VIDEO: ‘Many things coming of age’ in metastatic breast cancer research

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What we are hoping to achieve in breast cancer, both in the early setting and also in the metastatic setting, is to kind of tailor treatments, based both on the disease profile and the patient profile. And so, when we think of that, usually we think of biomarkers. One thing that is, for instance, entered practice in a way, but I think we still need to optimize the use of this tool, is circulating tumor DNA. So being able to track in patient's blood with a noninvasive blood draw, the genome of the tumor, how it evolves in time, and also what is the fraction of this ctDNA if it tracks with the worst prognosis or better prognosis. I think we still have to understand how to best utilize ctDNA in order to tailor treatment strategies. And we are learning this, and there are trials ongoing to kind of modify the treatment strategy, depending on ctDNA presence or absence, and also the mutations that are found in the ctDNA. And together with this in terms of tailoring, I think it's important to understand when we can escalate and deescalate treatment at the benefit of the patient. And so, for instance, we know that HER2+ breast cancer is an interesting disease in the metastatic setting because it can still, even if metastatic, be cured in certain cases with our treatments. And so, we are going to run a Dana-Farber bullet trial where we try to stop HER2 treatment like trastuzumab [Herceptin; Genentech] with pertuzumab [Perjeta; Genentech] for patients that are long-term responders, trying to see if we can maintain outcomes with less treatment. But also, at this different trial that is about to start, where for patients that have disease that seems more responsive to enter to treatment, given a frontline treatment that is intensified in order to kind of cure this patient, elevate the rate of cure of patients and these are all in the pipeline, is all about to happen.

And finally, I think that once again, I may be repeating myself, but I think that we are pharmacologically improving many of our treatments, and so for instance, antibody drug conjugates, I think, are just at the dawn. We realize that by binding chemotherapy to antibodies, we can deliver it in a more effective way to tumors. But we are also now realizing that we can bind several different things to antibodies in order to make them more effective. And so, for instance, in the pipeline we have immune-stimulating conjugates that are able to deliver toll-like receptor agonists directly to the tumor with potential synergism with immunotherapy. We are having radio immune-conjugates, they are able to deliver the radio nuclei to tumors, and also we can deliver targeted agents or PROTACs in the proximity of tumors. So, we are realizing that this antibody-based strategy of drug delivery is becoming more and more appealing. And finally, imaging. I feel that, for instance, PET imaging, and not only PET, there are several novel imaging techniques that are helping to understand if the tumor is responding to a certain treatment, and I can envision in the future that for tumors that respond well to a certain treatment, we can adapt the treatment strategies and further escalate and deescalate. So, many things are coming of age and are happening in the field, and I think soon they will collide and they will help all of us to treat patients in a more tailored way.