The European CanCer Organisation (ECCO) 11th European Breast Cancer Conference (EBCC-11) was held on the 21–23 March 2018 in Barcelona, Spain. The conference theme ‘Multidisciplinary Teams in the Real World’ was reflected in a number of industry-sponsored sessions. In this article, we highlight some of the key sessions provided by industry.
A session entitled ‘Constructing a new future in breast cancer treatment’, supported by Pfizer, highlighted the latest clinical data on therapies for hormone receptor positive and BRCA+ breast cancer, and included a discussion of real-world experience of CDK4/6 inhibitors in the clinic. The expert faculty comprised Aleix Prat of the Hospital Clinic of Barcelona, Spain; Stephen Johnston of the Royal Marsden Hospital, London, UK; and Giampaolo Bianchini of IRCCS Ospedale San Raffaele, Milan, Italy.1
The session ‘The Ups and Downs of Estrogen Suppression in Endocrine-Sensitive Premenopausal Breast Cancer’ (organised by PrIME Oncology) was presented by an expert panel comprising Michael Gnant of the University of Vienna, Austria; Prue Francis of the Peter MacCallum Cancer Centre, Melbourne, Australia; and Fedro Peccatori of the European Institute of Oncology, Milan, Italy and highlighted the important areas of fertility preservation and the impact of pregnancy in women with early breast cancer, the benefits of ovarian function suppression, and management of adverse events.2
Premenopausal patients were the focus of another session, entitled ‘Treatment Considerations for Patients With HR+ Breast Cancer.’ In this guided panel discussion supported by Novartis, Carlos Barrios of the Center for Research in Oncology at Hospital São Lucas, Pontifícia, Brazil and Grazia Arpino of the University of Naples Federico II Napoli, Campania, Italy presented three patient scenarios, which led to discussions about the treatment of HR+ advanced breast cancer in, selecting the right treatment for the right patient, and managing treatment side effects and maintaining quality of life.3
In a second PrIME Oncology symposium, a panel of experts comprising Sibylle Loibl of the Neu-IsenburgCenter for Hematology and Oncology Bethanien, Germany; Suzette Delaloge of the Institute Gustav Rossy, France; Wolfgang Janni of the University of Ulm, Germany; and Pierfranco Conte of the University of Padua, Italy, discussed the remaining challenges in the treatment of HER2+ breast cancer. The key points of the session were that HER+ breast cancer is a heterogeneous disease requiring a risk adapted treatment approach. Trastuzumab plus taxane-based chemotherapy remains the cornerstone of treatment of HER2+ early breast cancer. Extended adjuvant treatment with neratinib or dual blockade with trastuzumab and pertuzumab durther improves disease-free survival and may be beneficial for high-risk patients. Prophylaxis, side effect management and patient education are essential to ensure treatment acceptability and therapeutic adherence. Finally, the panel acknowledged the need for additional treatments to improve outcomes in metastatic HER2+ disease and address the unmet need of brain metastases.4
While the standard of care has improved for women with HER2+ early breast cancer, unmet needs remain in this treatment setting, especially for women at high risk of recurrence and the Roche supported session entitled ‘Navigating HER2-positive eBC treatment: What can we learn from clinical practice and trial data?’ presented by José Baselga of the Memorial-Sloan Cancer Center, US; Martine Piccart-Gebhart of the University of Brussels, Belgium; and Javier Cortés Spain of the Ramón y Cajal University Hospital, Madrid, Spain discussed the current standards of care for HER2+ early breast cancer, risk factors that affect treatment choice, and the role of neoadjuvant therapy.5
Genomic testing was another key theme of the meeting, and the Nanostring supported session – ‘Prosigna® in Early Breast Cancer Treatment Decisions: Clinical Evidence and Comparative Performance’ – focussed on Prosigna® (PAM50), a second-generation genomic test that measures the expression of several tumour genes simultaneously. This assay is designed to enable clinicians to make more informed treatment choices for women with endocrine responsive breast cancer by determining the intrinsic subtype as well as short and long-term risk of recurrence. It also helps identify women who are likely to benefit from chemotherapy and those may be spared adjuvant chemotherapy. The Prosigna Breast Cancer Prognostic Gene Signature Assay is indicated in female breast cancer patients who have undergone surgery in conjunction with locoregional treatment consistent with standard of care. The assay is currently being evaluated in the OPTIMA (Optimal Personalised Treatment of breast cancer using Multi-parameter Analysis) trial (UKCRN ID: 12255). Using tumour tissue removed during surgery, the test measures the activity of 50 genes within the tumour and combines these to give a numerical score. Patients with a score more than 60 will receive chemotherapy in addition to endocrine therapy, those with lower scores receive endocrine therapy alone.6
There was further discussion on gene expression testing in the Agendia sponsored session – ‘Assessing the value of gene expression tests – A European perspective on reimbursement, clinical utility and future directions’ – in which a panel of experts discussed the clinical application of gene expression testing and the implications of recent health technology assessments on access to these tests in clinical practice.7 Data from the landmark MINDACT trial (NCT00433589) of almost 7,000 European breast cancer patients, showed that 46% of patients originally classified as high-risk of their cancer returning according to clinico-pathological factors alone, were reclassified by the MammaPrint® (Agendia, Amsterdam, Netherlands) breast cancer recurrence assay to low-risk, and did not require chamotherapy.8 Another analysis of MINDACT data, which were presented at the ECCO meeting, showed that it was possible, on the basis of tumour characteristic and the MammaPrint assay, to identify women who could safely avoid not only chemotherapy after surgery, but possibly also radiotherapy.9 However, reimbursement policies regarding genomic testing vary considerably across Europe.
The industry-sponsored sessions featured a wide range of thought-provoking discussions and provided expert opinions on the key questions in breast cancer care.
1. ECCO, Constructing a new future in breast cancer treatment, 2018. Available at: www.ecco-org.eu/Events/EBCC11/Industry-Sessions/Pfizer (accessed 4 May 2018).
2. PrIME Oncology, Endocrine-Sensitive Premenopausal Breast Cancer
3. ECCO, Treatment Considerations for Patients With HR+ Breast Cancer, 2018. Available at: www.ecco-org.eu/Events/EBCC11/Industry-Sessions/Novartis (accessed 4 May 2018).
4. The Ups and Downs of Estrogen Suppression in Endocrine-Sensitive Premenopausal Breast Cancer. Available at: http://www.primeoncologyorg/live-education/solid-tumor/estrogen-breast-cancer-barcelona-2018/ (accessed 4 May 2018).
3. PrIME Oncology, HER+ breast cancer, 2018. Available at: www.primeoncology.org/live-education/solid-tumor/her2-positive-breast-cancer-barcelona-2018/ (accessed 3 May 2018).
5. Roche, Navigating HER2-positive eBC treatment, 2018. Available at: https://medically.roche.com/en/oncology/diseases/breast/ebcc-2018-symposium-navigating-her2-positive-ebc-treatment.html (accessed 3 May 2018).
6. NIHR, Landmark trial looking at test to predict who needs chemotherapy for breast cancer begins, 2017. Available at: https://www.nihr.ac.uk/news/landmark-trial-looking-at-test-to-predict-who-needs-chemotherapy-for-breast-cancer-begins/5281 (accessed 3 March 2018).
7. Assessing the value of gene expression tests – A European perspective on reimbursement, clinical utility and future directions, 2018. Available at: www.ecco-org.eu/Events/EBCC11/Industry-Sessions/Agendia (accessed 4 May 2018).
8. Cardoso F, van't Veer LJ, Bogaerts J, et al. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med. 2016;375:717–29.
9. Rutgers E, Aalders A, Poncet C, et al. Very low risk of locoregional breast cancer recurrence in the EORTC 10041/BIG 03-04 MINDACT trial: analysis of risk factors including the 70-gene signature. European Journal of Cancer. 2018;92(Suppl 3):S7–S9.