Martine J. Piccart, MD, PhD, professor, Université Libre de Bruxelles, director, Medicine Department, Institut Jules Bordet, discusses biomarkers in early breast cancer.

Piccart says that a big weakness of translational research in early breast cancer is the thought that looking at a myriad of different biomarkers before treatment will predict which patients will respond best. This approach, she adds, does not take into account the metabolism of the drug—as different people do not handle drugs the same way.

There are new models in place that take into consideration the patients’ reaction to a given drug, which will potentially be able to predict which patients will experience favorable outcomes with that drug. Piccart says that this will allow for smaller, more specific adjuvant trials in the future.

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Dr. Piccart Discusses Biomarkers in Early Breast Cancer

Martine J. Piccart, MD, PhD, professor, Université Libre de Bruxelles, director, Medicine Department, Institut Jules Bordet, discusses the importance of de-escalating treatment in early-stage breast cancer.

Historically, drug treatment in breast cancer has been aggressive and many patients are being overtreated, says Piccart. Systemic treatment plays a fundamental role in breast cancer, but there is substantial amount of evidence that shows only a small population of women benefit from escalating therapy.

The surgical and radiation fields, Piccart adds, have heavily focused on de-escalating therapy in selected women over the past few years, resulting in less mastectomies and axillary dissections, and shorter periods of radiation with successful outcomes.

View more from the St. Gallen's Breast Cancer Conference

Dr. Piccart on the Importance of De-Escalation in Early Breast Cancer

Martine J. Piccart, MD, PhD, professor of Oncology, Université Libre de Bruxelles, director of Medicine, Jules Bordet Institute, Brussels, Belgium, discusses the primary analysis of the prospective randomized MINDACT study, which evaluated the clinical utility of the 70-gene signature (MammaPrint) combined with common clinical-pathological criteria for selection of patients for adjuvant chemotherapy in breast cancer with 0 to 3 positive nodes.

Findings of the phase III study demonstrated that Mammaprint is the first test for patients with node-positive disease which can be used in clinical practice in an effort to decrease the use of chemotherapy, Piccart explains. Additional tests include Oncotype

DX, which is primarily used for women with node-negative disease.

Mammaprint was found to demonstrate a high level of accuracy at identifying a large subset of women with clinically high-risk early stage breast cancer for whom adjuvant chemotherapy was unlikely to produce benefit. The MINDACT study, Piccart adds, was a result of several collaborations.

Dr. Piccart on the MINDACT Study for Early-Stage Breast Cancer

Martine Piccart, MD, PhD, director of medicine at the Jules Bordet Institute in Brussels, Belgium, gives an update on a four-year follow-up analysis of the NeoALTTO trial.

In the NeoALTTO trial, patients with HER2-positive breast cancer were randomly assigned to preoperative therapy with paclitaxel and lapatinib, paclitaxel and trastuzumab, or paclitaxel plus both anti-HER2 drugs. The overall goal of the trial was to determine whether pathologic complete response (pCR) rate achieved with lapatinib plus trastuzumab translated into better overall survival or event-free survival.

Overall, the primary endpoint of the trial was met, establishing a significant connection between pCR and survival. Patients who achieved a pCR were 62% less likely to experience a cancer-related event, Piccart states. Moreover, pCR was associated with a 67% reduction in the risk of death. Taken together, these findings confirm that pCR is an acceptable surrogate endpoint, Piccart believes.

Dr. Piccart on a 4-Year Follow-Up of the NeoALTTO Trial

Martine Piccart, MD, PhD, director of medicine at the Jules Bordet Institute in Brussels, Belgium, discusses the success of trastuzumab for the treatment of breast cancer.

Piccart believes that trastuzumab is the most successful targeted agent for breast cancer thus far. Piccart says she wonders if the drug's success is not because of it's primary mechanism of action. Perhaps, she says, the most important aspect of trastuzumab is the stimulation of an immune response against the tumor. The oncology community will learn in the coming years about why some patients develop this immune response while others do not.

Piccart is most impressed with trastuzumb because it has demonstrated clear-cut activity in advanced and early disease. Other successful targeted agents demonstrate good, but not long-lived, responses and cannot be transposed from advanced to early stage disease.

Dr. Piccart on the Success of Trastuzumab

Martine Piccart, MD, PhD, director of medicine at the Jules Bordet Institute in Brussels, Belgium, gives an overview of the IMPAKT conference.

Piccart has been impressed by the exponential growth in information related to cancer biology and new technologies in recent years. She felt that there was a need to educate young medical oncologists on these technologies, including how to interpret results.

The conference usually has between 600 and 700 people attend and features a course to explain new technologies to pathologists, who have to cope with this rapidly changing field.

Dr. Piccart Explains the Benefit of the IMPAKT Conference

Martine Piccart, MD, PhD, director of medicine at the Jules Bordet Institute in Brussels, Belgium, discusses the development of metagene prognostic signatures for patients with breast cancer.

Piccart is not sure that metagene prognostic signatures can get any better as years have been spent developing what currently exists.

Piccart says there may be one exception in the case of Endopredict. This signature predicts for excellent long-term outcome and disease-free survival at 10 years. Endopredict has been validated in the context of large, randomized, "clean" clinical trials, according to Piccart.

Martine Piccart, MD, PhD, director of medicine at the Jules Bordet Institute in Brussels, Belgium, discusses the development of metagene prognostic signatures for patients with breast cancer.


Dr. Piccart on Metagene Prognostic Signatures

Martine Piccart, MD, PhD, director of medicine at the Jules Bordet Institute in Brussels, Belgium, discusses the implications of the HERA trial, which looked at two years compared with one year of trastuzumab after adjuvant chemotherapy in women with HER2-positive breast cancer.

Piccart does not believe that the HERA trial answered all relevant questions regarding the optimal use of trastuzumab in the adjuvant setting. Piccart noted that the trial used sequential administration of trastuzumab following chemotherapy and that the results are not transferable to the concomitant administration. The trial showed that the standard of care should remain one year of trastuzumab as two years demonstrated more side effects including mild cardiac side effects.

View coverage from the 2013 Miami Breast Cancer Conference

Martine Piccart, MD, PhD, discusses the implications of the HERA trial, which looked at two years compared with one year of trastuzumab after adjuvant chemotherapy in women with HER2-positive breast cancer.

Martine Piccart, MD, PhD

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