2) We continue to highlight the San Antonio Breast Cancer Symposium (#SABCS21), with more expert commentary for OUR #tweetorial followers! Our content authority is Hal Burstein MD (@drhburstein) from @DanaFarber Cancer Institute & @HarvardMed.
— @onc_ce (@onc_ce) January 5, 2022
4) @SABCSSanAntonio is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #breastcancer. #SABCS21 was a hybrid meeting this year, with many renowned researchers welcoming the opportunity to collaborate FTF!
— @onc_ce (@onc_ce) January 5, 2022
6) CDK4/6 inhibitors are approved for use in first line (with AIs) or in second line with the SERD fulvestrant. But how well do these drugs work in different subtypes of advanced, ER+ breast cancer?
— @onc_ce (@onc_ce) January 5, 2022
8) For a long time, there was some nihilism that we couldn't improve OS in ER+ advanced #breastcancer; there were too many possible lines of therapy. Recent updates have proven that is not the case! In fact, they suggest OS should be expected as a primary outcome for new agents.
— @onc_ce (@onc_ce) January 5, 2022
10) . . . and look to last longer/emerge later. Suggests CDK4/6i exposure truly shifts growth patterns of sensitive, ER+ tumors. pic.twitter.com/C137jMLr8i
— @onc_ce (@onc_ce) January 5, 2022
12) Implications? For tumors that are ER+ & BRCA2 associated, go with PARPi before CDK4/6i? Not really known, clinically. And maybe in adjuvant setting, for ER+ and BRCA2+, would opt for PARPi instead of CDK4/6i in higher risk cases . . .
— @onc_ce (@onc_ce) January 5, 2022
14) With success of CDK4/6i treatment, new cyclin-dependent kinase inhibitors are emerging. CT7001/samuraciclib is a CDK7 inhibitor. In combo with fulvestrant, it shows RR of 12% in pts with prior CDK4/6i treatment. Side effect profile differs in important ways from CDK4/6i… pic.twitter.com/zORXywMK34
— @onc_ce (@onc_ce) January 5, 2022
16) Genomic sequencing of ER+ MBC on liquid biopsy helps stratify patients. In BioltaLEE study from @BianchiniGP, all patients received let + ribo. Those tumors w/ no targeted mutations had better PFS than those with genomic mutations. pic.twitter.com/aboLIAbAhI
— @onc_ce (@onc_ce) January 5, 2022
18) Activating mutations in ER (ESR1m) are commonly found after AI treatment & on tumor progression. Presumably, they account for resistance to AI therapy as the ER is ‘on’ even in the absence of estrogen.
— @onc_ce (@onc_ce) January 5, 2022
20) Mark you answer and come back tomorrow for the remainder of this look at 🔑data from #SABCS21, along with your link to FREE CE/#CME! Nods to @erikahamilton9 @hoperugo @teamoncology @ElisaAgostinett @prat_aleix @StoverLab @drteplinsky @OncBrothers @MridulaGeorgeMD @jesusanampa
— @onc_ce (@onc_ce) January 5, 2022
22) Now that ESR1m can be identified on liquid biopsies, a question is whether early identification of ESR1m could prompt a change in therapy that would be clinically advantageous. The PADA-1 trial from @institut_curie set out to test that hypothesis. pic.twitter.com/oMCob3b2JO
— @onc_ce (@onc_ce) January 6, 2022
24) . . . to ongoing AI/palbo vs switching to fulvestrant/palbo. Switching led to longer PFS (12M vs 6M median). But … pic.twitter.com/vf9FzlujYV
— @onc_ce (@onc_ce) January 6, 2022
26) Finally, we saw the first phase 3 data for a new class of anti-estrogen targeting drugs, called selective estrogen receptor degraders (SERDs) (https://t.co/0Cs01K6ni6). (Figure from https://t.co/fb6SeSsNEz) pic.twitter.com/xvzrjcZDJQ
— @onc_ce (@onc_ce) January 6, 2022
28) The EMERALD study (@dradityabardia) compared the SERD, elecestrant, against standard of care (SOC) endocrine treatments in a cohort of patients with ER+ MBC and prior ET+CDK4/6i therapy. Nearly all patients had prior AI treatment. SOC options included AI or fulvestrant. pic.twitter.com/phOLo680uX
— @onc_ce (@onc_ce) January 6, 2022
30) Important to note that about half of the tumors are endocrine resistant and progress right away (red circle). Then the curves begin to diverge a bit favoring elecestrant, including a robust tail. pic.twitter.com/qzoyYm3Lgs
— @onc_ce (@onc_ce) January 6, 2022
32) What do you know?
— @onc_ce (@onc_ce) January 6, 2022
Side effects of the first oral SERD, elecestrant, include:
VOTE before you scroll down!
34) One possible lesson of EMERALD is that median PFS may not be the best endpoint for endocrine refractory ER+ cancers. It might be more clinically meaningful to focus on rates of 6M or 12M PFS, given that half the cancers progress right away. @tmprowell @FDAoncology
— @onc_ce (@onc_ce) January 6, 2022
35) SO there you have it–a quick review of data from #SABCS21 on ER positive breast cancer, advanced stage. You've just earned 0.5h CE/#CME! Go to https://t.co/ml5gmGoGmq to claim it! I am @drhburstein and I hope you will FOLLOW US for more expert-authored programs!
— @onc_ce (@onc_ce) January 6, 2022