C. Kent Osborne, MD: Breast Cancer Treatment – A Year In Review
Dr. C. Kent Osborne, the co-director of the CTRC-AACR San Antonio Breast Cancer Symposium (SABCS), discusses breast cancer advances and treatment highlights over the past year. He highlights three areas which he thinks will be practice changing: the overall treatment of HER2-positive breast cancer, the findings from the BOLERO-2 trial and the use of bisphosphonates in breast cancer treatment and prevention.
Dr. Osborne is professor of Medicine and Molecular and Cellular Biology, director of the Dan L. Duncan Cancer Center and the Smith Breast Center at Baylor College of Medicine and acting chief of the section of Hematology-Oncology at Baylor College of Medicine.
The Group Room at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium was made possible by support from:
Selma Schimmel, Founder & CEO, Vital Options International:
Hello and welcome to the Group Room where we’re at the annual CTRC – AACR San Antonio Breast Cancer Symposium where I’m so happy to welcome back Dr. Kent Osborne, Professor of Medicine and Molecular-Cellular Biology, the Director of the Daniel Duncan Cancer Center, and the Director of the Lester Ann Sue Smith Breast Center at the Baylor College of Medicine in Houston, Texas, and the Co-Director of the San Antonio Breast Cancer Symposium. Thank you so much for finding time.
C. Kent Osborne, MD, Co-Director, CTRC-AACR San Antonio Breast Cancer Symposium:
Thanks for having me.
You’ve been a busy man, obviously. And in a meeting that everyone is excited about because I’m hearing expressions like ‘practice-changing, impacting the standard of care’ and you’re going to talk to us about breast cancer treatment, a year in review. We’ll reflect on last year’s meeting to this year’s meeting and what really matters most to you as the Co-Director of this year’s conference.
C. Kent Osborne, MD:
I think this has been one of the best, if not the best, meeting from the point of view of the exciting science and clinical trial results that have been presented. I probably think about three or four areas – probably three stronger areas – that will practice-changing.
One is the treatment of Her2 Positive disease where we’ve made a lot of progress in the past few years anyway, with the introduction of Trastuzumab that targets that particular protein. And people have been studying combination of drugs to block the Her2 pathway more completely, and we’ve seen over the past year and then again in this meeting some really exciting data. At this meeting, metastatic breast cancer, with the addition of a drug called Pertuzumab, Trastuzumab was much more effective than with Trastuzumab by itself when combined with chemotherapy. So that’s one of the, I think, practice-changing papers that was presented. It was actually published in the New England Journal two days ago. And I think we’ll have wide-spread application.
Another one was another clinical trial called the Bolero-2 trial. And this trial took relatively heavily pre-treated estrogen receptor positive breast cancer, and it randomized them to a standard approach, which was treatment with another aromatase inhibitor called Exemestane, or Aromasin. And then another group got the same Exemestane plus a new drug that blocks a growth factor pathway that we think is involved in resistance to endocrine therapy. And that drug was called Everolimus – hard to say it. And that trial also showed pretty dramatic and sizeable effects of adding Everolimus to this group of patients who had been treated with many, many different therapies. Another very exciting result and a result that will also be practice-changing in a subset of estrogen receptive positive breast cancer.
And then we also had a whole series – I think it was four, maybe five studies – looking at these Bisphosphonates, or drugs that help to prevent breast cancer from tearing down the bone. And yes, we’ve shown a long time ago that it helps prevent tearing down the bone, and there are many fewer complications of bone metastasis in patients with breast cancer today than there was years ago when I first started, say in the mid-70s. But a doctor here in San Antonio actually, an endocrinologist who studied cancer in the bone by the name of Greg Mundy, who unfortunately passed away this past year, showed that when you have breast cancer in the bone and you treat with these drugs, which we call Bisphosphonates – they’re like Fasamax that you can take for osteoporosis – that not only do you prevent the bone from being destroyed, but you also kill cancer cells. And that observation was made many years ago. And actually a colleague of mine and I went to the drug company saying ‘let’s look at this not only to keep the bone strong but to help improve the outcome of patients’ and it took years and years of negotiating and presenting more data. And finally a series of trials has been completed now looking at these drugs almost as you would look at adding chemotherapy to surgery in patients with breast cancer.
And as I look at the data, and there are mixed results, but if you look there’s one consistent finding, and that is people who are for sure post-menopausal by either medical means where you can make them post-menopausal by using drugs that block the ovary, or truly post-menopausal naturally – meaning five or ten years after the menopause, say 55 or 60 years of age – these drugs seem to work. And they work by reducing the risk of recurrence of breast cancer, not only in preventing osteoporosis and weak bones but preventing recurrence of breast cancer – not only in the bone but other organs as well. Sort of difficult to explain the observation, but I think many people now are going to be thinking seriously about using these drugs in post-menopausal women, in addition to their standard chemotherapy and hormone therapy for their disease.
When we talk about practice-changing and how this meeting impacts the way women are going to be treated from perhaps this point on, what happens now within the community setting where the majority of cancer patients are seen, and how long does it take to adapt change based on studies and data that comes out of the San Antonio meeting?
C. Kent Osborne, MD:
There’s a couple of issues here. First, some of the drugs that have shown this practice-changing are not yet available. Hopefully they soon will be – Everolimus is available for other diseases because it’s been shown to be effective, I think, in kidney cancer. So that should be readily available and I think the FDA is likely to approve it for breast cancer because of the trial, the Bolero-2 trial. And since the data was published in New England Journal, a very widely read journal, and presented and covered widely by the press, I don’t think it’ll be very long before you see that kind of thing introduced into the community of physicians; words spreads like wildfire.
The other study of Pertuzumab plus Herceptin, that’s going to take a little bit longer because Pertuzumab right now is not available. It’s been applied to the FDA and I think, will become available shortly. And once that becomes available again with the wide coverage that the study has gotten I think you’ll see pretty rapid and wide-spread use of that combination in patients with Her2-Positive disease.
Of some of the earlier research that’s been presented, what are the trials that are on-going that you are now really focused on and trying to gather more positive data?
C. Kent Osborne, MD:
The whole focus now as you’ve probably now seen yourself over the past decade has been less and less run-of-the-mill chemotherapy, which works on some patients, so I don’t want to denigrate chemotherapy too much. But let’s face it, it’s relatively non-specific, we’re not picking out patients very well who will respond or who won’t, but the trend has been less and less chemotherapy, and more targeted therapy. By that I mean identifying what the genetic abnormality is in that particular patient’s tumor, and then treating that patient with a specific agent.
The first example of that was estrogen receptor breast cancer. We measure that, if it’s there we treat it with hormone therapy, if it’s not we don’t. Well, we’re now seeing we can do that with other abnormal genetic alterations like Her2 amplification. If a patient has Her2 we give her Herceptin, and now we’re able to dissect the tumor even further down to the minute mutations that occur in critical genes in that tumor, and we’re able to target those pathways.
So I think that’s the future of breast cancer and cancer research, so-called personalized cancer medicine, where we identify the genomic abnormality and treat that patient specifically with a drug that blocks whatever pathway is driving that particular tumor.
There were a few other interesting studies that came out that were not sort of in the area of treatment, but there was the IOM-environment study, again a number of obesity and what you eat and start your carbohydrates and all of those. You have this sprinkling of other important information that may impact breast cancer epidemiologically as well.
C. Kent Osborne, MD:
Absolutely, and there’s more and more data that what we eat than what we do affects our breast cancer incidents rates, and other cancers as well. And the obesity epidemic is going to cause an increase in the risk of breast cancer, and increase the rate of risk so there’s no question about it. It’s been known, I think, for forty years now that obesity was a risk factor for getting breast cancer. And that’s been seen in every study. What’s now been shown in several studies is that obesity is a risk factor for recurrence, after you’ve had the diagnosis of breast cancer, or gaining weight after the diagnosis of breast cancer is an adverse factor. And these are not small changes. They can be fairly significant changes.
So we really have to work together – physician and patient. Patients have to be told about these affects and not to gain weight and to continue to exercise and minimize alcohol consumption, all of which have shown to relate to, not only breast cancer incidents but breast cancer recurrence. And physicians need to be knowledgeable about this and inform their patients about it, and really work together to get over this hump of metabolic syndrome, which is what doctors call this syndrome of obesity, which affects all parts of our bodies. Not only a cancer risk but cardiovascular and other diseases as well.
So until next year, this time, more from you. I hope you get some rest this weekend, and I hope you’re feeling a real sense of pride for what was accomplished here.
C. Kent Osborne, MD:
Thank you very much.
I thank you very much, Dr. Kent Osborne, the Co-Director of the San Antonio Breast Cancer Symposium, Professor of Medicine and Molecular and Cellular Biology, Director of the Daniel Duncan Cancer Center, and the Director of the Lester and Sue Smith Breast Center at the Baylor College of Medicine in Houston, Texas.
C. Kent Osborne, MD:
END OF VIDEO