乌鸦传媒

Each year, the San Antonio Breast Cancer Symposium (SABCS) concludes with the always-popular "Year in Review" session. Last week, SABCS co-directors , of UT Health Sciences Center in San Antonio, and , of UT Southwestern Medical Center in Dallas, led a panel of experts in reviewing some of the most impactful, thought-provoking, and paradigm-shifting research in breast cancer published over the past year. But what is on the horizon for next year?

In this exclusive 乌鸦传媒 video, we asked Kaklamani to recap some of the 2022 session and to also look into her crystal ball and project what we might hear at next year's session.

The following is a transcript of her remarks:

At SABCS I was moderating the Year in Review. This is a session we do every year where we have four investigators talking about basic science, translational science, adjuvant therapy therapy in breast cancer, and metastatic [disease]. And it's always exciting because they really put a whole year into a 30-minute presentation.

So this year, when we were looking at what happened in the area of breast cancer, we started having it -- from the translational side -- a little more tailored approaches to therapy, started looking at more biomarkers, looking at ESR1 mutations and what that means to our patients. Looking at the AKT pathway and again, how will that change how we treat our patients next year? Starting to look at a different type of breast cancer, HER2-low. A lot of controversy during this meeting whether this was its own subtype or whether this really just was a treatment entity.

I think obviously we have trastuzumab deruxtecan [T-DXd, Enhertu], which is an antibody-drug conjugate, and that has shown activity in HER2-low. That was probably the number one story of this year. And this is exciting because a lot of patients' cancers are HER2-low. And to be able to find treatments, and many of these cancers might be endocrine resistant, or at some point they will become endocrine resistant. Many of them really don't respond to conventional chemotherapy. And so having a novel therapy, an antibody-drug conjugate for this sort of cancer is going to be very exciting.

We also started seeing more data with novel oral SERDs [selective estrogen receptor degraders]. SERDs are similar to fulvestrant [Faslodex], but now we have oral medications. So some data late last year with elacestrant. More data updated at this meeting with elacestrant showing activity, especially in tumors that have ESR1 mutations. So hopefully this drug will get approved early next year and will be in our clinic very soon for our patients.

And then AKT inhibition, initially a lot of excitement, then a little bit of questioning whether those are active drugs, at this meeting, with the CAPItello trial, showing that these are active drugs and hopefully, again, they'll make their way to the clinic.

So a lot of excitement this year, but what are the predictions for next year, right? What are we gonna talk about next year? And I may be wrong and probably will be, because it's hard to predict things. But if you look at, let's take surgery for example. A push is to see if patients have neoadjuvant chemotherapy, do they really need to have surgery if we see that they have a complete clinical response, or can we avoid surgery for these patients? And this data is emerging slowly.

When we look at the radiation therapy, we have some novel radiation therapy techniques that were also discussed at this meeting that may hopefully change how we view radiation in the future. Some data looking at whether we should be radiating micrometastatic disease or oligometastatic disease. And to me, we're probably not there yet, but a very intriguing concept.

And then moving on to the early-stage setting. We have trials with triple-negative breast cancer, where we're looking at early microscopic disease and how we can tackle that before it becomes macroscopic. And can we use targeted therapies to attack these cells again before they latch onto organs and start causing issues. And by then, it'll be extremely hard to be able to treat and cure these patients.

In the ER [estrogen receptor]-positive setting, in the early-stage setting, we're gonna have probably results from our third, or fourth, I should say, adjuvant CDK4/6 inhibitor trial, the . And we may have another option as far as the CDK4/6 inhibitors in the adjuvant setting.

In the HER2-positive setting, several trials that'll take a few years to really complete. But trying to see patients who do not achieve a pathologic complete response. Are we able to help improve their outcomes by giving something more than just TDM-1 [trastuzumab emtansine, Kadcyla], which has been our standard of care? So we're going to be looking at combinations with tucatinib [Tukysa], T-DXd, whether that's better. We're going to look at immunotherapy as well, whether that might add some benefit.

And then when we start moving into the metastatic setting, here again, we have the big data from the past several years on CDK4/6 inhibitors, they now have an improvement in overall survival, standard-of-care therapies. I think we'll have oral SERDs that we'll be able to use in some of our patients that are still endocrine sensitive after treatment with CDK4/6 inhibitors, hopefully capivasertib as well, since the data was positive from this meeting.

And in the HER2-positive setting, there's so many new drugs coming out, but this is a very crowded field. The improvements in benefits with T-DXd and tucatinib have been just overwhelming in the past couple of years. So I don't know that we'll have something even better, that would be a pretty high bar. But definitely a lot of new antibody-drug conjugates that will find their way to clinic.

We're targeting HER3 -- is this going to be an effective strategy? And in triple-negative breast cancer, how can we move our antibody-drug conjugates early on in the first-line setting? And several of these trials being done now that hopefully will present and have positive results.

So, very exciting. I think it's making things very complicated for our medical oncologists, but it's a good problem to have because we have more treatments for our patients.

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