Fabrice André, MD, PhD, professor of Medical Oncology at the Institut Gustave Roussy in Villejuif, France, discusses strategies to improve outcomes in patients with breast cancer.

At the 2020 ESMO Breast Cancer Virtual Meeting, André spoke to 4 research priorities in the field of breast cancer.

One of these priorities is to improve patient outcomes as they pertain to overall survival and disease-free survival, explains André.

One strategy to move toward improving these outcomes is to develop a biological model of each patient’s disease to determine the molecular mechanisms that contribute to their progression, says André.

Additionally, developing novel biotechnologies to identify new agents could translate into improved outcomes, says André.

For example, using new biotechnologies to create improved linkers for antibody-drug conjugates is being done currently in breast cancer, concludes André.

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Fabrice André, MD, PhD, discusses strategies to improve outcomes in patients with breast cancer.

Dr. Andre on Strategies to Improve Outcomes in Breast Cancer

Fabrice Andre, MD, PhD, professor of medical oncology, Institut Gustave Roussy, Villejuif, France, discusses the goals of the SOLAR-1 trial evaluating alpelisib plus fulvestrant (Faslodex) in patients with advanced breast cancer. The latest data were presented at the 2018 ESMO Congress.

Patients with hormone receptor (HR)-positive, HER2-negative metastatic breast cancer generally present with poor outcomes, Andre says. The median survival for these patients is 14 months and the vast majority of patients will develop progressive disease after 2 years on endocrine therapy and a CDK4/6 inhibitor. For these reasons, there is a need to develop new therapies for this subset of patients—particularly the 40% who harbor the PIK3CA gene&mdash;to improve outcomes.

Eligible patients were postmenopausal women or men with HR-positive, HER2-negative metastatic breast cancer who were previously treated with an aromatase inhibitor. The primary endpoint of SOLAR-1 was progression-free survival in the patients with 

Fabrice Andre, MD, PhD, professor of medical oncology, Institut Gustave Roussy, Villejuif, France, discusses the rationale for the SOLAR-1 trial in breast cancer.

Dr. Andre on Rationale for SOLAR-1 Trial in Breast Cancer

Fabrice André, MD, professor, Department of Medical Oncology, Institut Gustave Roussy, discusses the remaining questions with immunotherapy agents as potential therapy for patients with triple-negative breast cancer. Andre expanded on this in an interview with OncLive during the 35th Annual Miami Breast Cancer Conference.

The first question with immunotherapy is determining the prevalence of patients with triple-negative breast cancer that are sensitive to PD-L1, Andre explains; it currently is estimated to be 25% of patients in the first-line setting. Secondly, robust data emerging that, when a tumor is presenting with lymphocytic infiltration, the patient is more likely to be sensitive to immunotherapy.

Researchers are also seeking to improve the response rates currently reported with single-agent immunotherapy, Andre says. Currently, data in the neoadjuvant setting demonstrate that single-agent PD-1 therapy combined with chemotherapy. Until now, there are not phase III trial data in the first-line setting, but they are highly anticipated by the community, he concludes.

View more from the 2018 Miami Breast Cancer Conference

Dr. Andre on Questions With Immunotherapy in Triple-Negative Breast Cancer

Fabrice Andre, MD, PhD, Research Director, Head of INSERM Unit U981, Institut National des Sciences et de la Recherche Médicale, Associate Professor, Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France, discusses utilizing genomic alteration testing in clinical trials that explore novel targeted agents in breast cancer.

Andre says that current trials typically test for only one genomic alteration in their inclusion criteria, which leaves many patients ineligible and limits the potential of testing. As an example, in the case of the 

 mutation in breast cancer, 90% of patients tested are ineligible for treatment with a targeted agent, since only 10% have the mutation.

Increased emphasis should be placed on testing for more genomic alterations to speed up the clinical development of targeted therapies, Andre believes.

Fabrice Andre, MD, PhD, from the Institut Gustave Roussy, Villejuif, France, gives an overview of methods for improving the effectiveness of genomic alteration testing in clinical trials that explore novel targeted agents in breast cancer.

Dr. Andre Discusses Testing for Genomic Alterations

Fabrice Andre, MD, PhD, Research Director, Head of INSERM Unit U981, Institut National des Sciences et de la Recherche Médicale, Associate Professor, Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France, discusses upcoming research in metastatic breast cancer.

Andre finds research on genomics to be particularly interesting. With advanced testing, it becomes possible to screen for many genomic alterations, identify them, and treat patients accordingly. This is, and will continue to be, important for patients with metastatic breast cancer.

In addition, Andre feels that targeted therapies concerning mTOR will be important. There remains a need to improve the efficacy of mTOR inhibitors and analyze them to be combined with other agents. Immunotherapies are highly effective in melanoma and lung cancer. Though the current application of immunotherapies in breast cancer is minimal, Andre thinks this will change.

Fabrice Andre, MD, PhD, Research Director, Head of INSERM Unit U981, Institut National des Sciences et de la Recherche MÃ©dicale, Associate Professor, Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France, discusses upcoming research in metastatic breast cancer.

Fabrice Andre, MD, PhD

Articles

Dr. Andre on Strategies to Improve Outcomes in Breast Cancer

Dr. Andre on Rationale for SOLAR-1 Trial in Breast Cancer

Dr. Andre on Questions With Immunotherapy in Triple-Negative Breast Cancer

Dr. Andre Discusses Testing for Genomic Alterations

Dr. Andre on Research in Metastatic Breast Cancer