Paul Kelly Marcom, MD, a professor of medicine at Duke University School of Medicine and member of Duke Cancer Institute, discusses the use of liquid biopsies in breast cancer treatment.

Marcom does not feel as comfortable using liquid biopsies as he does tissue biopsies, even with assay metrics such as allele frequency. Despite Marcom’s discomfort with liquid biopsies, the SOLAR-1 trial highlighted a signal via cell-free DNA.

The degree of understanding and trust in liquid biopsy technology, according to Marcom, is 5 years behind next-generation sequencing from solid tumors. Currently, physicians can get a positive predictor out of finding a mutation using a liquid biopsy — if it is found. Physicians must be careful about excluding mutations, but the community is starting to gain confidence in the utility of these assays, Marcom concludes.

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Paul Kelly Marcom, MD, discusses the use of liquid biopsies in breast cancer treatment.

Dr. Marcom on Liquid Biopsies in Breast Cancer

Paul Kelly Marcom, MD, associate professor of Medicine, Duke University School of Medicine, Duke Cancer Institute, discusses the FDA approval of ribociclib (LEE011) for use in combination with letrozole as a frontline therapy for patients with hormone-receptor (HR)—positive, HER2-negative advanced breast cancer.

Paul Kelly Marcom, MD, associate professor of Medicine, Duke University School of Medicine, Duke Cancer Institute, discusses the FDA approval of ribociclib (LEE011) for use in combination with letrozole as a frontline therapy for patients with hormone-receptor (HR)–positive, HER2-negative advanced breast cancer.

Dr. Kelly on the FDA Approval of Ribociclib in HR+ Breast Cancer

Paul Kelly Marcom, MD, associate professor of Medicine, Duke University School of Medicine, Duke Cancer Institute, discusses the impact that the FALCON trial findings have had on the field of hormone receptor (HR)-positive breast cancer.

In the phase III FALCON trial, first-line treatment with fulvestrant (Faslodex) led to significantly better progression-free survival (PFS) versus anastrozole (Arimidex) for patients with HR-positive advanced breast cancer. Results showed that there was a median PFS of 16.6 months with fulvestrant versus 13.8 months with anastrozole. A consistent advantage favoring fulvestrant also emerged from a subgroup analysis. The overall advantage appeared to be driven by a substantial difference in PFS among patients without visceral metastases treated with fulvestrant.

What is fascinating about the FALCON trial, Marcom explains, is that it was a bold attempt to identify patients who are completely endocrine-naïve. These are patients who never received adjuvant endocrine therapy and went on to develop metastatic disease, or never received adjuvant endocrine therapy for another reason.

Additional correlative work will come out in the ensuing years, especially to understand the issues of de novo endocrine resistance versus secondary endocrine resistance, Marcom says. It could be practice changing to have standard frontline therapy include fulvestrant versus an aromatase inhibitor.

Selective estrogen receptor downregulators, he adds, will likely be the go-to agent in combinations with the appropriate targeted therapy.

Paul Kelly Marcom, MD, associate professor of Medicine, Duke University School of Medicine, Duke Cancer Institute, discusses the impact that the FALCON trial findings have had on the field of hormone receptor-positive breast cancer.

Dr. Marcom on Impact of FALCON Trial on HR+ Breast Cancer

Paul Kelly Marcom, MD, associate professor of Medicine, Duke University School of Medicine, Duke Cancer Institute, discusses how the field of hormone receptor (HR)-positive breast cancer has evolved in an interview during the 2016 

 State of the Science Summit on Metastatic Breast Cancer.

This has clearly been an area that has exploded over the last 5 years due to the developments of targeted therapies in combination with standard endocrine therapy, which has been translated into significant clinical benefit for patients, Marcom explains. The approval of everolimus (Afinitor) marked a step forward in the disease; however, with developments of CDK 4/6 inhibitors, such as palbociclib (Ibrance), there has been even more improved outcomes.

These advancements point to a different part of the biology of breast cancer, he adds. Next steps will involve exploring unique combinations and researching how to sequence them, he adds.

Paul Kelly Marcom, MD, associate professor of Medicine, Duke University School of Medicine, Duke Cancer Institute, discusses how the field of hormone receptor (HR)-positive breast cancer has evolved.

Paul Kelly Marcom, MD

Articles

Dr. Marcom on Liquid Biopsies in Breast Cancer

Dr. Kelly on the FDA Approval of Ribociclib in HR+ Breast Cancer

Dr. Marcom on Impact of FALCON Trial on HR+ Breast Cancer

Dr. Marcom Reflects on Field of HR+ Breast Cancer