Shirley and I are here in San Antonio at SABCS (San Antonio Breast Cancer Symposium), a premier conference for oncologists and researchers from around the world with an attendance of about 7000 people.
AN INTERNATIONAL EXPERIENCE
It’s my first experience, but Shirley is a veteran and has been here six times. She was surprised and happy to see metastatic presentations throughout the four day conference. “Years ago” she said, “it seemed like metastatic was relegated to the last day.” We have met many people — researchers, oncologists, radiation oncologists and advocates–from the US and internationally– and have had some significant and interesting conversations. Getting a world perspective is particularly eye opening: A breast surgeon from Iran pointed out to me that metastatic breast cancer in Iran is not usually treated, since it is a terminal disease. In India, Her2 treatments are rare because of the costs. In Colombia and Brazil, breast cancer advocacy groups exist, but do not usually include metastatic. In many parts of the world, there is still a stigma associated with cancer and particularly breast cancer.
BONE MODIFYING AGENTS
Many of us with bone mets are familiar with bisphosphonate drugs like zometa and xgeva that strengthen bones and are usually taken every few weeks initially and then every couple of months after a year or two. I did attend a wonderful session on Bone Metastases and Bone Modifying Agents. Speaker Alison Stopeck MD from University of Arizona in Tucson offered arguments and evidence of the superiority of denosumab (xgeva) over zoledronic acid (zometa) in terms of longer time to a first SRE (skeletal related event) meaning a fracture; better control of pain and fewer side effects. So that is something I added to my list to discuss with my oncologist.
HER2: Perjeta and TDM-1
Last night was the most hopeful and exhilarating presentation–a panel of experts on Her2+ breast cancer. Among them were Dennis Slamon, MD from UCLA, the original researcher and 20 year crusader for herceptin research and Kimberly Blackwell, MD from Duke University, one of the researchers on TDM-1 . The panel of clinician/researchers were enthusiastic about the range of options now available for Her2+ metastatic disease and the excitement was contagious. Dr. Slamon spoke about the potential of HER2+ MBC becoming a chronic disease in the near future. Dr. Blackwell urged patients to rethink a “cure” for cancer, pointing out that in most fields of medicine, except for infectious diseases like pneumonia or smallpox or tuberculosis, diseases are managed and not cured. People are treated chronically in the US for cholesterol, hypertension, diabetes, arthritis, etc and hopefully HER2+ metastatic breast cancer will soon be included in this list.
Using higher doses of fulvestrant (faslodex) provided longer overall survival without adding to toxicity for metastatic ER+ patients. Results were from the phase 3 CONFIRM trial, so check with your oncologist, if this applies to you.
NO METASTATIC BREAKTHROUGHS
There’s been no groundbreaking announcement or significant finding for metastatic disease, other than the HER2 advances, which were already known. We are expecting the announcement this evening on the final data for OS (overall survival) for perjeta and TDM-1 is expected to be approved in January or February by the FDA.
As someone living with Triple Negative Breast Cancer, I was hoping for more progress reported on novel treatments, but perhaps I’m a bit naive. There is a veritable alphabet soup of pathways and molecules being investigated. When I met Dr. Slamon last night I said, “I hope there is someone out there with your dedication and determination who is studying TNBC.”
“Oh, there is,” he said, “there definitely is.”
Ginny Knackmuhs, MBCN