European Society of Medical Oncology 2020
Every year the European Society of Medical Oncology (ESMO) hosts a multidisciplinary meeting in Europe, bringing together the world’s best cancer researchers to present on the latest in breast cancer research and treatments and to help design the next generation of clinical trials.
This year due to COVID-19 restrictions the meeting went virtual, with delegates logging on from all over the world to the ESMO 2020 Breast Cancer Virtual Meeting. ESMO 2020 is a congress designed for researchers and clinicians who have a specific interest in innovation (including translational research, new agents, molecular and functional diagnostics, biomarkers and cutting-edge research applications in the clinical setting) and care.
We have provided a summary of some of the key research presented at this year’s ESMO 2020.
Immunotherapy Benefit In Metastatic Breast Cancer
Two novel biomarkers (which are a way to measure what is happening in a cell or organism at any given moment) have been found to be connected with improved outcomes in those with metastatic breast cancer. It is hoped these biomarkers will help identify which patients will benefit most from immunotherapy treatments, according to exploratory studies reported at ESMO 2020.
Previous studies have shown that not every patient with metastatic breast cancer will benefit from immunotherapy treatments. Immunotherapy is a type of cancer treatment which aids the body’s immune system to fight cancer cells. Trials have focussed on patients with triple negative breast cancer and more recently HER2-positive breast cancer. However, these traditional biomarkers have not been specific enough.
To explore new potential biomarkers for immunotherapy in advanced breast cancer, researchers assessed the predictive value of copy number alteration (CNA) for the PDL1 gene (a biomarker), which measures whether the gene number has decreased, remained the same or increased. They measured CNA values in tumour tissue collected from 126 patients with metastatic breast cancer taking part in the SAFIR-IMMUNO study, the first randomised trial comparing immunotherapy using durvalumab, to maintenance chemotherapy in this setting.
The study found that nearly one in four patients had a copy gain or amplification of the PDL1 gene. This exploratory translational analysis suggested a higher efficacy of durvalumab as maintenance treatment for patients with PDL1 copy gain or amplification. Further research is needed, but the study authors suggest that this could help to identify metastatic patients that immunotherapy could benefit.
The second potential immunotherapy biomarker involved a different method of PD-L1 measurement, the combined positive score (CPS). This may also predict for increased benefit with immunotherapy.
Breast Cancer Trials currently has one immunotherapy trial open to metastatic breast cancer patients. You can read more about the DIAmOND clinical trial here.
The Drug Trastuzumab Deruxtecan Shows Promise For Metastatic HER-2 Positive Breast Cancer
Trastuzumab deruxtecan is a new type of drug called an antibody-drug conjugate, that combines a targeted therapy with a chemotherapy payload directed only at the cells that exhibit a specific signal, in this case, HER2. A trial using this drug has shown benefits in patients with HER-2 positive metastatic breast cancer who have already received previous treatments. In a study of 184 patients who had already undergone an average of six previous treatments, 60% of patients had a positive response to the drug, resulting in the average duration of progression free survival being around 16 months. This is impressive, because typically very few tumours would respond to treatment after so many other treatments have already failed.
While further study is required to confirm the efficiency of this drug in a larger patient population, this result is positive for those with metastatic HER-2 positive breast cancer.
Read the full study here.
Supportive Care and Physical Activity Underutilised To Help Cancer Related Fatigue
Cancer related fatigue is common for those who have received breast cancer treatment and can prevent patients from returning to life as they lived before their diagnosis. A study presented at ESMO 2020 has found that this fatigue may be due to early breast cancer patients not adhering to the recommended guidelines of physical activity.
The study found patients who reported severe levels of fatigue were less like than those with non-severe symptoms to have followed physical activity guidelines for cancer patients. The study’s authors said the take-away from these results is that patients need to be encouraged to stay active and understand that it is physical activity and not rest which will help them to overcome fatigue.
In the patient population studied, it was also found that the uptake of supportive services was low, with only one out of 10 women consulting a psychologist.
This study shows that the strategies patients adopt to help manage side effects like fatigue are strongly connected to the type and intensity of their fatigue. Ideally, people with a history of cancer should aim towards 30 minutes per day, five days per week of moderately strenuous physical activity (or more). This may require support from health professionals and accredited exercise physiologists. The authors state that even though physical activity has been proven to reduce cancer related fatigue, it needs to form part of a more holistic treatment plan that includes access to other support services like a psychologist.
You can read more about this study here.
You can read more about the importance of getting psychological help during your cancer diagnosis here.
Circulating Tumour DNA Is Emerging As An Important Aspect Of Breast Cancer Monitoring And Prediction
Circulating tumour DNA is found in the blood and refers to the DNA that comes from cancerous cells and tumours. As a cancer grows, cancer cells die and are replaced by new ones. The dead cells get broken down and their contents, including DNA, go into the bloodstream. These very small pieces of DNA are called circulating tumour DNA (ctDNA).
Circulating tumour DNA was identified at ESMO 2020 to be of increasing research interest. This is because circulating tumour DNA can be used in detecting and diagnosis a tumour, guiding tumour-specific treatment, monitoring treatment and monitoring patients in remission.
Breast Cancer Trials will open the CAPTURE clinical trial this year, which uses a blood test for circulating tumour DNA to detect if a patient has the PIKC3A gene mutation. This mutation occurs in 35-40% of oestrogen receptor positive (ER+) breast cancer and may make tumours more sensitive to treatments such as alpelisib that target the PI3K pathway. The study aims to find out if treatment with alpelisib plus fulvestrant increases survival without cancer progression compared to capecitabine in women and men with oestrogen receptor positive (ER+), HER2-negative advanced breast cancer who have a PIKC3A mutation identified in circulating tumour DNA (ctDNA).
Other Trial Results Presented At The ESMO Congress
- KATHERINE trial: post-neoadjuvant TDM-1 is effective, even if the tumour converts from HER2-positive at pre-therapy biopsy to HER2-negative at surgery.
- PALOMA-3: patients have prolonged progression-free survival on their next line of therapy after palbociclib and fulvestrant.
- Tumour infiltrating lymphocytes on tumour biopsy and immunoscore predict for pathological complete response in patients with operable breast cancer treated with neoadjuvant immunotherapy.
- Another mouthful – Ladiratuzumab Vedotin! This time an antibody drug conjugate (like TDM-1) for triple negative breast cancer (TNBC). This early phase trial demonstrated a 35% response rate in the overall trial population, and 69% in de novo metastatic TNBC.
- Window-of-opportunity trials, where patients are given a short duration (eg two weeks) of chemo- or endocrine therapy with serial biopsies, might be of increasing interest, as presented by an eminent cancer researcher at an educational session during the meeting.
- Tucatinib (HER2Climb) in heavily pre-treated metastatic HER2-positive breast cancer prolongs progression-free and overall survival even in the difficult to treat, poor prognosis group with brain metastases.