VIDEO: Challenges in treating de novo metastatic breast cancer

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One challenge that we find is that somewhere between five to 7% of patients develop what we call de novo metastatic breast cancer, meaning that at the time they present with their original breast cancer, the cancer has already spread. And so that's not so common. It tends to be a bit more common in HER2 positive disease, but in general, it isn't something we commonly see. And you know, I think there's been some thought. Should the treatment approach be different for the de novo metastatic patients, compared to those who developed recurrent disease from an early breast cancer that then developed metastatic disease? And the reason we sort of have been thinking about this a bit is that, you know, patients who have de novo metastatic disease tend to live longer than patients who have recurrent disease. Obviously these patients are treatment-naive. Their cancer is very likely to be exquisitely sensitive to our therapies.

But on the flip side, there's also this thought: If they have very minimal metastatic disease at the time of their presentation, and they're treatment-naive, could we potentially cure them, now that our systemic therapies are so much better? And this has become a major question, particularly in HER2 positive disease, where these targeted drugs really, you know, are just becoming so effective, we wonder if there is the potential to cure them. And in fact, there is a trial that is just about to start led by one of my colleagues, Heather Parsons, where she is trying to take this strategy in patients who do have, usually it's the de novo metastatic patients, who, again, do very well. And so if we took them, and gave them sequential serial HER2-directed therapies, kind of like we give a patient with early stage breast cancer, we give them adjuvant therapies, could we potentially cure these people? And again, I think this is a completely out-of-the-box idea. I don't know if it will work or not, but I do think we're getting to a point where we need to think about this. And so right now, there isn't a different approach for de novo metastatic disease relative to recurrent disease. You're just basing on what prior therapies they may have had versus not. But I do hope that as we get better and better systemic treatments, that maybe we'll come up with strategies that could allow us to cure some of our metastatic patients.