VIDEO: Exciting ongoing breast cancer research on genomic mutations, MRD assays and more

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It is a very exciting time to be an oncologist. So, I came into this field at the right time. There's so much research going on and so many things to be excited about. But if I had to pick a few areas, I think one of the main areas I'm excited about that will grow, I think, in the next futures is our ability to be more precise and targeted in our treatment decisions for patients with early-stage breast cancer. We have accumulated decades of understanding of subtypes of breast cancer, and identifying different markers that may predict a better or a worse prognosis with different treatments.

So I'm excited to see that in certain subtypes of breast cancer that traditionally would be treated primarily with chemotherapy, we're starting to narrow down into certain groups that perhaps do not need as much chemotherapy, or maybe even be treated without chemotherapy. For example, we're seeing research ongoing for patients that have germline mutations like BRCA mutations and even PALB2 mutations where traditional chemotherapy backbone for a patient, let's say, with triple-negative breast cancer that has a BRCA mutation is replaced by an oral targeted therapy like a PARP inhibitor. And we see that a large proportion of those patients, in some studies about half of the patients with these mutations, can have complete responses to that treatment, and may in the future offer the opportunity to avoid chemotherapy. So that would be, I think, a game changer to be diagnosed with triple-negative breast cancer and be told, yep, you take a pill and you don't need chemotherapy. Very exciting, in my mind.

And along the same lines, you know, understanding that the patients with BRCA mutations are an important subset, but a small subset of patients with breast cancer. There is many other tests including assessments of the immune system like tumor infiltrating lymphocytes, and certain genomic assays that are helping us identify patients that do very well, even without chemotherapy. And perhaps future studies will help us define, you know, how to use these markers to avoid the toxicities of our treatments if the patient is projected to do very well without them.

Along those lines as well, I think that we are getting more sophisticated in our tests to try to detect very minimal amounts of cancer in the blood. So we have this minimal residual disease assays that rely on measuring circulating tumor DNA in the blood that I think are going to, in the next few years, really change how we approach breast cancer. And how we decide who needs more or less treatment as well. And who could be cured, beyond what we can currently achieve with our imaging tests today. So that's on the area of trying to decrease the toxicities of treatment, and decrease the intensity of our treatments if patients do not need it.

We still recognize that there's many areas of unmet need where our treatments are just not good enough, you know. Where our treatments are not achieving enough control of the cancer, particularly in patients with metastatic disease and with triple-negative breast cancer. And in this space, I'm very excited about the new wave of antibody drug conjugates that we're seeing. And we're seeing kind of unprecedented levels of efficacy for some of these agents. And there's way too many to even list in development. Which I think is going to be really, really favorable for our patients. And it's going to make our field also much more rewarding because we're going to be able to help larger numbers of patients in the future.