COVER STORY
BREAKTHROUGHS IN BREAST CANCER RESEARCH The 2022 American Society of Clinical Oncology (ASCO) Annual Meeting was held in early June. Cancer researchers and clinicians from around the world gathered to discuss the latest research and how to ensure that all people with cancer receive the care they need.
CLINICAL TRIALS CHANGING THE FUTURE OF BREAST CANCER Most of the major treatment advances for breast cancer are based on results from clinical trials and studies conducted with people in Australia and overseas. The benefits of participating in a clinical trial include early access to new treatments, close monitoring and developing new treatments that may help other people diagnosed with breast cancer in the future. BCNA will continue to advocate for improved access to clinical trials, especially for those who live in rural and regional areas who may struggle to access clinical trial sites. trial, speak with your treating team to see if you are eligible. Many trials for breast cancer treatments are run in Australia (and New Zealand) by Breast Cancer Trials . If you are interested in participating in a clinical Also on the topic of radiotherapy, the LUMINA trial evaluated the rates of breast cancer recurrence in women who have undergone breast- conserving surgery for luminal A breast cancer, a subtype of ER+ HER2- breast cancer with a particular protein bio-marker. Participants were treated with adjuvant endocrine therapy alone, without adjuvant radiation, after breast- conserving surgery. Study findings show the five-year rate of local recurrence was only 2.3 per cent, which suggests that some people with luminal A early breast cancer may be able to safely avoid adjuvant radiotherapy and reduce the length and impact of treatment.
Professor Bruce Mann is the Study Chair of PROSPECT and the Director of Research at BCT. He is also a BCNA Board member. ‘Until now attempts to identify large numbers of patients diagnosed with early breast cancer who can safely avoid radiation therapy have had limited success and subsequently breast conserving surgery with adjuvant radiotherapy is recommended for most patients. Various trials are using new methods of analysing the known cancer to find those at minimal risk of recurrence, but PROSPECT is the only trial we know of that is focusing on previously unsuspected ‘occult’ cancers. The results are even better than we expected and hoped for.’ Professor Mann said.
Professor Bruce Mann
In this article, The Beacon highlights some of the key successful breast cancer trials. However, among the breakthroughs and advances at ASCO there were also some setbacks with some trial results not as promising as had been hoped. Even when results suggest a treatment may not be better than the current treatment, the learnings from the research can lead to the development of other, more effective treatments. SIGNIFICANT CLINICAL RESULTS FOR METASTATIC BREAST CANCER TREATMENT When the results from the DESTINY-Breast04 phase III clinical trial were announced, the audience of oncologists and researchers united in a standing ovation. This clinical trial – widely considered the biggest breakthrough in breast cancer research since Herceptin was approved in 1998 – evaluated the effectiveness of trastuzumab deruxtecan (Enhertu™) compared to chemotherapy, in patients with
HR-positive or HR-negative, HER2-low metastatic breast cancer. HER2-low breast cancer (IHC 1+, or 2+/ISH-negative) has not had targeted treatment until now. When compared to standard chemotherapy, the results show that treatment with trastuzumab deruxtecan (Enhertu™) doubles progression-free survival among people with metastatic breast cancer that expresses low levels of HER2. The treatment can also lengthen a person’s life, regardless of their hormone receptor status. Although it will take time to pass through the regulatory requirements, it is hoped this treatment will become a new standard of care for people with HER2-low in the future. PROGRESS WITH EARLY BREAST CANCER TREATMENT Breast Cancer Trials’ (BCT) PROSPECT study showed that use of magnetic resonance imaging (MRI) before surgery may identify people with a low risk of breast cancer recurrence who could be treated safely
without radiotherapy. MRIs were able to identify additional areas of cancer or pre-cancer in the breast that standard imaging (mammogram and ultrasound) were unable to detect. It was hypothesised that most recurrence from early breast cancer was from the previously unidentified ‘occult’ cancer, leading researchers to believe that if the breast was clear of these, then it may be safe to avoid radiotherapy. Approximately 200 people were found to fit the study criteria and were treated without radiotherapy. The recurrence rate after five years was only 1 per cent, leading to the conclusion that treatment without radiation appears to be safe for people identified through MRI as having a lower risk of recurrence. Radiotherapy is often associated with a number of side effects and high toxicity that can affect people even after treatment has stopped. Being able to safely avoid radiotherapy for some people may allow for higher quality of life and even alleviate some financial impacts of breast cancer by facilitating a quicker return to work.
‘The results are even better than we expected and hoped for.’ – Professor Mann
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September 2022 | Issue 92
Breast Cancer Network Australia
bcna.org.au
Issue 92 | September 2022
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