2024-SABCS-Takeaways - 7

Top Clinical Pearls in
MEDICAL ONCOLOGY
from 2024 SABCS®
FROM LEFT: Jennifer Gao, MD; Tiffany Ricks, PhD;
Suparna Wedam, MD; and Mallorie Fiero, PhD
insertion, and deletion and
copy number alterations in
324 genes as well as select
gene rearrangements.
The manufacturer has
committed to developing
a companion tissue
diagnostic. It will also
conduct a randomized
clinical trial to evaluate
the approved dose
compared to a lower
dose, to provide final
OS results, and to
further characterize
pharmacokinetics,
pharmacodynamics,
safety, and efficacy in a
more diverse population.
While largely ignored in
the past, ovarian toxicity
during clinical trials and
treatment is emerging
as an important factor
in drug development.
Treatment effects on the
ovaries can affect quality
of life with hot flashes,
genitourinary symptoms,
sexual dysfunction,
amenorrhea, and more.
Health after breast
cancer can be an issue
with accelerated bone
loss and cardiovascular
disease. Additionally,
fertility is a question
given that preservation
of menses is not
synonymous with fertility.
Multiple drug
classes can affect
the mechanisms of
fertility, including
immunotherapy, and
inhibitors targeted to
EGFR/HER, CDK4/6,
and PARP. Observational
data suggest that women
lose approximately three
years of fertility with
adjuvant chemotherapy.
More women are delaying
childbearing until later
in life despite a general
decline in gonadal
function with age and
an increase in infertility
and miscarriage with
increasing maternal age.
A 2023 American Society
of Clinical Oncology (ASCO)
Research Statement calls
for measurement of ovarian
toxicity, collection of ovarian
function measures at
multiple timepoints, and
assessment of both clinical
measures and biomarkers
of ovarian function in
clinical trial design. The FDA
issued a draft guidance in
November 2024, reflecting
these concerns. 
December 10-13, 2024 | San Antonio, Texas
» Quality of life is important. Treatments that
patients cannot tolerate cannot truly work.
» Too many patients with TNBC do not receive
neoadjuvant pembrolizumab, as dictated by
KEYNOTE-522 data. Clinicians must work
together more effectively to ensure that these
patients do not undergo surgery without
appropriate neoadjuvant therapy.
» Consider anthracyclines for patients with the
highest genomic risk HR-positive, HER2-negative,
node-negative disease.
» OlympiA reinforced the importance of germline
BRCA testing in patients with high-risk HER2negative
primary breast cancer.
» Combination therapy of palbociclib with
anti-HER2 therapy and ET may represent a new
standard of care for patients diagnosed with
HR-positive, HER2-positive metastatic breast
cancer.
» PADMA strongly supports guideline
recommendations favoring CDK4/6 inhibition
plus ET for HR-positive, HER2-negative metastatic
breast cancer.
Looking Ahead
» Biomarkers may identify subsets of patients
with TNBC who might benefit from adding
atezolizumab to neoadjuvant/adjuvant therapy.
» SWOG S1418/NRG BR-006 may clarify
whether adjuvant pembrolizumab is effective for
patients with TNBC and with residual disease
after neoadjuvant chemotherapy.
» Future trials designs could (and should) include
assessment of ovarian toxicity with routine and
systematic data collection in relevant trials and
patient populations.
» Look for new data on olaparib for
chemoprevention of breast cancer using an
interrupted dosing schedule.
» Clinicians need useful biomarkers to select
patients with TNBC who received surgery but
missed neoadjuvant immunotherapy in order
to determine the most appropriate adjuvant
approach.
» The final analysis of OlympiA and adjuvant
olaparib is due in 2029.
7
2024-SABCS-Takeaways

Table of Contents for the Digital Edition of 2024-SABCS-Takeaways
