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Systemic therapy for metastatic breast cancer
Annals of Oncology 30 (Supplement 6): vi61, 2019 doi:10.1093/annonc/mdz367
EDUCATIONAL LECTURE 25 : SYSTEMIC THERAPY FOR METASTATIC BREAST CANCER EL25
Systemic therapy for metastatic breast cancer
Toshimi Takano Department of Medical Oncology, Toranomon Hospital
C The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz367/5582942 by guest on 24 October 2019
For metastatic breast cancer (MBC), many drugs including chemotherapy, endocrine therapy, and molecular-targeted therapy have been widely used, and there remain many clinical questions on optimal use of these agents. In patients with HER2-positive MBC, anti-HER2 agents such as trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (T-DM1) are used, and trastuzumab þ pertuzumab þ taxane (HPT) for first-line treatment and T-DM1 for second-line treatment have been established as the standard of care by CLEOPATRA study and EMILIA study, respectively. New anti-HER2 agents such as neratinib, margetuximab, and antiHER2 antibody-drug conjugates (ADC) are under development. In patients with HER2-negative, estrogen receptor (ER)-positive MBC, many molecular-targeted agents such as CDK4/6 inhibitors, mTOR inhibitors, PI3K inhibitors, Akt inhibitors, and HDAC inhibitors are studied in combination with endocrine therapy.
Also in patients with triple negative breast cancer (TNBC), many promising agents are under development. Although TNBC is defined by the lack of expression of ER and HER2, from now on, we should not treat this subtype as "disease characterized by lack" but "disease characterized by gain". The third or more targets other than ER and HER2 have been suggested and many drugs designed to affect such targets have been studied. Immune checkpoint inhibitors and PARP inhibitors have been investigated mostly in TNBC. Among each subtype, several smaller subtypes have been identified and found to differentially respond to specific drugs. We must efficiently develop appropriate classification and treatment to establish "precision medicine". In this education lecture, I want to discuss current standard of care, perspectives of new drug development, and future direction of precision medicine.
EDUCATIONAL LECTURE 25 : SYSTEMIC THERAPY FOR METASTATIC BREAST CANCER EL25
Systemic therapy for metastatic breast cancer
Toshimi Takano Department of Medical Oncology, Toranomon Hospital
C The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz367/5582942 by guest on 24 October 2019
For metastatic breast cancer (MBC), many drugs including chemotherapy, endocrine therapy, and molecular-targeted therapy have been widely used, and there remain many clinical questions on optimal use of these agents. In patients with HER2-positive MBC, anti-HER2 agents such as trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (T-DM1) are used, and trastuzumab þ pertuzumab þ taxane (HPT) for first-line treatment and T-DM1 for second-line treatment have been established as the standard of care by CLEOPATRA study and EMILIA study, respectively. New anti-HER2 agents such as neratinib, margetuximab, and antiHER2 antibody-drug conjugates (ADC) are under development. In patients with HER2-negative, estrogen receptor (ER)-positive MBC, many molecular-targeted agents such as CDK4/6 inhibitors, mTOR inhibitors, PI3K inhibitors, Akt inhibitors, and HDAC inhibitors are studied in combination with endocrine therapy.
Also in patients with triple negative breast cancer (TNBC), many promising agents are under development. Although TNBC is defined by the lack of expression of ER and HER2, from now on, we should not treat this subtype as "disease characterized by lack" but "disease characterized by gain". The third or more targets other than ER and HER2 have been suggested and many drugs designed to affect such targets have been studied. Immune checkpoint inhibitors and PARP inhibitors have been investigated mostly in TNBC. Among each subtype, several smaller subtypes have been identified and found to differentially respond to specific drugs. We must efficiently develop appropriate classification and treatment to establish "precision medicine". In this education lecture, I want to discuss current standard of care, perspectives of new drug development, and future direction of precision medicine.