Leading expert in breast cancer precision medicine, Dr. Giuseppe Curigliano, MD, explains how new targeted therapies and genomic tests are transforming early-stage treatment. He details the significant survival benefits of adding immunotherapy to chemotherapy for triple-negative breast cancer and identifies which patient groups can now safely avoid chemotherapy altogether based on genomic test results like Oncotype DX.
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Precision Medicine in Early Breast Cancer: Targeted Therapy and Chemotherapy Avoidance
Jump To Section
- Immunotherapy for Triple-Negative Breast Cancer
- Who Can Avoid Chemotherapy?
- Role of Genomic Tests Like Oncotype DX
- Treatment for Premenopausal Patients
- When to Use Extensive Genetic Testing
- NGS Testing and Clinical Trial Access
Immunotherapy for Triple-Negative Breast Cancer
Dr. Giuseppe Curigliano, MD, highlights immune checkpoint inhibitors as a pivotal advancement in early breast cancer treatment. He references the KEYNOTE-522 clinical trial, a prospective randomized study that evaluated pembrolizumab in early triple-negative breast cancer.
The addition of pembrolizumab to standard chemotherapy significantly improved pathological complete response rates. Most importantly, Dr. Giuseppe Curigliano, MD, notes it improved invasive disease-free survival and showed a positive trend in overall survival for these patients.
Who Can Avoid Chemotherapy?
A major focus of precision medicine is identifying patients for whom chemotherapy-free treatment is a safe and effective option. Dr. Giuseppe Curigliano, MD, confirms that several genomic tests now enable this personalized approach.
He explains that these tests can accurately select a large population of breast cancer patients who can avoid chemotherapy in the early-stage setting, fundamentally changing their treatment experience and reducing side effects.
Role of Genomic Tests Like Oncotype DX
Dr. Curigliano specifically details the use of the Oncotype DX Recurrence Score test. He states that a postmenopausal woman with estrogen receptor-positive, HER2/neu-negative breast cancer can safely avoid chemotherapy with a low or intermediate risk score.
This holds true even for patients with cancer involvement in one to three lymph nodes, expanding the number of individuals eligible for less intensive treatment regimens.
Treatment for Premenopausal Patients
Dr. Anton Titov, MD inquires about chemotherapy avoidance specifically in premenopausal patients. Dr. Giuseppe Curigliano, MD, acknowledges that the data is not as robust as for postmenopausal women.
However, he is confident that some premenopausal breast cancer patients with low recurrence scores can also avoid chemotherapy. For these individuals, endocrine therapy alone can be a sufficient treatment strategy.
When to Use Extensive Genetic Testing
The conversation with Dr. Anton Titov, MD turns to the role of more extensive genomic sequencing panels, such as Tempus xT or Foundation Medicine. Dr. Curigliano provides clear guidance on their application.
He emphasizes that in the context of a new, early breast cancer diagnosis, the routine use of these large panels is not standard. Their utility is more specialized and targeted to specific clinical scenarios.
NGS Testing and Clinical Trial Access
Dr. Giuseppe Curigliano, MD, clarifies the primary indication for next-generation sequencing (NGS) panels. He states that in metastatic breast cancer, these tests should be reserved for patients who are candidates for clinical trials.
At a comprehensive cancer center like the European Institute of Oncology in Milano, Dr. Curigliano advocates offering NGS to all metastatic breast cancer patients who are potential candidates for clinical trials, thereby unlocking access to novel, targeted therapies.
Full Transcript
Dr. Anton Titov, MD: A new diagnosis of breast cancer presents the patient with serious clinical decisions to make. Early-stage breast cancer treatment in the precision medicine era, as you mentioned, evolves all the time. New targeted therapies for early-stage breast cancer treatment go through many clinical trials. What is new in customizing the cancer treatment for patients with early breast cancer?
Dr. Giuseppe Curigliano, MD: I believe the most important data involves immune checkpoint inhibitors. Recently, we had the opportunity to review the data from KEYNOTE-522. That is a prospective randomized clinical trial. It evaluated the role of pembrolizumab in early triple-negative breast cancer.
The addition of pembrolizumab to standard chemotherapy improved the rate of pathological complete response. But most importantly, pembrolizumab improved the rate of invasive disease-free survival, with a positive trend in overall survival. So using immune checkpoint inhibitors, both in the neoadjuvant and adjuvant setting for early triple-negative breast cancer, may potentially improve overall survival in this patient population.
Dr. Anton Titov, MD: In what situations might patients with early breast cancer avoid chemotherapy altogether? Is there such a chemotherapy-free breast cancer treatment scenario available now? Will it be available shortly for some patients?
Dr. Giuseppe Curigliano, MD: This is a very good question. We have several genomic tests, like Recurrence Score or MammaPrint. They can really select those patients who can avoid chemotherapy. Let us go into the details specifically.
You may be a postmenopausal woman with estrogen receptor-positive and HER2/neu-negative breast cancer. You perform an Oncotype DX Recurrence Score test. If you have an intermediate-risk score or a low-risk score, you can for sure avoid chemotherapy even if you have cancer involvement in one to three lymph nodes.
So this is a large population of breast cancer patients who, in the early breast cancer setting, can really avoid chemotherapy.
Dr. Anton Titov, MD: Is there anybody in the premenopausal women patients who might avoid chemotherapy altogether?
Dr. Giuseppe Curigliano, MD: This is a very good question. For premenopausal patients with breast cancer, we don't have exactly the same results as in the postmenopausal breast cancer setting. But I am quite sure that some breast cancer patients with low recurrence scores may for sure avoid chemotherapy. They can receive endocrine therapy alone for breast cancer.
Dr. Anton Titov, MD: There is more and more use of extensive genomic sequencing. For example, Tempus xT panel and Foundation Medicine panels are available. How often do you recommend to your patients to have more extensive genetic testing in the setting of a new breast cancer diagnosis?
Dr. Giuseppe Curigliano, MD: In the context of metastatic breast cancer, the use of those genomic panels should be reserved for patients who are candidates to participate in clinical trials. So, in my opinion, in a comprehensive cancer center like mine, the European Institute of Oncology of Milano, we should offer NGS for all metastatic breast cancer patients who are potential candidates for clinical trials.