  Kelly E. McCann, MD, PhD, discusses her experiences and challenges navigating work-life balance as a woman in oncology.

Dr McCann on Navigating Work-Life Balance As a Woman in Oncology

Kelly E. McCann, MD, PhD, breast medical oncologist, assistant clinical professor, medicine, UCLA Health David Geffen School of Medicine, UCLA Health, discusses her experiences and challenges navigating work-life balance as a woman in oncology, and the importance of mentorship programs and support networks for those in oncology care.

McCann begins by acknowledging the challenges of maintaining a work-life balance in her own demanding career. She notes that she does not currently have a partner or children, and does not have to worry about this aspect of work-life balance as a result. Recognizing the need for boundaries, McCann is working to set some limits with patients to create more balance. McCannemphasizes that delegating tasks to a trusted support staff can allow oncologists to create these boundaries while still supporting their patients and ensuring they have access to comprehensive care.

McCann goes on to emphasize the importance of mentorship for professional development, as observing how other people balance their lives is crucial for navigating the complexities of their own careers effectively. Medicine, with its apprenticeship model, offers opportunities for mentorship, but seeking out mentors who can provide guidance in different aspects of life is essential. McCann acknowledges that finding the right mentors can be challenging, and believes in the value of diverse perspectives.

McCann reflects that there are often institutionally supported mentorship programs in medicine, particularly for women in oncology, and emphasizes the need for proactive engagement in seeking mentorship from many different people throughout one's career. It may also need to be tailored to individual needs or directed towards those from underrepresented groups. She also adds that good mentorship allows women in oncology to become better leaders and mentors themselves going forward.

Overall, many women in oncology face unique challenges in balancing work and personal life, and mentorship programs specifically designed to address these challenges can be beneficial, McCann states. Ultimately, a proactive effort in seeking mentorship, setting boundaries, and building a support network can help ensure professional and personal success for women in oncology, she concludes.

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Kelly E. McCann, MD, PhD, discusses her experiences with mentorship and work-life balance as a woman in oncology.

Experts in breast cancer discuss precision medicine in treatment of patients with metastatic triple negative breast cancer.

Data from the following clinical trials are discussed:

KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. (Cortes J et al. 2020 ASCO annual meeting. Abstract 1000.)

TBCRC 048: A phase II study of olaparib monotherapy in metastatic breast cancer patients with germline or somatic mutations in DNA damage response pathway genes (Olaparib Expanded). (Tung NM et al. 2020 ASCO annual meeting. Abstract 1002.)

Results of a phase II randomized trial of cisplatin +/- veliparib in metastatic triple-negative breast cancer and/or germline 

-associated breast cancer (SWOG S1416). (Sharma P et al. 2020 ASCO annual meeting. Abstract 1001.)

Veliparib plus carboplatin-paclitaxel in patients with HER2-negative advanced/metastatic gBRCA-associated breast cancer: Results in hormone receptor-positive and triple-negative breast cancer subgroups from the phase III BROCADE3 trial. (Ayoub J et al. 2020 ESMO Breast Cancer annual meeting. Abstract 140O.)

Final results of the double-blind placebo-controlled randomized phase II LOTUS trial of first-line ipatasertib + paclitaxel for inoperable locally advanced/metastatic triple-negative breast cancer. (Dent R et al. 2020 ESMO Breast Cancer annual meeting. Abstract 139O.)

Precision Medicine in Metastatic Triple Negative Breast Cancer

KOLs in breast cancer provide insights on de-escalation of adjuvant anti-HER2 therapy and need for HER2 testing of residual disease after neoadjuvant therapy.

Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2-blockade for HER2-positive breast cancer (TRAIN-2): A randomized phase III trial. (van der Voort A et al. 2020 ASCO annual meeting. Abstract 501.)

Primary analysis of KAITLIN: A phase III study of trastuzumab emtansine (T-DM1) + pertuzumab versus trastuzumab + pertuzumab + taxane, after anthracyclines as adjuvant therapy for high-risk HER2-positive early breast cancer. (Harbeck N et al. 2020 ASCO annual meeting. Abstract 500.)

Adjuvant trastuzumab emtansine (T-DM1) vs trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2+ breast cancer: Subgroup analysis from KATHERINE. (Loibl S et al. 2020 ESMO Breast Cancer annual meeting. Abstract 96O.)

HER2+ Early-Stage Breast Cancer: Peri-Operative Therapy

Breast cancer experts review recently approved treatment options for relapsed or refractory HER2+ MBC, their intracranial efficacy, and sequencing of therapies.

Tucatinib, trastuzumab, and capecitabine for HER2-positive metastatic breast cancer: HER2CLIMB. (Murthy RK et al. 

Trastuzumab deruxtecan in previously treated HER2-positive breast cancer: DESTINY-Breast01. (Modi S et al. 

Neratinib plus capecitabine versus lapatinib plus capecitabine in HER2+ metastatic breast cancer previously treated with ≥ 2 HER2-directed regimens: phase III NALA trial. (Saura C et al. 

Tucatinib versus placebo added to trastuzumab and capecitabine for patients with previously treated HER2+ metastatic breast cancer with brain metastases: HER2CLIMB. (Lin NU et al. 2020 ASCO annual meeting. Abstract 1005.)

CNS metastases in HER2-positive metastatic breast cancer treated with trastuzumab deruxtecan: DESTINY-Breast01 subgroup analyses. (Jerusalem G et al. 2020 ESMO Breast Cancer annual meeting. Abstract 138O.)

Impact of neratinib on development and progression of central nervous system metastases in patients with HER2-positive metastatic breast cancer: Findings from the NALA, NEfERT-T, and TBCRC 022 trials. (Awada A et al. 2019 SABCS. Poster P2-20-01.)

Trastuzumab deruxtecan vs investigator's choice for HER2-low breast cancer that has spread or cannot be surgically removed: DESTINY-Breast04. (NCT03734029. Updated October 6, 2020. https://clinicaltrials.gov/ct2/show/NCT03734029)

Metastatic HER2+ Breast Cancer

Sarah Sammons, MD, and Julie Collins, MD, discuss the study details of the PARSIFAL and BYLieve trials in patients with metastatic HR+ breast cancer.

PARSIFAL: A randomized, multicenter, open-label, phase II trial to evaluate palbociclib in combination with fulvestrant or letrozole in endocrine-sensitive patients with ER[+]/HER2[-] metastatic breast cancer. (Llombart-Cussac A et al. 2020 ASCO annual meeting. Abstract 1007.)

Alpelisib + fulvestrant in patients with 

-mutated HR+/HER2- advanced breast cancer previously treated with CDK4/6 inhibitor + aromatase inhibitor: BYLieve study results. (Rugo HS et al. 2020 ASCO annual meeting. Abstract 1006.)

Metastatic HR+ Breast Cancer

Kelly McCann, MD, PhD, a medical oncologist in the Breast Cancer Research Group at the University of California, Los Angeles, discusses resistance mutations in ovarian cancer.

Physicians know that patients with germline 

 mutations can get reversion mutations, regain the ability to perform homologous recombination and become resistant to PARP inhibitors. That is 1 mechanism of resistance, but there are other mechanisms of resistance that have been identified, explains McCann such as efflux pumps that pump the drug back out of the cell.

There is some interest in using PI3K inhibitors in these patients because activation of and increased signaling in that pathway may contribute to PARP inhibitor resistance, says McCann. PI3K is activated in many cancers because cell proliferation is increased. It may also be involved in angiogenic pathways, McCann adds.

Therefore, many clinical trials are trying to use PARP inhibitors and target the PI3K pathway simultaneously, so that they can be used longer in the patients who benefit from the treatment, states McCann.

Dr. McCann on Resistance Mutations in Ovarian Cancer

Kelly McCann, MD, PhD, a medical oncologist in the Breast Cancer Research Group at the University of California, Los Angeles, discusses ongoing research in the field of HER2-positive breast cancer.

In addition to a lot of the escalation therapies such as pertuzumab (Perjeta) plus trastuzumab (Herceptin) in the adjuvant setting, and adding neratinib (Nerlynx) to long-term chemotherapy plus 1 year of trastuzumab, physicians are also looking at de-escalation therapies for tumors that are much smaller. These include trials with just a taxane plus trastuzumab with or without pertuzumab. Those have been promising, but long-term overall survival and disease-free survival has not been released yet. Therefore, physicians cannot make conclusions about that, says McCann.

For very small tumors—less than 1 cm&mdash;some physicians are starting to use a taxane plus trastuzumab for node-negative patients, says McCann. However, physicians know that these tumors have a chance to recur, so not doing any therapy at all is ill advised. Physicians also know that trastuzumab alone is not as potent and efficacious as trastuzumab plus chemotherapy.

Dr. McCann on Ongoing Research in HER2-Positive Breast Cancer

Kelly McCann, MD, PhD, a medical oncologist in the Breast Cancer Research Group at the University of California, Los Angeles, discusses the current prognosis for patients with HER2-positive breast cancer.

HER2-positive breast cancer used to have the worst prognosis, and now it has one of the best prognoses in terms of breast cancers. That’s largely because physicians have learned how to deal with HER2-positive cancers.

The field is currently divided into 3 major types of breast cancers, which are hormone receptor (HR)-positive/HER2-negative, HER2-positive, and triple-negative breast cancer. A large part of physician’s success in treating HER2-positive breast cancers is in developing targeted therapies to the HER2-receptor, says McCann. These include trastuzumab (Herceptin), pertuzumab (Perjeta), neratinib (Nerlynx), and lapatinib (Tykerb).

HR-positive/HER2-positive cancers and HR-negative/HER2-positive cancers have very different biologies. This has been recognized in many clinical trials. Physicians are starting to realize that HR-positive/HER2-positive cancers—even though they don’t have a high rate of pathologic complete response&mdash;have better overall outcomes than HR-negative/HER2-positive cancers. In the future, they may be treated differently in more ways than just adding in endocrine therapy, says McCann.

Dr. McCann on Prognosis for Patients With HER2-Positive Breast Cancer

Kelly McCann, MD, PhD, a medical oncologist in the Breast Cancer Research Group at the University of California, Los Angeles, discusses combination trials of PARP inhibitors in patients with ovarian cancer.

PARP inhibitors seem to work best in the BRCA1/2 population, but they can also work in any patient who has homologous recombination repair deficiency. Homologous recombination is a type of DNA repair that repairs DNA double strand breaks. Clinical trials have tried to look at combining PARP inhibitors with chemotherapy. When they are combined, McCann states that they both tend to have myelosuppressive toxicities, giving patients anemia, thrombocytopenia, and neutropenia.

Most of these trials, McCann states, have started at full dose chemotherapy and escalated the PARP inhibitor. Many of these trials have not given patients the full therapeutic dose. Therefore, other combination strategies that don’t have overlapping toxicities have been explored. These include combinations with angiogenesis inhibitors that can induce a BRCA-like state in the cells. Bevacizumab (Avastin) and cediranib are 2 such agents that are currently in ongoing trials.

Kelly McCann, MD, PhD, a medical oncologist in the Breast Cancer Research Group at the University of California, Los Angeles, discusses combination clinical trials of PARP inhibitors in patients with ovarian cancer.

Kelly McCann, MD, PhD, Ronald Reagan UCLA Medical Center

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