Howard "Skip" A. Burris, III, MD, chief medical officer, Sarah Cannon Research Institute, 2019 ASCO president-elect, and a 2014 Giant of Cancer Care

 in Drug Development, discusses the impact of molecular profiling in breast cancer.

Determining the role of next-generation sequencing (NGS) and molecular profiling in the management of patients with breast cancer in practice is of great debate. Burris says that he surveyed community oncologists at Sarah Cannon Research Institute and the resounding response was that they would want to better understand the molecular profile of a resistant tumor. With that being said, how to handle the data associated with this is a challenge, Burris notes.

For patients with relapsed or recurrent breast cancer, NGS should be part of the standard treatment decision-making process, says Burris; this not only increases the chances that these patients could get enrolled in a relevant clinical trial, but it also necessary for the field as a whole. The more patients with resistant and recurrent disease who undergo molecular profiling, the better physicians will be able to understand where to utilize certain drugs.

For example, researchers are seeing increasing evidence to suggest that high tumor mutational burden and microsatellite instability-high may be associated with higher chance of response to checkpoint inhibitors. While this needs to be confirmed in clinical trials, NGS can at least identify these patients and point them toward the right trial for them.

Videos

Howard "Skip" A. Burris, III, MD, chief medical officer, Sarah Cannon Research Institute, 2019 ASCO president-elect, and a 2014 Giant of Cancer Care® in Drug Development, discusses the impact of molecular profiling in breast cancer.

Dr. Burris on Molecular Profiling in Breast Cancer

Howard “Skip” A. Burris, III, MD, chief medical officer, Sarah Cannon Research Institute, and a 2014 Giant of Cancer Care® in Drug Development, discusses the promise of ado-trastuzumab emtansine (T-DM1; Kadcyla) in the treatment of patients with HER2-positive breast cancer.

For many years, investigators have liked the concept of T-DM1, Burris says. Traditionally, the antibody-drug conjugate (ADC) was used palliatively while data in the adjuvant and neoadjuvant setting continued to accrue. Now, based on data from the phase III KATHERINE trial presented at the 2018 San Antonio Breast Cancer Symposium, the role of T-DM1 has become practice-changing, he says.

Burris says that it makes sense to give additional chemotherapy in the neoadjuvant setting and it makes sense to give trastuzumab-based therapy. Results showed that substituting T-DM1 for adjuvant trastuzumab (Herceptin) in patients who had residual disease after receiving neoadjuvant chemotherapy reduced the risk of invasive disease recurrence or death by 50% compared with standard trastuzumab in patients with early-stage HER2-positive breast cancer. Three-year invasive-disease survival rate was 88.3% with the ADC versus 77.0% with the HER2-targeted agent. Burris feels that this therapy will be quickly adopted and yield greater patient outcomes.

Howard “Skip” A. Burris, III, MD, chief medical officer, Sarah Cannon Research Institute, and a 2014 Giant of Cancer Care® in Drug Development, discusses the promise of T-DM1 in the treatment of patients with HER2-positive breast cancer.

Howard "Skip" Burris, III, MD

Articles

Dr. Burris on Molecular Profiling in Breast Cancer

Dr. Burris Discusses Promise of T-DM1 in HER2+ Breast Cancer