Experts to explore clinical controversies in early nonmetastatic breast cancer


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3 minutes

Covering some of the most debated topics in breast cancer care, the 2023 SABCS® program includes two Controversies sessions featuring lightning discussions between experts in the field on three different topics.

Lisa A. Carey MD, ScM
Lisa Carey, MD, ScM, FASCO

The first of these two sessions, Clinical Controversies, will be on Thursday, December 7, at 2:00 p.m. CT, in the Stars at Night Ballroom 3-4. There will be two expert discussants for each of the three topics. Lisa Carey, MD, ScM, FASCO, Deputy Director of Clinical Sciences, UNC Lineberger Comprehensive Cancer Center, will moderate the first session. 

This session will focus on hot topics in the multidisciplinary management of early nonmetastatic breast cancer.

“This is important because, in early breast cancer, we are treating with curative intent with multidisciplinary therapy in an integrated fashion. However, many of the interventions we use, including surgery, radiation, and both infusional and oral anticancer drugs, have short-term and long-term toxicity, so we need to be really thoughtful about tailoring our approach and using those interventions only in those who are likely to benefit from them,” Dr. Carey said.

Topic 1: Are we ready to stop staging the axilla? 

Discussants: Monica Morrow, MD, FACS, Chief, Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, and Armando E. Giuliano, MD, Regional Medical Director, Cancer Breast Oncology Program, Cedars-Sinai Medical Center

There are still many uncertainties and controversies surrounding axillary management of patients with breast cancer. As it becomes more apparent that axillary management is mainly used as staging for adjunctive therapies (e.g., drugs and radiation), questions arise about using less invasive options.

Join the experts as they debate whether we can gain enough information for breast cancer decision-making without invasive procedures.

Topic 2: How to treat small triple-negative breast cancer 

Discussants: Priyanka Sharma, MD, Professor, Medical Oncology, University of Kansas Medical Center, and Alexandra Thomas, MD, FACP, Professor, Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center

In the post-KEYNOTE-522 era, immunotherapy is used in all but the smallest triple-negative breast cancers. Specifically, patients with triple-negative breast cancer (TNBC) larger than 2 cm or with axillary lymph node involvement undergo treatment with four chemotherapy drugs and one year of an immune checkpoint inhibitor. However, recent data suggests that in small node-negative TNBC, prognosis is generally good, and chemotherapy without immunotherapy has augmented these outcomes. Therefore, immunotherapy is not recommended for T1N0 cancer.

Join the experts as they discuss where and how to draw the line in treating small triple-negative breast cancer.

Topic 3: Biology or stage? Tailoring treatment for premenopausal women with nodal involvement but low genomic assay results 

Discussants: Eric P. Winer, MD, Director, Yale Cancer Center, and Kevin M. Kalinsky, MD, MS, Director, Glenn Family Breast Center Emory Winship Cancer Institute

Findings from the RxPONDER trial, along with insights from the MINDACT and TAILORx trials, indicate that the benefits of adjuvant chemotherapy differ by menopausal status. In RxPONDER, postmenopausal women with one to two positive lymph nodes did not benefit from chemotherapy, while premenopausal women with the same lymph node involvement had a significant 5% absolute benefit from chemotherapy.

Join the experts as they discuss if modifying menopausal status with ovarian suppression can impact the benefit of chemotherapy and possible interpretations and interventions suggested by these data.

Read SABCS Meeting News for more on the second Controversies session, Translational Research Controversies, set for 1:30 p.m. – 2:30 p.m. CT, Friday, December 8.