In The Know: Analyst answers — The latest in breast cancer treatment

What milestones have been reached in the treatment of breast cancer in the last year? We sat down with lead analyst Francois Pagnini to dive into the latest research. After conducting in-depth interviews with key opinion leaders (KOLs), here he provides a sneak peek into the findings of what changes have come to the treatment landscape and what experts envision for the near future.

FirstWord: What was the main objective for this research?

Francois Pagnini: The goal was to understand key trends in the evolution of treatment of patients with breast cancer, with an emphasis on current and future treatment pathways. This was done for the three different breast cancer types; HER2-positive, HER2-negative/hormone receptor (HR) positive and triple-negative breast cancer (TNBC). The focus was on targeted therapies as this category is the most dynamic and, according to KOLs, offers the greatest potential to transform treatment of the disease. Consequently, targeted therapies present patients and pharmaceutical companies with their greatest opportunity in terms of clinical benefit and market potential, respectively.


FW: Based on the research, what is the general sentiment from KOLs on the progression of the breast cancer treatment landscape?

FP: Overall there is a sense of optimism, but experts point out different levels of advancement for the different breast cancer types. The research came up with six main conclusions:

  • Roche’s Herceptin will continue to dominate all three settings in HER2-positive breast cancer with biosimilar trastuzumab expected to have limited impact in the US.

  • Margetuximab’s mechanism of action is exciting and the agent could be positioned as a third-line therapy for metastatic HER2-positive disease.

  • Ibrance prescribing is increasing, with KOLs using the agent in first and second-line settings for HER2-negative/HR-positive metastatic breast cancer.

  • Experts are excited about late-stage PI3-alpha kinase inhibitors.

  • The launch of Lynparza is a welcome arrival for patients with BRCA germline mutations.

  • KOLs remain unimpressed with checkpoint inhibitors for breast cancer. Nonetheless, the experts believe that if approved, checkpoint inhibitors could be used in combination with chemotherapy in the first-line metastatic disease setting for TNBC.


FW: What was one of the most insightful interview quotes? What did it teach us?

FP: KOLs were really excited about the launch of Lynparza. This is the first targeted therapy for the treatment of BRCA-mutated TNBC and the experts are pleased to have an oral therapeutic option that is considered to have a superior safety profile to chemotherapy. The general opinion is that Lynparza will be used as a second-line option after chemotherapy in BRCA-mutated TNBC.

“Lynparza is long overdue. Since a lot of these patients are triple negative, it's a really nice thing to be able to have an oral drug that once you get used to its toxicity pattern, is certainly better tolerated than chemotherapy, which is really the only other thing that we currently have commercially available for triple negative breast cancer. If I had a patient with really horrible triple negative disease, I would move in a direction of chemotherapy first and then maybe try to move in the direction to maintain a chemotherapy-induced response with Lynparza.” [US KOL]


FW: According to KOLs, what is one of the most notable changes in breast cancer treatment over the last 12 months?

FP: Ibrance’s impressive efficacy and safety has meant that it has been well accepted by oncologists, driving Afinitor’s usage further down the treatment paradigm. Ibrance is now the therapy of choice in first- and second-line HER2-negative/HR-positive metastatic breast cancer, while the launch of other CDK4/6 inhibitors such as Kisqali and Verzenio has provided oncologists with several treatment options.


FW: What is our research team going to explore for the next bulletin on this topic?

FP: Our forthcoming bulletin will look at KOLs’ thoughts on the recent submission for sacituzumab govitecan, an antibody-drug conjugate, for the treatment of patients with metastatic TNBC; Nerlynx’s (neratinib) positive opinion in the EU for the extended adjuvant treatment of HER2-positive early-stage breast cancer; as well as their opinions on the Phase III IMpassion130 study investigating Tecentriq (atezolizumab) plus chemotherapy meeting its primary endpoint in TNBC.

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