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Yangtze River Academic Belt Breast Alliance experts take you to chase breast cancer "hot spots"!
At the beginning of 2022, the Yangtze River Academic Belt Breast Alliance (YBCSG) and the medical media opened the 2022 New Year Academic Show, combined with the progress of breast cancer in 2021 to conduct an annual inventory and future direction prediction, discuss controversial topics, and bring wonderful academic reviews and prospects to Chinese clinical oncologists.
Professor Zhang Jian, chairman of YBCSG and affiliated cancer hospital of Fudan University, said at the opening of the conference: "I hope that through this New Year's academic show, all of you will grasp the top ten annual keywords and perceive the new trend of breast cancer treatment in 2022 in advance; I also look forward to the members of YBCSG in 2022 to produce more academic achievements and occupy the academic highland." This article draws on the best of YBCSG's New Year's Academic Show for the benefit of readers.
Genetics and Genes of Breast Cancer Progression in 2021
Professor Li Hengyu, Vice Chairman and Secretary General of YBCSG and Shanghai Changhai Hospital, introduced the academic keywords of breast cancer in 2021, and brought the research progress in the field of breast cancer treatment in 2021, and explained in detail the relevant updates of the hereditary breast cancer management guidelines of the American Society of Clinical Oncology (ASCO), the American Society of Radiation Oncology and the Society of Surgical Oncology, as well as the test standards in the National Comprehensive Cancer Network (NCCN) Genetic/Family High-Risk Assessment Guidelines.
Figure 1
Professor Li Hengyu analyzed the clinical management strategies of medium eminence susceptibility genes, from screening to prevention and treatment, and pointed out future research directions. At the same time, with the release of data from the OlympiAD study and the OlympiA study, the value of BRCA genetic testing and the scope of application of PARP inhibitors (PARPi) and the beneficiaries have been further clarified. The Guidelines for the Diagnosis and Treatment of Breast Cancer of the Chinese Anti-Cancer Association have also been updated in line with the latest developments. In terms of multi-gene detection of breast cancer, the population selection of postoperative adjuvant chemotherapy for breast cancer was mainly analyzed, and the new results of RxPONDER research and MINDACT research were used to further clarify the beneficiary groups of chemotherapy and endocrine therapy.
What kind of vitality can HER2-ADC inject into breast cancer treatment?
Professor Luo Ting, vice chairman of YBCSG and West China Hospital of Sichuan University, deeply interpreted the progress of HER2-ADC in the field of breast cancer treatment, and the results of the DESTINY-Breast03 study showed the significant advantages of DS-8201: far exceeding the treatment effect and controllable safety of the existing treatment regimen - leading the treatment leap of ADC drugs and rewriting the treatment pattern of patients with advanced HER2-positive breast cancer. At the same time, the results of recent subgroup analysis have given new hope to people with worse prognosis and more difficult treatment for stable brain metastases.
Figure 2
In addition to DS-8201, the current research and development of HER2-ADC has shown a trend of "a hundred flowers blooming, a hundred schools of thought contending", ARX778, MRG002, A166, RC-48 and other drugs have shown certain therapeutic potential. Professor Luo Ting pointed out: "The unique lysable connectors from HER2-ADC, highly efficient cytotoxic loading and bystander effects have broadened the boundaries of benefits of anti-HER2 therapy and enabled more patients with HER2 low expression breast cancer to benefit." Recent DAISY studies have also confirmed that DS-8201 also has therapeutic potential in some patients with IHC0+ with very low HER2 expression, making us very much looking forward to the new breakthroughs brought by ADCs in the low EXPRESSION of HER2 in the future. ”
What is progress in the treatment of young breast cancer?
What is the future trend of chemotherapy, a well-established treatment?
Professor Chen Wenyan, vice chairman of YBCSG and the Third Hospital of Nanchang City, brought the "annual academic keyword" interpretation of the blockbuster research progress of young breast cancer, and predicted the new trend of chemotherapy. Professor Chen Wenyan interpreted the best partners of ovarian function suppression (OFS): aromatase inhibitor (AI) vs tamoxifen (TAM); SOFT & TEXT study data update; the age definition controversy of young breast cancer; and whether luminal adjuvant chemotherapy in young breast cancer patients with Luminal type A can benefit.
Figure 3
At the same time, Professor Chen Wenyan made an in-depth interpretation of the necessity of chemotherapy in BRCA1/2 mutant populations, neo-yew chemotherapy drugs, chemotherapy drug combinations, the final analysis of the clinical study of UTD1 and capecitabine Phase III. and the time & dosage of advanced chemotherapy drugs.
PARPi's past, present and future
Professor Han Xinghua, vice chairman of YBCSG and the First Affiliated Hospital of the University of Science and Technology of China, made a wonderful summary of the annual academic keyword PARPi. Professor Han Xinghua pointed out: "Orapali's breast cancer indications approved by the US Food and Drug Administration (FDA) can be said to be the first FORRPi in the field of breast cancer treatment. At the same time, the application range of PARPi has gradually changed from positive BRCA gene mutation to homologous recombinant repair (HRR) positive. Professor Han Xinghua introduced a retrospective study on germline mutations in the homologous recombinant repair pathway of multiple cancer species in China.
Figure 4
From OlympiAD to OlympiA studies, PARPi has also shown excellent efficacy in the field of early breast cancer. Therefore, it is crucial to accurately identify patients with early-stage breast cancer with BRCA germline mutations (gBRCA). At the same time, the applicable population of PARPi adjuvant therapy, the advantages and disadvantages of other therapies, and other issues are still inconclusive. Professor Han Xinghua said that the combination treatment of PARPi may be the direction of breast cancer development in the future.
CDK4/6i gradually changes the treatment pattern of PATIENTS with HR+ breast cancer
Professor Li Wei, vice chairman of YBCSG and Jiangsu Provincial People's Hospital, interpreted the cutting-edge progress of CDK4/6 inhibitors (CDK4/6i). CDK4/6i in combination with endocrine therapy is one of the treatment options for patients with hormone receptor-positive (HR+) breast cancer. Since 2014, the results of PALOMA-1, 2, 3, MONARCH-1, 2, MONALEESA-2, 3 and other studies have been published, and CDK4/6i has gradually changed the treatment pattern of patients with HR+HER2-advanced breast cancer.
Figure 5
CdK4/6i second-line treatment of patients with HR+ and HER2-advanced breast cancer also brings survival benefits. The results of the PALOMA-3, MONARCH-2, MONALEESA-3, and DWANA-1 studies all supported the effectiveness of CDK4/6i combined with fulvestrant to prolong progression-free survival (PFS) in patients with HR+, HER2-advanced breast cancer. At present, CDK4/6i has been shown to provide long-term survival benefits for patients with HR+ and HER2-advanced breast cancer. Major guidelines have listed cdk4/6i combination therapy as the first-line treatment of choice for patients with HER2-advanced breast cancer.
PI3Ki has "come to the fore",
How will the endocrine therapy landscape change?
Professor Liu Shu, Vice Chairman of YBCSG and Affiliated Hospital of Guizhou Medical University, made an in-depth interpretation of the relevant frontier research of PI3K inhibitors (PI3Ki) and prospected the new diagnosis and treatment trend of endocrinology. Professor Liu Shu pointed out that PI3Ki has "shown its head" in reversing endocrine therapy resistance. SOLAR1, BYlieve, BELLE-2, SANDPIPER, POSERIDON and other studies have shown considerable application prospects for PI3Ki, and look forward to more data support.
Figure 6
In terms of the new trend of endocrine therapy, Professor Liu Shu said: a variety of drugs for advanced endocrine therapy have blossomed, and the survival of patients has been prolonged; early auxiliary endocrine therapy gene detection has helped precision treatment, targeting "+" and adding new evidence; and it is crucial for new auxiliary endocrine therapy to choose reasonable and effective observation indicators, and more clinical problems still need to be further solved.
Immunotherapy has broad prospects for early/late TNBC applications
Professor Qi Xiaowei, vice chairman of YBCSG and Southwest Hospital of Army Military Medical University, shared the progress of PD-1/PD-L1 inhibitors in the treatment of triple negative breast cancer (TNBC). IMpassion031 study, KEYNOTE-522 study, GeparNuevo study, NeoTRIP study four major new adjuvant immunotherapy studies suggest that anthracycline drugs are still indispensable, immunotherapy is still a dominant treatment model, whether chemotherapy can do "subtraction" still needs more data support. In terms of efficacy prediction indicators, early TNBC neoadjuvant immunotherapy does not rely on factors such as PD-L1 expression and lymph node status, so it is still necessary to further explore accurate biomarkers (bio-markers). Early TNBC adjuvant immunotherapy is also still ongoing.
Figure 7
In addition to early TNBC, the KETNOTE-355 study provides high-level evidence-based evidence for immunotherapy in patients with advanced TNBC who have positive PD-L1 expression, and more studies of immunocomposent chemotherapy are constantly being explored.
TKI has become one of the "Big Three" of anti-HER2 treatment
Professor Zheng Yabing, vice chairman of YBCSG and Zhejiang Cancer Hospital, summarized the heavy progress of tyrosine kinase inhibitors (TKI) in the field of breast cancer treatment, and Professor Zheng Yabing pointed out that targeted therapy for breast cancer has changed from the past step by step to a stage of going hand in hand.
Figure 8
TKI in anti-HER targeted therapy has become a "three-legged" trend with macromolecular monoclonal antibodies and ADC drugs, due to the unique mechanism of action, for trastuzumab treated patients, TKI can exert its advantages to torsional resistance. At the same time, because the molecular weight of TKI is small, it is easy to penetrate the blood-brain barrier, which has a unique curative effect for patients with brain metastases and has a high safety profile. The future trend of TKI will be to find new indications in neoadjuvant, adjuvant prolongation, and advanced first-line therapy, as well as to explore new treatment models in combination with endocrine drugs in patients with triple-positive breast cancer.
The combination therapy model helps patients with breast cancer brain metastases survive better
Professor Xiong Huihua, Vice Chairman of YBCSG and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, brought a wonderful report on the progress and prospects of breast cancer brain metastase treatment. HER2-positive breast cancer with brain metastases as the first metastatic organ may represent a specific biological trait with a relatively poor prognosis. Pirlotinib plus capecitabine, tucatanib plus trastuzumab, and capecitabine may be available as options for brain metastasis in HER2-positive breast cancer.
Figure 9
In the context of the increased accessibility of targeted drugs, brain radiotherapy for patients with BRAIN metastasis of HER2-positive breast cancer can not be completely replaced, and the best combination of HER2 ADC drugs and brain radiotherapy needs to be explored in the future, and the treatment of solid tumors of brain metastases is still dominated by multidisciplinary consultation (MDT) mode.
Figure 10
Finally, Professor Ye Songqing, vice chairman of YBCSG and Fujian Provincial Hospital, concluded: "The times are changing, and the concept of treatment is constantly being updated. Looking forward to 2022, we look forward to the continuous research and development of more new drugs in the future, more and more clinical basic and translational research data, providing more knowledge for clinical decision-making and bringing more benefits to patients. The Yangtze River Academic Belt Breast Alliance will continue to promote the exchange of breast cancer diagnosis and treatment technology in and outside the Yangtze River Basin as its mission, actively carry out multi-center clinical research on breast cancer, promote and improve the technical level of standardized diagnosis and treatment of breast cancer practitioners, and help the growth of young doctors. ”
About the Yangtze River Academic Belt Breast Alliance (YBCSG)
The Yangtze River Academic Belt Breast Alliance (YBCSG) is a branch group of the Yangtze River Academic Belt Cancer Collaboration Group (YCOG), which takes it as its mission to promote academic exchanges in breast cancer diagnosis and treatment in and outside the Yangtze River Basin, actively carries out multi-center clinical research on breast cancer, and promotes the continuing education, standardization and improvement of breast cancer practitioners in breast cancer professions. YBCSG has opened twelve colleges, the School of Breast and Plastic Surgery, the School of Radiotherapy, the School of Targeting and Immunology, the HER2 House, the College of Support and Rehabilitation, the School of Diagnostics, the College of Clinical Research, the School of Endocrinology, the College of Genetics and Genetics, the College of Chemotherapy, the College of Neoadjuvant Medicine, and the School of Basic and Translational Medicine, which have received universal attention and praise.
At present, Professor Zhang Jian of the Affiliated Cancer Hospital of Fudan University serves as the chairman of YBCSG, Professor Li Hengyu of the First Affiliated Hospital of naval military medical university serves as vice chairman and secretary general of YBCSG, and Professor Li Wei, Professor Zheng Yabing, Professor Ye Songqing, Professor Han Xinghua, Professor Chen Wenyan, Professor Xiong Huihua, Professor Wang Shouman, Professor Qi Xiaowei, Professor Luo Ting, Professor Nie Jianyun and Professor Liu Shu from all provinces and cities of the Alliance serve as vice chairmen.
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Source: Medical Oncology Channel
Review: Yangtze River Academic Belt Breast Alliance
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
Plate making: Xue Jiao