logo
episode-header-image
Aug 2022
8m 47s

Chemotherapy and Targeted Therapy for HE...

AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO)
About this episode

An interview with Dr. Beverly Moy from Massachusetts General Hospital in Boston, MA, lead author on "Chemotherapy and Targeted Therapy for HER2-Negative Metastatic Breast Cancer That is Either Endocrine-Pretreated or Hormone Receptor-Negative: ASCO Guideline Rapid Recommendation Update." Dr. Moy reviews data from the recently published DESTINY-Breast04 study, and the ASCO Expert Panel's updated recommendation on the use of trastuzumab deruxtecan. For more information, visit www.asco.org/breast-cancer-guidelines.

 

TRANSCRIPT

Brittany Harvey: Hello, and welcome to the ASCO Guideline podcast series brought to you by the ASCO podcast network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts.

My name is Brittany Harvey, and today I’m interviewing Dr. Beverly Moy from Massachusetts General Hospital in Boston, Massachusetts, lead author on 'Chemotherapy and Targeted Therapy for HER2-Negative Metastatic Breast Cancer That is Either Endocrine-Pretreated or Hormone Receptor-Negative: ASCO Guideline Rapid Recommendation Update'. Thank you for being here, Dr. Moy.

Dr. Beverly Moy: It’s my pleasure. Thank you for having me.

Brittany Harvey: Great. First, I’d like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology.

Dr. Moy, do you have any relevant disclosures that are directly related to this guideline topic?

Dr. Beverly Moy: I do not have any relevant disclosures that are directly relevant to this guideline topic.

Brittany Harvey: Thank you. Then let’s talk about this rapid update. So first, what prompted a rapid update to this guideline on chemotherapy and targeted therapy for patients with HER2-negative metastatic breast cancer that is either endocrine-pretreated or hormone receptor-negative, which was last updated in 2021?

Dr. Beverly Moy: First, I would state that ASCO issues rapid guideline recommendation updates when really important advances in the treatment and management of cancer have been presented. This mechanism really allows clinicians to keep up with the rapid advances in cancer management. The fact that a rapid update had to be issued just one year after the full updated guideline that was published in 2021, as you just mentioned, is really a testament to the advances in cancer research and clinical trials that have been made recently.

But I will state that the reason why this rapid update was done was because the result of the DESTINY-Breast04 study were so strong and compelling and showed such a large degree of benefit to a large group of metastatic breast cancer patients that we felt as the guideline panel that this rapid update had to be out there. We really wanted to make sure that the oncology community was aware of these results. That’s based on the strength of the trial. The DESTINY-Breast04 trial was a very large randomized study that showed that trastuzumab deruxtecan significantly improved progression-free survival and overall survival compared to treatment of physician’s choice in patients with metastatic, “HER2-low” breast cancer.

Brittany Harvey: So then based off this new data from the DESTINY-Breast04 trial that you just mentioned, what is the updated recommendation from the guideline expert panel?

Dr. Beverly Moy: So the updated recommendation is that patients with HER2-low, or to be specific, HER2 IHC1+ or 2+ and ISH negative metastatic breast cancer who have received at least one prior chemotherapy for metastatic disease, if they’re hormone receptor-positive, are refractory to endocrine therapy, those patients should be offered treatment with trastuzumab deruxtecan.

Brittany Harvey: And then what should clinicians know as they implement this new recommendation for trastuzumab deruxtecan?

Dr. Beverly Moy: I think that there are a few things that clinicians really need to be aware of. One is that it significantly improved progression-free survival and overall survival, and that’s pretty important. The paper was published in the New England Journal of Medicine, and folks can refer to that study specifically. But to be specific, it improved progression-free survival at a median follow-up of about 18 months from 9.9 months with trastuzumab deruxtecan compared to 5.1 months with treatment of physician choice in the entire study population. Median overall survival was 23.4 months with trastuzumab deruxtecan and 16.8 months with treatment of physician’s choice. So that’s really a marked improvement in both of those outcomes.

It is also important to note that trastuzumab deruxtecan has a very important side effect, and that’s the potential of developing drug-related interstitial lung disease or pneumonitis. And that could be very serious. This side effect was confirmed in about 12% of the patients who received trastuzumab deruxtecan, and about 1.3% of patients actually had severe symptoms requiring oxygen, and three patients in the study, so less than 1% actually died of this side effect. So that’s something that needs to be monitored for very carefully, and clinicians need to be very cognizant of this potential side effect when using this drug.

Brittany Harvey: Thank you for reviewing both the impact on survival and then the adverse event of interstitial lung disease. So how does this guideline update impact patients with breast cancer?

Dr. Beverly Moy: So metastatic breast cancer is incredibly common. And this HER2-low, and I say, “HER2-low” because this is a definition that has never been made before. The patients with HER2 IHC1+ or 2+ and ISH negative disease, that's a very large group of patients. That's a lot of patients. So it's really important that this guideline is going to impact a very large group of patients. Again, it's those who've had at least one prior line of chemotherapy in the metastatic setting. And if they had hormone receptor-positive disease, it has to be refractory to endocrine therapy. But that's a lot of patients. And the results of this randomized study do show that trastuzumab deruxtecan is superior to other treatment of physician’s choices that were available before this study came out in terms of its efficacy. So this guideline is very significant for clinicians and metastatic breast cancer patients across the world.

Brittany Harvey: Definitely. It's great to have a new option and one that has such a great clinical impact for patients.

So then finally, Dr. Moy, what are the outstanding questions regarding chemotherapy and targeted therapy for HER2-negative metastatic breast cancer?

Dr. Beverly Moy: I think like any good study, this raises a lot of other important questions. Again, this HER2-low definition that I described is an interesting one. It’s a very large bucket of patients. One obvious question is, would this drug be as effective in patients who are truly HER2-negative, so HER2 IHC of 0? Kind of, overnight, the results of this study has changed the paradigm for many oncologists because we used to just say HER2-positive or HER2-negative. And now we're looking back at patients' charts to see what their immunohistochemistry results were. Does it really matter if it's IHC 0 or 1+ or 2+? So that would be very interesting.

Another outstanding question is: what about the use of trastuzumab deruxtecan earlier in the treatment? I said that it should be offered for patients who’ve received at least one prior line of chemotherapy? What about first line chemotherapy in the metastatic setting? And there are multiple studies studying this drug in actually early stage breast cancer as well. So lots of unanswered questions about this compound that's pretty remarkable.

Brittany Harvey: Great. Well, I want to thank you so much for your time today, Dr. Moy, for discussing the results of the DESTINY-Breast04 trial with me, and for your work to rapidly update this guideline.

Thank you so much.

Dr. Beverly Moy: Thank you, Brittany. It was a pleasure.

Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/breast-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.

Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

 

Up next
May 27
Medically Integrated Dispensing Pharmacy: ASCO-NCODA Standards Update
Dr. Luis Raez and Michael Reff share the newest update to the medically integrated dispensing pharmacy standards from NCODA and ASCO. They review updates to domain one, on key patient-centered quality standards on health equity and social determinants of health, drug access, pati ... Show More
25m 5s
May 9
Symptom Management for Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors Guideline
Dr. Kimberly Perez and Dr. Jaydira Del Rivero discuss the new guideline from ASCO on symptom management for well-differentiated GEP-NETs. They share the latest recommendations on managing symptoms related to hormone excess, including carcinoid syndrome and carcinoid heart disease ... Show More
19m 20s
May 2
Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer Guideline Update
Dr. Rohan Garje shares the updated recommendations for the ASCO guideline on systemic therapy for patients with metastatic castration-resistant prostate cancer. He discusses the systemic therapy options for patients based on prior therapy received in the castration-sensitive and ... Show More
22m 48s
Recommended Episodes
May 2023
ASCO23: PALMIRA, LEONARDA-1, and Other Advances in Breast Cancer
Dr. Allison Zibelli and Dr. Megan Kruse highlight the PALMIRA and LEONARDA-1 trials, a new standard of care in the treatment of hand-foot syndrome for patients receiving capecitabine, and other key breast cancer studies that will be featured at the 2023 ASCO Annual Meeting. TRANS ... Show More
19m 49s
Apr 2024
A Revolution in Immunotherapy for Cervical and Endometrial Cancers
Doctors James Ferriss, Linda Duska, and Jayanthi Lea discuss the promise and the challenges of targeting the immune system with immune checkpoint inhibitors, or ICIs, in cervical and endometrial cancers. They also examine emerging data that support the use of ICIs in recurrent ce ... Show More
26m 18s
Aug 2021
Clinical Challenges in Breast Surgery: Triple Negative Breast Cancer
A young woman is referred urgently to your breast surgical oncology clinic for a second opinion. She has been told that she needs to have an urgent mastectomy for a palpable triple negative breast cancer with suspicious axillary lymphadenopathy. Are there other options she should ... Show More
26m 17s
Apr 2022
#328 Updates in Hospital Medicine, Primary Care, Breast Health, Sexual Health, Addiction Medicine, Meded and more! Highlights from #SGIM22
Fill up with delicious practice-changing knowledge food from #SGIM22 as The Curbsiders team discusses breast cancer survivorship, sexual dysfunction, How climate change will affect health, Are PT consults necessary in the hospital?, Do we need antibiotics for aspiration events?, ... Show More
1h 20m
Jun 2024
ASCO24: Transforming the Lung Cancer Treatment Landscape
Drs. Vamsi Velcheti and Nathan Pennell discuss novel approaches and key studies in lung cancer that were showcased at the 2024 ASCO Annual Meeting, including the Plenary abstracts LAURA and ADRIATIC.   TRANSCRIPT Dr. Vamsi Velcheti: Hello, I am Dr. Vamsi Velcheti, your guest host ... Show More
33m 17s
Dec 2023
Thinking Beyond TROP2 at ESMO 2023
What were the biggest takeaways from ESMO 2023 related to TNBC and IBC? Tune in to hear experts Drs Kevin Kalinsky and Filipa Lynce discuss. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/991259). The topics and dis ... Show More
17m 6s
Nov 2023
Hereditary Breast Cancer, Genetic Testing, and Therapeutic Implications
Join Drs Kevin Kalinsky and Jennifer Litton as they discuss hereditary breast cancer, genetic testing, and therapeutic implications. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/991258). The topics and discussions ... Show More
19m 26s
Dec 2022
Vom Bereuen einer radikalen Krebstherapie
mit Dr. med. Valentin Meissner, Urologe Die Patienten der Studie waren vor rund 20 Jahren an einem lokal begrenzten Prostatakarzinom erkrankt, und bei allen fiel die Therapieentscheidung zur radikalen Prostatektomie. Diese kann, wie fast jede Behandlung, mit unerwünschten Nebenwi ... Show More
22m 41s
May 2024
Exploring CAR T Cells in GI Cancers at ASCO24
Dr. Shaalan Beg and Dr.Mohamed Salem discuss key abstracts that will be presented at the 2024 ASCO Annual Meeting, including hypoxia-response CAR T- cell therapy for solid tumors, GPC3-specific CAR T- cell therapy in hepatocellular carcinoma, and the promising efficacy of targete ... Show More
17m 58s
Dec 2021
Journal Review in Breast Surgery: Management of Residual Disease After Neoadjuvant Chemotherapy
Why should a surgeon care about breast cancer chemotherapy trials? Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the benefits of neoadjuvant chemotherapy over upfront surgery and the role of adjuvant chemotherapy for select patients who harbor residu ... Show More
18 m