, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, 

 covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.

In today’s episode, supported by Pfizer and Novartis, we had the pleasure of speaking with the panelists from 

 inaugural Women in Oncology event, which took place during the 

, is the director of Breast Oncology at Lifespan Cancer Institute, as well as an associate professor of medicine at Brown University, both in Providence, Rhode Island. 

, is a medical oncologist at Miami Cancer Institute and chief of Breast Medical Oncology at Baptist Health’s Wellness and Medical Complex in Florida. 

, is a breast medical oncologist and an assistant clinical professor of medicine at the University of California, Los Angeles Health David Geffen School of Medicine. 

, is the Winterhof Family Endowed Professor in Breast Cancer at the University of California San Francisco (UCSF), as well as a professor of medicine in the Division of Hematology and Oncology, director of Breast Oncology, director of Clinical Trials Education, and director of Cancer Infusion Services at the UCSF Helen Diller Family Comprehensive Cancer Center. 

In our exclusive interview, Drs Graff, Mahtani, McCann, and Rugo shared moments throughout their lives and careers that sparked their interest in oncology, setbacks they overcame when building their careers, obstacles they continue to encounter as women in the field, and ways that gender bias can be confronted at both the individual and institutional levels.

That’s all we have for today! Thank you for listening to this episode of 

, supported by Pfizer and Novartis. Check back on Mondays and Thursdays for exclusive interviews with leading experts in the oncology field.

For more updates in oncology, be sure to visit www.OncLive.com and sign up for our e-newsletters.

 is also on social media. On Twitter, follow us at @OncLive. On Facebook, like us at OncLive, and follow our OncLive page on LinkedIn.

, please consider subscribing to our podcast on Apple Podcasts, Spotify, Google Podcasts, Amazon Music, and many of your other favorite podcast platforms,* so you get a notification every time a new episode is posted. While you are there, please take a moment to rate us!

*OncLive On Air is available on: Apple Podcasts, Google Podcasts, Spotify, Amazon Music, Audacy, CastBox, Deezer, iHeart, JioSaavn, Listen Notes, Player FM, Podcast Addict, Podchaser, RadioPublic, and TuneIn.

Podcasts

Drs Graff, Mahtani, McCann, and Rugo share moments that sparked their interest in oncology and setbacks they overcame when building their careers. 


Breast Cancer Experts Share Obstacles and Successes as Women in Oncology

Dr Mahtani on Addressing Unmet Needs in Breast Cancer

Reshma L. Mahtani, DO, medical oncologist, Miami Cancer Institute, chief, breast medical oncology, Baptist Health’s Wellness and Medical complex, 

discusses how attempts to address unmet needs in breast cancer

Throughout the course of her career, Mahtani says she has witnessed significant advancements aimed at addressing the unmet needs in breast cancer management, which she categorizes into 4 distinct areas. Firstly, early detection and diagnosis have undergone substantial evolution, Mahtani begins. Initially, a major challenge lay in the quest for reliable methods of early detection, according to Mahtani. However, over time, technological progress, including the refinement of mammography, MRI, and ultrasound, has significantly enhanced early detection rates, she explains. Moreover, the advent of genetic testing has ushered in an era of personalized screening and early intervention strategies, thereby markedly improving patient outcomes, Mahtani states.

Secondly, the realm of personalized medicine has witnessed remarkable progress, Mahtani says. Enhanced comprehension of breast cancer biology and genetics has paved the way for the development of targeted therapies, Mahtani reports. This advancement holds particular significance for patients with metastatic breast cancer, as targeted therapies have considerably broadened the array of available treatment options, Mahtani notes.

Thirdly, there has been a concerted focus on survivorship and enhancing quality of life post-treatment, she continues. Recognizing the enduring physical and psychological repercussions of breast cancer therapy, efforts have been directed toward the establishment of survivorship care plans, support groups, and specialized survivorship clinics, Mahtani emphasizes. Moreover, research endeavors targeting issues such as fatigue and cognitive dysfunction have yielded interventions that substantially bolster support mechanisms for survivors, she adds.

Lastly, confronting the disparities in access to care based on race, ethnicity, and socioeconomic status remains a formidable challenge, Mahtani expands. Nevertheless, there has been a notable shift toward acknowledging and addressing these disparities, she elucidates. Research initiatives aimed at elucidating the biological variances based on race and ethnicity, alongside endeavors to comprehend the impact of social determinants of health, underscore a concerted effort to tackle the underlying factors contributing to healthcare inequities, Mahtani emphasizes.

Moreover, the promotion of culturally competent care practices represents a crucial stride toward fostering inclusivity within health care, Mahtani concludes.

Videos

Reshma L. Mahtani, DO, discusses how attempts to address unmet needs in breast cancer have evolved over time.

Reshma L. Mahtani, DO, discusses how the expansion of HER2-targeted agents has impacted the management of HER2-positive breast cancer.

Dr Mahtani on the Expansion of Targeted Therapies in HER2+ Breast Cancer

Reshma L. Mahtani, DO, medical oncologist, Miami Cancer Institute, chief, breast medical oncology, Baptist Health’s Wellness and Medical complex, discusses how the expansion of HER2-targeted agents has impacted the management of HER2-positive breast cancer care, and thereby improved patient outcomes.

Approximately 15% to 20% of breast cancers are classified as HER2-positive, representing a particularly aggressive subtype of the disease associated with an elevated risk of systemic and brain metastases, Mahtani begins. The introduction of trastuzumab (Herceptin) and subsequent HER2-directed therapies has markedly improved the prognosis for patients with this disease subtype, she states. Presently, there are 8 approved therapies targeting HER2, encompassing monoclonal antibodies, TKIs, and antibody-drug conjugates, Mahtani notes.

The expanded armamentarium of HER2-targeted therapies has revolutionized the management of HER2-positive breast cancer, providing patients with prolonged survival and increased treatment options, Mahtani emphasizes. However, the availability of these treatments also presents challenges, she says. Clinicians must remain vigilant regarding potential toxicities associated with HER2-targeted therapies and ensure appropriate monitoring of patients. Furthermore, dose adjustments may be necessary to mitigate adverse effects (AEs)and maintain patients' quality of life, Mahtani adds.

In managing HER2-positive breast cancer, research focus and endeavors now extend beyond extension of survival to encompassing the preservation of patients' overall well-being, Mahtani continues. It is imperative to prioritize strategies that optimize both clinical outcomes and quality of life. This entails a comprehensive approach that includes close monitoring, judicious use of therapies, and tailored interventions to address treatment-related AEs. Ultimately, by balancing the benefits and risks of HER2-targeted therapies, clinicians can optimize patient outcomes and enhance their overall treatment experience, Mahtani concludes.

Reshma L. Mahtani, DO, discusses unique challenges women may face when transitioning between different career roles within oncology.

Dr Mahtani on Unique Challenges Women in Oncology Experience During Career Transitions

Reshma L. Mahtani, DO, medical oncologist, Miami Cancer Institute, chief, breast medical oncology, Baptist Health’s Wellness and Medical complex, discusses unique challenges women may face when transitioning between different career stages or roles within oncology.

Following her participation as a panelist in the Women in Oncology event held during the 

, Dr Mahtani helped facilitate a conversation on career transitions within oncology.

Some of the unique challenges discussed included gender bias and stereotypes, which impact opportunities for career advancement and recognition, Mahtani recounts. These biases can influence hiring practices, promotion decisions, and access to leadership roles, perpetuating disparities within the profession, she explains.

Balancing professional responsibilities with personal and family obligations is another challenge, exacerbated by the demanding nature of oncology work, Mahtani adds. Women encounter obstacles related to family responsibilities, including securing adequate childcare, managing parental leave, and re-entering the workforce after time off. Achieving work-life balance amidst these demands can be challenging, Mahtani says.

Salary disparities in oncology is another critical issue, Mahtani continues. Women often earn less than their male counterparts for comparable work, leading to financial insecurity and feelings of undervaluation, she states. It is essential to acknowledge and rectify these gaps, fostering an environment of equity and respect, Mahtani says.

As more women assume leadership positions, mentorship and sponsorship become vital resources for navigating these challenges, Mahtani emphasizes. Advocacy efforts to address systemic inequities and promote meaningful change are imperative. Those in positions of influence must speak up, provide support and guidance, and advocate to empower women in oncology to effect positive change in the profession, Mahtani concludes.

Reshma Lillaney Mahtani, DO, chief, Breast Medical Oncology, Baptist Health Wellness and Medical Complex, discusses available therapies in the first-, second-, and later-line settings in patients with HER2-positive metastatic breast cancer.

HER2-targeted treatment decisions in the first and second lines are often based on standard algorithms that guide the care of patients with HER2-positive breast cancer, Mahtani says. One standard frontline treatment option is pertuzumab (Perjeta) plus trastuzumab (Herceptin) and taxane-based chemotherapy. Final overall survival (OS) results from the phase 3 CLEOPATRA trial (NCT00567190) showed that patients who received the pertuzumab combination achieved a median overall survival (OS) of 56.5 months vs 40.8 months in those who received placebo, trastuzumab, and docetaxel.

In the second-line setting, findings from the phase 3 DESTINY-Breast03 trial (NCT03529110), a head-to-head study comparing the antibody-drug conjugates fam-trastuzumab deruxtecan-nxki (Enhertu) and ado-trastuzumab emtansine (Kadcyla), establishedtrastuzumab deruxtecan as the standard of care for most patients with HER2-positive metastatic breast cancer. In DESTINY-Breast03, the median progression-free survival (PFS) was 28.8 months with trastuzumab deruxtecan vs 6.8 months with trastuzumab emtansine. Another option in the second line and beyond, especially for patients with significant central nervous system metastases, is tucatinib (Tukysa) plus capecitabine (Xeloda) and trastuzumab, based on findings from the phase 2 HER2CLIMB trial (NCT02614794), Mahtani notes. In HER2CLIMB, the 1-year PFS rate was 33.1% in patients who received the tucatinib combination vs 12.3% in those who received placebo plus trastuzumab and capecitabine.

In the third-line setting and beyond, treatment recommendations should be individualized based on factors such as patient preference for oral vs intravenous therapies, disease burden, symptomatology, and the adverse effect profiles of the treatments, Mahtani explains. Although treatment decisions in the later-line settings are not as clearly defined as those in the earlier-line settings, several treatment regimens are available, Mahtani says. For instance, margetuximab-cmkb (Margenza) plus chemotherapy, 

 based on findings from the phase 3 SOPHIA trial (NCT02492711), is a potential option for some patients. Trastuzumab emtansine, neratinib in combination with capecitabine, and chemotherapy in combination with trastuzumab could also be considered, Mahtani concludes.

Reshma Lillaney Mahtani, DO, discusses available therapies in the first-, second-, and later-line settings in patients with HER2-positive metastatic breast cancer.

Dr Mahtani on Treatment Sequencing in HER2+ Metastatic Breast Cancer

Reshma L. Mahtani, DO, assistant professor of clinical medicine, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, discusses side effects of ovarian suppression in patients with breast cancer.

Updated data from the TEXT and SOFT clinical trials in premenopausal women with hormone-receptor positive breast cancer showed that there is a benefit to ovarian function suppression. Although, investigators observed that absolute benefits were greater in patients who had higher risk of disease.

Generally, ovarian function suppression is associated with more side effects for most pre-menopausal patients, says Mahtani. Additionally, the use of an aromatase inhibitor (AI) as opposed to tamoxifen may lead to join discomfort, osteoporosis, and issues with libido. Mahtani says that when ovarian function suppression is used with an AI, side effects can be more prevalent, so clinicians should be sure to only use that option in the patients who will derive the most benefit.

Dr. Mahtani on Side Effects of Ovarian Suppression in Breast Cancer

Reshma L. Mahtani, DO, assistant professor of clinical medicine, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, discusses the updated data from the TEXT and SOFT clinical trials in premenopausal women with hormone-receptor positive (HR+) breast cancer.

The trials demonstrated that there is a benefit to the addition of ovarian function suppression. There’s a small survival signal and an improvement in overall survival in the patients who had received prior chemotherapy. The absolute benefits are higher in patients who have higher risk disease such as those who are very young and those who require chemotherapy. This underscores the need for individualized patient care, says Mahtani.

For most premenopausal patients, ovarian function suppression is associated with more side effects. A woman who receives an aromatase inhibitor as opposed to tamoxifen may experience issues with joint discomfort, osteoporosis, and libido. Physicians need to make sure that they’re only exposing patients to those additional side effects if they expect to see a benefit, states Mahtani.

Dr. Mahtani on TEXT and SOFT Trial Data in HR+ Breast Cancer

Reshma L. Mahtani, DO, assistant professor of clinical medicine, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, discusses the use of CDK 4/6 inhibitors in older patients with estrogen receptor-positive breast cancer.

An FDA pooled analysis of the registration trials that led to the approval of CDK 4/6 inhibitors was presented at the 2017 San Antonio Breast Cancers Symposium. In the analysis, investigators looked at the studies with respect to age and treatment effect. Although CDK 4/6 inhibitors are very efficacious and pretty well tolerated, physicians wondered whether older patients could tolerate the medication as well as younger patients.

The use of CDK 4/6 inhibitors is something that should be considered in older patients, says Mahtani. Age should not be used as a reason not to administer these agents. Although there was an increased incidence of treatment discontinuation and increased grade 3/4 toxicity, the differences in select adverse events that are associated with the use of these therapies were not that great.

Reshma L. Mahtani, DO

Articles