Hatem Soliman, MD, medical oncologist, The Center for Women’s Oncology, Moffitt Cancer Center, discusses the utility of antibody-drug conjugates (ADCs) in breast cancer.

ADCs offer a treatment platform that deliver toxic payloads precisely to tumor cells, Soliman explains. Moreover, ADCs are designed to allow active agents that are too toxic to be delivered intravenously or orally to be given with minimal toxicity. 




Notably, the efficacy of an ADC is based on the agent’s ability to deliver the toxic payload to the tumor cells while sparing normal tissue, says Soliman. Some ADCs may improve the therapeutic index while retaining good quality of life for patients. 




It is possible that a patient will develop resistance to an ADC as the tumor may become resistant to the toxic payload. Additionally, the tumor may downregulate the target that the antibodies attach to, Soliman says. 


However, research efforts are focused on identifying a variety of targets that are highly expressed by tumor cells but not by normal tissue, concludes Soliman.

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Hatem Soliman, MD, discusses the utility of antibody-drug conjugates in breast cancer.  



Dr. Soliman the Utility of ADCs in Breast Cancer 

Hatem Soliman, MD, medical oncologist, The Center for Women’s Oncology, Moffitt Cancer Center, discusses the rationale for using immunotherapy in triple-negative breast cancer (TNBC).

More aggressive subtypes of breast cancer can elicit tumor lymphocyte infiltration, says Soliman, making TNBC an ideal cancer for immunotherapy.

In contrast to immunologically “cold” tumors, inflamed tumors are good targets for checkpoint inhibitors, such as atezolizumab (Tecentriq) or pembrolizumab (Keytruda), Soliman explains. 

As such, TNBC has biologic rationale for immunotherapy. Moreover, clinical research has shown that TNBC appears to be more amenable to immunotherapy compared with hormone receptor–positive breast cancer. 

Immunotherapy should continue to be evaluated in the TNBC paradigm, concludes Soliman. 

Hatem Soliman, MD, discusses the rationale for using immunotherapy in triple-negative breast cancer. 



Dr. Soliman on the Rationale for Using Immunotherapy in TNBC 

Hatem Soliman, MD, medical oncologist, The Center for Women’s Oncology, Moffitt Cancer Center, discusses the use of combination therapies in the treatment of patients with breast cancer.

Immunotherapy agents, specifically checkpoint inhibitors, has received the most focus because that is where the most development has occurred. These agents have been run through early phase trials, and some of these agents are in phase III registration studies as well, states Soliman.

Physicians also want to look at future combinations and strategies using other checkpoint inhibitors or immunomodulatory drugs, such as LAG-3 agents, which appear to be showing some potential promise in combination with other checkpoint treatments. The use of oncolytic therapy is also being explored in a clinical trial at Moffitt Cancer Center, says Soliman.

Dr. Soliman on Investigational Combination Therapies in Patients With Breast Cancer

Hatem Soliman, MD, associate member of The Center for Women’s Oncology at the Moffitt Cancer Center discusses the prospective registry IMPACt study, which measured the impact of the MammaPrint 70-gene Breast Cancer Recurrence Assay in the routine management of women with early-stage breast cancer.

The intent of the trial was to gauge how the results given by MammaPrint were changing the treatment recommendation for patients. MammaPrint tests the tissue of patients to determine whether they are high risk or low risk through a high or low score, which is interpreted by physicians in coordination with treatment options.

Patients who participated in the study were predominately hormone receptor (HR)-positive, HER2-negative. Those who were eligible and consented to a tissue test would receive a result of either a high Mammaprint score or a low Mammaprint score.

Physicians were surveyed prior to the test to see what their recommended treatment option was for a their respective patients, as well as their decision-making process on whether or not to administer chemotherapy.

After the test was complete, results were given to the physician to discuss with the patients. That discussion and ultimate decision would be recorded to see whether or not there was a change in recommendations of treatment for the patients.

There was a significant proportion of patients who were recommended chemotherapy by their physicians prior to the test, but after the MammaPrint results were discussed, those who received a low MammaPrint score were recommended to receive endocrine therapy if they were HR-positive. Conversely, those who were not intially recommended chemotherapy and received a high MammaPrint score were then recommended to have adjuvant chemotherapy.

Currently, researchers are looking at MammaPrint in smaller subsets, such as those with patients with small tumors that are triple-negative or HER2-positive, as well.

Hatem Soliman, MD

Articles

Dr. Soliman the Utility of ADCs in Breast Cancer

Dr. Soliman on the Rationale for Using Immunotherapy in TNBC

Dr. Soliman on Investigational Combination Therapies in Patients With Breast Cancer

Dr. Soliman on Impact of MammaPrint in Patients With Early-Stage Breast Cancer