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A Look Ahead to the 2019 SABCS Meeting

Sara Hurvitz, MD, FACP

Professor of Medicine
Breast Oncology Program
Division of Hematology-Oncology
Department of Medicine
David Geffen School of Medicine at UCLA
Los Angeles, California

Sara Hurvitz, MD, FACP, has disclosed that she has received funds for research support from Ambrx, Bayer, Daiichi-Sankyo, Dignitana, Genentech/Roche, GlaxoSmithKline, Immunomedics, Lilly, MacroGenics, Novartis, OBI Pharma, Pfizer, Pieris, Puma, Radius, Sanofi, and Seattle Genetics and consulting fees from Pfizer and Roche

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Joyce O'Shaughnessy, MD

Celebrating Women Chair in Breast Cancer Research
Breast Cancer Research Program
Baylor University Medical Center
Texas Oncology
US Oncology Network
Dallas, Texas

Joyce O’Shaughnessy, MD, has disclosed that she has received consulting fees from AbbVie, Agendia, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Eisai, Genentech, Genomic Health, GRAIL, Immunomedics, Heron, Ipsen, Jounce, Lilly, Merck, Myriad, Novartis, Odonate, Pfizer, Puma, Roche, Seattle Genetics, and Syndax

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Sara Tolaney, MD, MPH

Associate Professor of Medicine
Division of Breast Oncology
Harvard Medical School
Chief, Division of Breast Oncology
Breast Oncology Program
Dana-Farber Cancer Institute
Boston, Massachusetts

Sara Tolaney, MD, MPH, has disclosed that she has received funds for research support paid to her institution from AstraZeneca, Bristol-Myers Squibb, Cyclacel, Exelixis, Eisai, Genentech/Roche, Immunomedics, Lilly, Merck, Nektar, Novartis, Odonate, Pfizer, and Sanofi and consulting fees from AbbVie, AstraZeneca, Athenex, Bristol-Myers Squibb, Celldex, Daiichi-Sankyo, Eisai, Genentech, Immunomedics, Lilly, Merck, NanoString, Nektar, Novartis, Paxman, Pfizer, Puma, Sanofi, and Seattle Genetics.

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Released: December 9, 2019

At the SABCS 2019 annual meeting, important results from many clinical trials on breast cancer will be reported. Here, renowned experts have highlighted some of their most anticipated abstracts, which will be covered online as a part of CCO’s Independent Conference Coverage of SABCS 2019. As the SABCS annual meeting unfolds, remember to check the CCO Web site often for downloadable slidesets summarizing the data from these studies and then again after the meeting for CME-certified online activities featuring expert commentaries on the clinical implications of the data.

Top Picks: HER-Positive Disease
Tucatinib is a new potent and selective HER2 tyrosine kinase inhibitor that has shown promising activity in phase I studies that enrolled patients with pretreated HER2-positive metastatic breast cancer (MBC). In particular, tucatinib has demonstrated activity in active central nervous system (CNS) disease leading to an orphan drug designation by the FDA. The randomized phase II HER2CLIMB study is evaluating tucatinib in combination with capecitabine and trastuzumab in patients with HER2-positive MBC who are refractory to standard-of-care regimens. The patient population enrolled on this study included patients with untreated or progressive CNS metastases. Data including PFS will be presented in the overall population as well as the subgroup of patients with brain metastases and, if favorable, may lead to a change in practice for these patients.

Another key study focused on the care of patients with HER2-positive MBC that will be presented is the multicenter, open-label, single-arm phase II DESTINY trial. This study is evaluating trastuzumab deruxtecan (formerly DS-8201a), a novel antibody–drug conjugate targeting HER2 with a unique topoisomerase inhibitor payload, in patients with HER2-positive MBC previously treated with T-DM1. Depending on the findings reported in terms of toxicity profile and efficacy outcomes, this agent might be approved for patients with heavily pretreated HER2-positive MBC in the not too distant future.

Two interesting trials in patients with early-stage HER2-positive breast cancer will also be presented at SABCS 2019. An update of the randomized, double-blind, placebo-controlled APHINITY trial comparing chemotherapy plus dual HER2-targeted therapy (trastuzumab plus pertuzumab) with chemotherapy plus trastuzumab alone as adjuvant therapy in patients with early-stage HER2-positive breast cancer will report an interim survival analysis.

The randomized phase II ATEMPT trial comparing adjuvant therapy with T-DM1 with standard paclitaxel/trastuzumab for patients with stage I HER2-positive breast cancer will also be reported. The single-arm phase II APT trial evaluating paclitaxel/trastuzumab demonstrated an outstanding disease-free survival (DFS) rate associated with the less intense paclitaxel/trastuzumab in patients with a relatively low risk of disease relapse. Results from ATEMPT show a very promising therapeutic index in favor of T-DM1 for stage I HER2-positive breast cancer. Although the trial was not designed to formally compare the DFS between the 2 arms, the outcome associated with T-DM1 appears to be similar—if not better—than that associated with paclitaxel/trastuzumab, and thus, these data may change current practice.

Top Picks: Hormone Receptor–Positive Disease
The randomized phase III PEARL trial is comparing palbociclib plus endocrine therapy vs capecitabine in hormone receptor–positive MBC with progression on aromatase inhibitors (AIs). Although there are now robust data that suggest that endocrine therapy in combination with a CDK4/6 inhibitor can improve both PFS and OS compared with endocrine therapy alone, many physicians are giving chemotherapy to patients with hormone receptor–positive MBC in the first-line setting, particularly in those patients with visceral disease. This study will address if endocrine therapy plus CDK4/6 inhibition may be better than chemotherapy for patients with hormone receptor–positive MBC and progression on AIs.

Long-term follow-up data from the phase III NSABP B-42 trial comparing 10 years vs 5 years of adjuvant AI in patients with early-stage hormone receptor–positive breast cancer will also be reported. The results from this study continue to show improved DFS and breast cancer–free interval with extended AI therapy in this disease setting.

Top Picks: Triple-Negative Disease
The KEYNOTE-522 study compared neoadjuvant pembrolizumab plus chemotherapy vs placebo plus chemotherapy followed by adjuvant pembrolizumab vs placebo for early-stage triple-negative breast cancer. The primary results from this study were presented earlier at ESMO 2019, showing a significant improvement in pathologic CR rate with the addition of pembrolizumab. At the 2019 SABCS meeting, data from key patient subgroups will be presented.

Remember to Check the CCO Web Site Often!
These are just a few of the interesting and important abstracts selected by the experts from SABCS 2019. Downloadable slideset summaries of these studies and more will be available on the CCO Web site as the data are presented at the meeting. After the meeting, analyses by these experts will explore the clinical implications of the data in CME-certified clinical commentaries.

Your Thoughts
What studies across the spectrum of breast cancer will most likely have an impact on your practice the most? Join the conversation below!

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