Banu Arun, MD, professor in the Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses immunogenicity in triple-negative breast cancer (TNBC).

Immunotherapy is very interesting and very complicated, explains Arun. It has garnered a lot of excitement in the field of TNBC. The first studies with PD-1 and PD-L1 inhibitors such as the KEYNOTE-012 trial showed very promising results with an 18% response rate. However, the subsequent KEYNOTE-086 study showed only a 4.7% response rate.

It is clear that single-agent immunotherapy is not the path forward, explains Arun. Physicians have to determine the right subgroup and the right combinations. There are many ongoing studies with combinations, either with chemotherapy or other targeted agents, including PARP inhibitors, says Arun.

Trials that use biomarkers to help physicians identify which subgroup will benefit most will be of the utmost importance, says Arun. Currently, physicians are still putting patients with a very heterogeneous group of cancers in the same bucket and trying to understand the results.

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Dr. Arun on Immunogenicity in Triple-Negative Breast Cancer

Banu Arun, MD, professor in the Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses biosimilars in the context of global cancer care.

There are pros and cons to the use of biosimilars, explains Arun. Some of the studies that were reported at the 2018 ASCO Annual Meeting looked very promising. However, it is important to consider biosimilars in the context of global cancer care as well, says Arun.

Biosimilars are enabling physicians all over the world to treat their patients with these agents. Targeted agents are very expensive, explains Arun, and it is very disheartening for both physicians and patients alike to forego treatment because of lack of access. For example, when trastuzumab (Herceptin) became available, many countries did not have access to it. Biosimilars will therefore be very important in bridging this gap, explains Arun.

Dr. Arun Considers Biosimilars in the Context of Global Cancer Care

Banu Arun, MD, professor in the Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses ongoing research in triple-negative breast cancer (TNBC).

TNBC is a very heterogeneous disease. The disease can be broken down into multiple subtypes and can most likely be targeted with multiple agents that target different pathways, says Arun. Physicians are pretty confident that a single agent will not be enough to treat the disease, unless they can identify a very specific pathway that is involved in the proliferation of that subtype.

Physicians have yet to reach that conclusion, says Arun, and as there are no existing biomarkers of response, research continues to investigate different therapeutic agents. Physicians are now starting to explore targeted therapies with immunotherapy and immunomodulation as well as targeting the PI3K/mTOR/AKT pathway. There are some antibody-drug conjugates under development as well.

Another approach is to target the androgen receptor in TNBC, though none of these approaches are standard of care, notes Arun.

Banu Arun, MD, professor in the Department of Breast Medical Oncology, Division of Cancer Medicine and Department of Clinical Cancer Prevention, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, discusses ongoing research in triple-negative breast cancer (TNBC).

Banu Arun, MD

Articles

Dr. Arun on Immunogenicity in Triple-Negative Breast Cancer

Dr. Arun Considers Biosimilars in the Context of Global Cancer Care

Dr. Arun on Ongoing Research in Triple-Negative Breast Cancer