoring Treatment to Breast Cancer Subtypes

Denise Yardley, MD, senior investigator, Sarah Cannon Research Institute, discusses the RESPECT trial in HER2-positive breast cancer.

The RESPECT trial looked at patients with HER2-positive disease. It was the first trial that focused on elderly patients, explains Yardley. Patients had to be between 70 and 80 years old with HER2-positive breast cancer. Investigators randomized patients to 1 year of trastuzumab monotherapy (Herceptin) or trastuzumab with chemotherapy. Though the trial failed to meet its primary endpoint, there were few events in both arms, Yardley says.

These results indicate that these patients do well with HER2-targeted therapy. When physicians look at some of the differences, one of the key messages was that elderly patients did well with standard of care chemotherapy plus trastuzumab.

As the differences between groups were small, Yardley says that patients who do not want chemotherapy may receive trastuzumab monotherapy. The expectations are approximately a 3-year disease-free survival of 89%, which is good with just trastuzumab alone, says Yardley. This gives physicians the confidence to administer HER2-targeted therapy alone.

Dr. Yardley on the RESPECT Trial in HER2-Positive Breast Cancer

Denise Yardley, MD, senior investigator, Sarah Cannon Research Institute, shares insight on the potential impact of biosimilars in breast cancer.

The role of biosimilars is a moving target right now, and community oncologists are waiting to see how the implementation of biosimilars would fit into practice, Yardley says. Sarah Cannon Research Institute has had a number of biosimilar clinical trials come its way, but they have yet to participate in them. Yardley says that she understands the need for biosimilars and the potential benefit to patients, but right now her practice is a proponent of standard drugs.

Several biosimilars have been approved by the FDA, including the trastuzumab (Herceptin) biosimilar MYL-1401O (Ogivri; trastuzumab-dkst) for use in patients with HER2-positive breast cancer. Phase III data from the HERITAGE trial presented at the 2018 ASCO Annual Meeting indicated clear equivalence for MYL-1401O compared with standard trastuzumab. MYL-1401O combined with taxane-based chemotherapy for frontline treatment of patients with HER2-positive disease mirrored the progression-free survival of patients treated in the same setting with trastuzumab.

Dr. Yardley Shares Insight on the Impact of Biosimilars

Denise Yardley, MD, senior investigator at the Sarah Cannon Research Institute, discusses the results of the APT and APHINITY trials for patients with HER2-positive breast cancer.

The durable response from the APT trial at 5 and 7 years has shown that patients have continued to see benefits, explains Yardley. According to Yardley, this is changing the dynamic of HER2-positive breast cancer.

Additionally, the magnitude of benefit from the addition of trastuzumab (Herceptin) in the APHINITY trial has been tremendous and continues to reduce a patient’s risk for recurrence, states Yardley.

Dr. Yardley on the Results of the APT and APHINITY Trials for HER2+ Breast Cancer

Denise Yardley, MD, senior investigator at the Sarah Cannon Research Institute, discusses the APHINITY trial investigating pertuzumab (Perjeta) for patients with adjuvant HER2-positive breast cancer.

The design of the APHINITY trial was either an anthracycline-based regimen for node-positive patients, chemotherapy with a trastuzumab (Herceptin)-based regimen for node-negative patients, or pertuzumab in combination with trastuzumab, explains Yardley.

Overall, this study has shown positive results of pertuzumab in the adjuvant setting for patients with HER2-positive breast cancer, states Yardley.

Dr. Yardley on the APHINITY Trial for HER2-Positive Breast Cancer

Denise Yardley, MD, senior investigator at the Sarah Cannon Research Institute, discusses the tNACity trial for patients with triple-negative breast cancer.

The tNACity trial is a first-line study where patients will be randomized into 1 of 3 arms. The treatment arm is evaluating abraxane which has had an increase of signal activity in these patients. Due to the results of previous trials, one of the control arms was iniparab gemcitabine/carboplatin. The doublet arm was gemcitabine/abraxane and carboplatin/abraxane.

There is controversy surrounding the doublet therapy, according to Yardley, but with the need for responses in patients due to the aggressive relapses and short disease-free intervals, it has become more accepted, particularly in the triple-negative patients.

Denise Yardley, MD, Tennessee Oncology

Articles

Dr. Yardley on Importance of Tailoring Treatment to Breast Cancer Subtypes

Dr. Yardley on the RESPECT Trial in HER2-Positive Breast Cancer

Dr. Yardley Shares Insight on the Impact of Biosimilars

Dr. Yardley on the Results of the APT and APHINITY Trials for HER2+ Breast Cancer

Dr. Yardley on the APHINITY Trial for HER2-Positive Breast Cancer

Dr. Yardley on tNACity Trial for Triple-Negative Breast Cancer