Stephanie L. Graff, MD, director of the Breast Program at the Sarah Cannon Cancer Institute at HCA Midwest Health, and associate director of the Breast Cancer Research Program at Sarah Cannon Research Institute, discusses patient factors used to consider the optimal treatment duration of tamoxifen in patients with breast cancer.

For patients with ductal carcinoma in situ (DCIS), there is not a well-defined treatment regimen to use based on clinical studies. In fact, recent clinical trials have randomized patients to receive either the standard 5 mg of tamoxifen or no tamoxifen. A rising treatment option in this setting has been the aromatase inhibitors, which have shown a slight survival advantage over tamoxifen.

Graff says that deciding the right approach for patients will be determined by age, side effects that they have on the medication, comorbidities, and the features of their DCIS. This includes the disease grade, how it was managed surgically, and whether or not radiation therapy was utilized. Researchers are taking all of these factors into consideration in order to formulate the best treatment strategy, Graff concludes.

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Stephanie L. Graff, MD, director of the Breast Program at the Sarah Cannon Cancer Institute of HCA Midwest Health, and associate director of the Breast Cancer Research Program at Sarah Cannon Research Institute, discusses patient factors used to consider optimal treatment duration of tamoxifen in patients with breast cancer.

Dr. Graff Discusses Optimal Dosing of Tamoxifen in Breast Cancer

Stephanie L. Graff, MD, director of the Breast Program at the Sarah Cannon Cancer Institute of HCA Midwest Health, and associate director of the Breast Cancer Research Program at Sarah Cannon Research Institute, discusses the use of tamoxifen in the treatment of patients with breast cancer.

At the 2018 San Antonio Breast Cancer Symposium, data were presented on the use of tamoxifen in women with ductal carcinoma in situ (DCIS) or higher-risk, precancerous lesions—such as lobular carcinoma in situ or atypical ductal hyperplasia, explains Graff. For the trial, investigators compared the benefit of 5 mg of tamoxifen versus no therapy in a preventive setting. Although the standard dose of tamoxifen is 20 mg, it has been associated with several severe adverse events, such as thromboembolic disease and uterine carcinoma, she notes.

Data showed that the 5 mg dose was beneficial to patients compared with no therapy, which suggests that de-escalation is possible in patients with stage 0 DCIS who may be concerned about adverse events or have poor tolerance, concludes Graff.

Dr. Graff on Tamoxifen De-Escalation in Breast Cancer

Stephanie L. Graff, MD, director, Breast Program, Sarah Cannon Cancer Institute, associate director, Breast Cancer Research Program, Sarah Cannon Research Institute, discusses novel therapies for patients with metastatic breast cancer.

CDK4/6 inhibitors are a mainstay in the treatment of patients with hormone receptor-positive metastatic breast cancer, says Graff. At the 2018 ASCO Annual Meeting, physicians saw updates in both frontline and second-line CDK4/6 inhibitors in premenopausal patients.

An FDA pooled analysis took women with metastatic estrogen receptor (ER)-positive breast cancer across all the CDK4/6 inhibitors and evaluated whether all the patient populations equally benefitted. The answer, notes Graff, was a resounding “yes.” Based on these data, CDK4/6 inhibitors should be used early in essentially all patients with ER-positive metastatic breast cancer.

Another topic that was discussed at the 2018 ASCO Annual Meeting was novel therapies for patients with HER2-positive metastatic breast cancer. There were also updates on therapeutic agents like niraparib (Zejula).

Dr. Graff on Novel Therapies in Metastatic Breast Cancer

Stephanie L. Graff, MD, director, Breast Program, Sarah Cannon Cancer Institute, associate director, Breast Cancer Research Program, Sarah Cannon Research Institute, discusses the use of sacituzumab govitecan (IMMU-132) in breast cancer.

At the 2018 ASCO Annual Meeting, Aditya Bardia, MD, MPH, of Massachusetts General Hospital, presented updated results on the use of sacituzumab govitecan in the metastatic hormone-receptor (HR)-positive setting. Bardia also presented updated results in the triple-negative space at the 2017 San Antonio Breast Cancer Symposium.

Sacituzumab govitecan has shown tremendous response rates in both groups, says Graff. Graff notes that the data presented by Bardia at the 2018 ASCO Annual Meeting in HR-positive patients are equally as compelling as the data seen in triple-negative breast cancer (TNBC). The maker of the antibody-drug conjugate is seeking an accelerated approval by the FDA. The phase III trial in metastatic TNBC is currently accruing.

The compound is likely to become a breakthrough drug, says Graff, and may be tool for physicians to use across multiple breast cancer subtypes in the clinic very soon.

Stephanie L. Graff, MD, FACP

Articles

Dr. Graff Discusses Optimal Dosing of Tamoxifen in Breast Cancer

Dr. Graff on Tamoxifen De-Escalation in Breast Cancer

Dr. Graff on Novel Therapies in Metastatic Breast Cancer

Dr. Graff on the Use of Sacituzumab Govitecan in Breast Cancer