Podcasts about breast oncology

In this episode, listen to Stephanie L. Graff, MD, FACP, FASCO; and Laura M. Spring, MD, share their clinical insights and takeaways regarding the current treatment landscape for first-line treatment of patients with HER2-positive metastatic breast cancer including:Data from multicenter, single-arm, phase IIIb/IV DESTINY-Breast12 evaluating trastuzumab deruxtecan (T-DXd) in patients with advanced HER2-positive metastatic breast cancer and 2 or fewer previous therapiesTreatment sequencing and preferred treatment options in patients with brain metastasesResults from phase III PATINA trial of trastuzumab, pertuzumab, plus endocrine therapy with or without palbociclib in hormone-receptor positive/HER2-positive metastatic breast cancerThoughts on the use of T-DXd earlier in the treatment paradigm in light of recent results from the PATINA trial and highly anticipated results from the DESTINY-Breast09 trialProgram faculty:Stephanie L. Graff, MD, FACP, FASCODirector of Breast Oncology, Brown University HealthCo-Lead, Breast Cancer Translational Disease Research GroupLegorreta Cancer Center at Brown UniversityAssociate Professor of MedicineWarren Alpert Medical School of Brown UniversityProvidence, Rhode IslandLaura M. Spring, MDBreast Medical OncologistMass General Hospital Cancer CenterHarvard Medical SchoolBoston, Massachusetts Resources:To access the patient cases associated with this podcast discussion, please visit the program page and register for an upcoming webinar on this topic.

In this enlightening episode of the Patient From Hell, host Samira Daswani interviews Dr. Sara Tolaney, a leading oncologist specializing in breast cancer. They delve into the evolving landscape of triple-negative breast cancer (TNBC), exploring advancements in treatment, from targeted therapies to immunotherapy, and the challenges faced by patients in both early-stage and metastatic settings. With her characteristic warmth and expertise, Dr. Tolaney provides actionable insights for patients and caregivers, offering hope and understanding in navigating this complex diagnosis. Key Highlights: 1. A New Paradigm in Early-Stage TNBC Treatment: Dr. Tolaney explains how neoadjuvant chemotherapy combined with immunotherapy has revolutionized outcomes, achieving pathologic complete response rates above 60%. 2. Metastatic TNBC Advances: The discussion highlights the critical role of biomarker testing and the introduction of innovative therapies like antibody-drug conjugates, providing extended survival for many patients. 3. Empowering Patient Symptom Management: The episode underscores the importance of patient-reported outcomes and emerging tools like health apps to enhance self-management and real-time support for side effects. About our guest: Sara Tolaney, MD, MPH is the Chief of the Division of Breast Oncology at Dana-Farber Cancer Institute, and is internationally recognized for her research and education leadership in breast cancer. She also serves as Associate Director of the Susan F. Smith Center for Women's Cancers and is a Senior Physician at Dana-Farber Cancer Institute and Associate Professor of Medicine at Harvard Medical School. Dr. Tolaney received her undergraduate degree from Princeton University and her medical degree from UC San Francisco. She subsequently completed her residency in Internal Medicine at Johns Hopkins University, and fellowships in hematology and medical oncology at Dana-Farber Cancer Institute. She obtained her Masters in Public Health from Harvard School of Public Health. Her research focuses on the development of novel therapies in the treatment of breast cancer and developing more effective and less toxic treatment approaches. Her work has demonstrated that a relatively low risk regimen is beneficial in women with early stage node-negative HER2-positive cancers, and this works has been incorporated into national and international guidelines. She has developed several follow-up studies looking at novel approaches to early stage HER2-positive disease and has also played a significant role in development of cdk 4/6 inhibitors, antibody drug conjugates, and immunotherapy in breast cancer. She is the author of over 150 peer-reviewed publications with manuscripts included in many prestigious journals such as the New England Journal, Lancet Oncology, Journal of Clinical Oncology, and JAMA Oncology. Key Moments: At 8 minutes: "It used to be that if someone had a triple negative breast cancer, we would often take someone to surgery and then after surgery give them some chemotherapy to kill any stray cells that might've gotten into the bloodstream and integrate radiation as needed. But we've really changed our approach very dramatically over the last few years where we've learned that if someone has an early stage, stage two or three triple negative breast cancer, it is actually very critical that they not go to upfront surgery, but in fact get chemotherapy with immunotherapy prior to surgery." Disclaimer: All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Join us for an empowering and insightful conversation as Dr. Jennie Berkovich sits down with Dr. Amy Comander, a leading breast oncologist and advocate for patient-centered care. In this episode, Dr. Comander shares her expertise on the latest advancements in breast cancer detection, treatment, and survivorship. Discover how personalized medicine and multidisciplinary care are revolutionizing outcomes for breast cancer patients. Dr. Comander also delves into the critical role of lifestyle medicine—including exercise, nutrition, and mindfulness—in promoting healing and resilience. With her unique perspective as a passionate runner and physician, Dr. Comander draws inspiring parallels between running and the cancer journey, offering hope and practical advice for patients and their families navigating a diagnosis. Whether you're a healthcare professional, patient, or advocate, this episode will leave you informed, inspired, and ready to run the race toward better cancer care. Don't miss it! Dr. Amy Comander specializes in the care of women with breast cancer.  Dr. Comander is Medical Director of the Mass General Cancer Center in Waltham, where she also serves as Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham and at Newton Wellesley Hospital. She is an Instructor in Medicine at Harvard Medical School. She received her undergraduate degree and a master's degree in Neuroscience at Harvard University. She received her medical degree at Yale University School of Medicine. She completed her Internal Medicine residency training and Hematology-Oncology fellowship training at Beth Israel Deaconess Medical Center and Harvard Medical School. She is board certified in Hematology and Medical Oncology, and she is a Diplomat of the American Board of Lifestyle Medicine. _________________________________________________ Sponsor the JOWMA Podcast! Email digitalcontent@jowma.org Become a JOWMA Member! www.jowma.org Follow us on Instagram! www.instagram.com/JOWMA_org Follow us on Twitter! www.twitter.com/JOWMA_med Follow us on Facebook! https://www.facebook.com/JOWMAorg Stay up-to-date with JOWMA news! Sign up for the JOWMA newsletter! https://jowma.us6.list-manage.com/subscribe?u=9b4e9beb287874f9dc7f80289&id=ea3ef44644&mc_cid=dfb442d2a7&mc_eid=e9eee6e41e

The Breast Cancer Prevention and Control Policy is an important documentaimed at prioritizing breast cancer awareness, prevention, treatment andcare in South Africa. It provides the clinical support for women, who are bothat-risk of developing the disease later in life and are currently undergoing treatment to survive and live healthy lives. Joining us for this discussion for tonight’s Medical Matters is Dr Phumudzo Ndwambi, Specialist Surgeon specialising in Breast Oncology at Chris Hani Bara Academic Hospital.See omnystudio.com/listener for privacy information.

Disclaimer: This video is intended solely for educational purposes and opinions shared by the guest are his personal views. We do not intent to defame or harm any person/ brand/ product/ country/ profession mentioned in the video. Our goal is to provide information to help audience make informed choices. Order 'Build, Don't Talk' (in English) here: https://amzn.eu/d/eCfijRu Order 'Build Don't Talk' (in Hindi) here: https://amzn.eu/d/4wZISO0 Follow Our Whatsapp Channel: https://whatsapp.com/channel/0029VaokF5x0bIdi3Qn9ef2J Subscribe To Our Other YouTube Channels:- https://www.youtube.com/@rajshamaniclips https://www.youtube.com/@RajShamani.Shorts

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Hope S. Rugo, MD, FASCO While endocrine therapy (ET) and CDK4/6 inhibitors are the standard for treating ER+/HER2- metastatic breast cancer, patients can become resistant to ET. To overcome these resistance mechanisms, the ELEVATE study examines whether combining elacestrant with ET could help address this unmet need. Here to share the preliminary findings from ELEVATE with Dr. Charles Turck is lead study investigator Dr. Hope Rugo. She's also the Winterhof Distinguished Professor of Breast Oncology and the Director of Breast Oncology and Clinical Trials Education at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center.

Treatment for high risk early-stage breast cancer is transforming, with CDK4/6 inhibitor data extending survival. We explore the management of patients in this setting with Jenny Gilchrist, Nurse Practitioner in Breast Oncology at Macquarie University Hospital, Samantha Moules, McGrath Breast Care Nurse, Genesis Care Northern Sydney and Michael Fitzgerald, Nurse Practitioner – Medical Oncology Cancer Services at Flinders Medical Centre in Adelaide. This podcast is available to CNSA Members. To listen to the full podcast, log into the membership portal.

Cancer is the second cause of death worldwide, and cases are set to increase to 35 million over the next two decades. Even though we've made great strides in research and therapeutic advances, the risk of cancer is still high.   That doesn't mean we have to just accept that cancer will happen to more of us. There are steps we can take to prevent it and increase our survivorship if we do get it.   It has been proven that lifestyle choices can reduce your risk of cancer. What we eat and how active we are can have a huge impact on the likelihood of getting cancer. By far, things like our weight and our habits are the most modifiable risk factors, and the good news is, they are entirely in our control.   Why has there been a rise in the global cancer burden? How can we reduce our risk? In this episode, I'm joined by the Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham, Dr. Amy Comander. She shares how we can address the rising global cancer burden by changing our lifestyles.    30-40% of cancers can be prevented by avoiding risk factors and applying good and healthy lifestyle choices to our own lives. -Dr. Amy Comander    Three Things You'll Learn In This Episode    -Why your lifestyle choices matter If certain lifestyle choices increase the risk of cancer, that means our choices can also reduce it. How can we combat the disease by implementing good lifestyle choices?    -The bad news about the genetics (and the good news) Genetics and hereditary alterations are known factors that increase the risks of cancer. Can lifestyle choices protect those who are predisposed to cancer, and even stop it from transmitting to the next generation?     -This lifestyle change will reduce your risk of cancer Excess fat cells have been found to be a risk factor for cancer. How do fat cells propagate the development of cancer cells?    Guest Bio Dr. Amy Comander specializes in the care of women with breast cancer. Dr. Comander is Medical Director of the Mass General Cancer Center in Waltham, where she also serves as Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham and at Newton Wellesley Hospital. She is director of Lifestyle Medicine at the Mass General Cancer Center, and an Instructor in Medicine at Harvard Medical School. She received her undergraduate degree and a master's degree in Neuroscience at Harvard University. She received her medical degree at Yale University School of Medicine. She completed her Internal Medicine residency training and Hematology-Oncology fellowship training at Beth Israel Deaconess Medical Center and Harvard Medical School. She is board-certified in Hematology and Medical Oncology, and she is a Diplomat of the American Board of Lifestyle Medicine. Dr. Comander is well-known for her compassionate care and passionate devotion to her patients. She has served as a medical advisor to Oneinforty, a non-profit organization dedicated to educating people of Ashkenazi Jewish heritage about the one-in-forty chance of having inherited a BRCA mutation. She is proud to serve on the board of the Ellie Fund, a non-profit that provides services and support to women diagnosed with breast cancer in Massachusetts. Dr. Comander has a strong interest in improving the quality of life and outcome of cancer survivors through important lifestyle interventions, including physical activity, diet, and mind/body interventions. She promotes healthy lifestyles for both her active treatment patients as well as those in the survivorship phase of care. She has launched PAVING the Path to Wellness, a 12-week lifestyle medicine-based survivorship program for women with breast cancer. Connect with Dr. Comander on LinkedIn.  Go to https://www.aicr.org/cancer-prevention/how-to-prevent-cancer/ to read about the 10 cancer prevention recommendations.

Last year, Dr. Sara Tolaney, Chief of the Division of Breast Oncology at Dana-Farber Cancer Institute, served as co-chair of i3 Health's webinar and online activity, Pathology and Oncology Expert Perspectives in the Management of Triple-Negative Breast Cancer (TNBC). With numerous advances in TNBC research occurring since then, Dr. Tolaney sat down with Oncology Data Advisor to share additional updates from clinical trials and a preview into the future of treatment with emerging therapies for TNBC.

In this interview, Jason Mouabbi, MD, an Oncology Data Advisor Editorial Board Member and Assistant Professor in the Department of Breast Oncology at the University of Texas MD Anderson Cancer Center, sat down with Valerie Brutus, MD, FACS, a Breast Surgical Oncologist at St. Vincent's Medical Center of Hartford HealthCare, and Elizabeth Stirling Craig, MD, Director of Microvascular Breast Reconstruction at St. Vincent's Medical Center of Hartford HealthCare, to discuss improving breast cancer surgical outcomes with lymphovenous bypass surgery. Dr. Mouabbi engages Dr. Brutus and Dr. Craig in a thought-provoking discussion about lymphovenous bypass surgery: what it is, who qualifies for this procedure, its viability, what to expect from this procedure and its treatment process, and more about breast cancer surgical outcomes.

When Stephanie Graff was a breast oncology fellow in 2010, one of her patients brought a marked up copy of “Dr. Susan Love's Breast Book” to an appointment. “One of my patients had brought it in and was using it almost as her cancer notebook, and had pages flagged and said, 'Well, what about this? What about this? It says here…,'” Graff, director of Breast Oncology at Lifespan Cancer Institute and medical advisor for the Dr. Susan Love Foundation for Breast Cancer Research, said to The Cancer Letter. It was the first time that the book, written by Susan Love, a breast cancer surgeon, activist, and founder of the Dr. Susan Love Foundation for Breast Cancer Research, had shown up on Graff's radar. “Dr. Susan Love's Breast Book” was first published in 1990. Now, Graff is a contributing author of the seventh edition, the most recent version of the book published in 2023. Graff spoke with Alexandria Carolan, associate editor of the Cancer History Project. A full transcript of this conversation, including how Graff came to know and work with Susan Love, appears on the Cancer History Project.

This is an introduction the latest episode Podcast, where we discuss Triple Negative Breast Cancer and the role of IO therapy. Jenny Gilchrist, a Nurse Practitioner in Breast Oncology at Macquarie University Health Services Centre and Chief Clinical Lead for the Metastatic McGrath Breast Cancer nurses, is joined by Melanie Rabbets, Clinical Nurse Practitioner at Blacktown Hospital. . This podcast must be accessed via the member portal at https://www.cnsa.org.au/congressevents/podcast CNSA has big plans for the next twelve months, with over 30 webinars scheduled; Breast Cancer, Management and Educator Communities of Practice tackling relevant and practical topics; and of course the Annual Congress in June. Jemma Still, Chief Executive Officer Cancer Nurses Society of Australia give a brief insight into what is coming for 2024.

Drs. Hope Rugo and Sara Tolaney discuss the promise of antibody-drug conjugates (ADCs) in the treatment of breast cancer, highlighting key trials that shed light on matching the right ADC to the right patient in the right setting. They also explore how combinations and sequencing of ADCs can augment their efficacy, the mechanisms of resistance, and the future potential of biomarkers to predict patient response. TRANSCRIPT Dr. Hope Rugo: Hello, I'm Dr. Hope Rugo, your guest host of the ASCO Daily News Podcast today. I'm a professor of medicine and director of breast oncology and clinical trials education at the University of California, San Francisco's Comprehensive Cancer Center. Antibody-drug conjugates, or ADCs, are rapidly changing the treatment landscape for patients with breast cancer. ADCs consist of antibodies that target tumor-specific antigens on the cell surface, chemical linkers, and cytotoxic payloads that can act powerfully to kill cancer cells. On today's episode, we'll be discussing advances in research to match the right ADC to the right patients and in the right setting. We'll also talk about the next steps, assessing how combinations and sequencing of ADCs can augment their efficacy, improve options for patients, and identify biomarkers in the future to predict how patients will respond so that we can match the right treatment to the right patient and their tumor. We need to gain a better understanding of the mechanisms of resistance that occur upfront as well as under the pressure of treatment.  Joining me for this important discussion is Dr. Sara Tolaney. Dr. Tolaney is an associate professor of medicine at Harvard Medical School, associate director of the Susan Smith Center for Women's Cancer, and chief of the Division of Breast Oncology at the Dana-Farber Cancer Institute in Boston.  You'll find our full disclosures in the transcript of this episode and disclosures of all guests on the podcast are available at asco.org/DNpod. Dr. Tolaney, we're delighted to have you on the podcast today. Thanks for being here. Dr. Sara Tolaney: Thank you so much for having me. I'm looking forward to the discussion. Dr. Hope Rugo: Great! So, we'll move forward, and because we're friends and colleagues, I'm going to refer to you as Sara, and I'm Hope, since we'll dispense with formalities in our discussion.  A lot of the talks that we give about ADCs start out with “a revolution in breast cancer therapy.” And indeed, this is a really exciting time with ADCs as treatment for breast cancer, and we're rapidly moving these agents into earlier disease settings. Can you tell us a little bit about the possibilities and challenges of using ADCs for the treatment of breast cancer today? Dr. Sara Tolaney: It's interesting that you say antibody-drug conjugates as revolutionizing outcomes of breast cancer, which I think is true. But on the flip side, I think it's also bringing up a lot of questions about how to use them, when to use them, and how to manage side effects. So there are a lot of good strengths for these antibody-drug conjugates, but a lot of unknowns that we're still trying to figure out. We had an older antibody-drug conjugate T-DM1 that we were all very familiar with that for years had been a treatment that we used very commonly in metastatic disease and now even use in early breast cancer, and I think has changed outcomes for patients. But over time, we've been able to develop newer antibody-drug conjugates as the technology has really evolved so that these agents now are able to deliver a lot of chemotherapy into a cancer cell. We're seeing very high drug-to-antibody ratios, and we're also seeing that these drugs can function via bystander effect, whereas T-DM1, for example, was not able to do that. But our newer ADCs, like sacituzumab govitecan or trastuzumab deruxtecan, are agents that do allow chemotherapy to get into that cancer cell, but also to get into neighboring cells.  And I think the technology evolution in being able to build these so-called next-generation ADCs has allowed for really unprecedented efficacy that we've not seen before. And it's also allowed us to develop these drugs in a way that's been different. Originally, we were developing T-DM1 to turn off HER2 signaling and to deliver chemotherapy into a HER2 cell. At least that's what we thought originally. And now we're really evolving so that we can just find a tiny bit of protein on a cancer cell and use it as a target, really in a subtype-agnostic way. And I think it's just a different way of thinking about how to use these agents to really deliver a lot of chemotherapy into cancer cells and have very robust efficacy. Dr. Hope Rugo: Yes, it is fascinating that some of the suppositions that we made with the first ADC don't seem to really hold true as well. And maybe they hold true in varying levels for the different ADCs. For example, this bystander effect is thought to allow us to target cells that have very low expression of the receptor that can be internalized even lower than our ability to detect these receptors by immunohistochemistry. And maybe we'll talk about that in a little bit.   But first, you mentioned already sacituzumab and trastuzumab deruxtecan, the ADCs that are currently approved for breast cancer. But can you tell us a little more about those ADCs and the key trials that have led to approval of these targeted agents? Dr. Sara Tolaney: Yes, I think when we first saw the data that came out with T-DXd and DESTINY-Breast01, I think my jaw dropped because I had never seen a waterfall plot like that. This was a single-arm study that looked at T-DXd in patients with very heavily pretreated metastatic HER2-positive breast cancer and saw very high response rates of over 60% and a clinical benefit rate of almost 98%, meaning that almost every single patient who got the drug and had a median of six prior lines of therapy had reduction in tumor size. And that's unreal. I think it was revolutionary in the sense that we had never seen that kind of activity in such a pretreated population. The agent was studied in other registration trials, DESTINY-Breast03, which looked at T-DXd and compared it head to head with T-DM1 in a predominantly second-line metastatic HER2-positive population, and here, again, unprecedented results. I've never seen a p value like that or a hazard ratio of, again unreal, of a little under 0.3 and seeing a 28-month PFS with T-DXd relative to just a little under 7 months PFS with T-DM1. We have never seen patients with metastatic HER2-positive breast cancer have a PFS that long. Even in CLEOPATRA, it's a little under 19 months in the first-line setting, where people were predominantly naïve to HER2-directed therapies. This, again, is really changing outcomes for patients.   But then, I think, when we go to the next step, we studied T-DXd in patients with HER2-positive breast cancer and it had again these unprecedented results. But there was some early data suggesting that it could even work in tumors that weren't truly HER2-positive but what we call HER2-low, meaning that they weren't HER2/3+, they weren't HER2-0 but they were 1+ to 2+ and not FISH amplified. And so even with a little bit of protein there, they were seeing activity in the early phase studies and so it led to DESTINY-Breast04, which compared T-DXd to chemotherapy of physician's choice in people who had had one or two prior lines of chemotherapy in the metastatic setting. It was predominantly geared to look at outcomes in hormone receptor-positive breast cancer. But there was a small group of 58 patients with triple-negative disease that were also included in that trial. And here again, a very unprecedented outcome seeing a response rate of about 50%, which, again, we never see in pretreated hormone receptor-positive disease. And a PFS of 10 months, and again, these are people who already had one or two prior lines of chemotherapy. So it's, again, really changing outcomes. And so now I think it leads us to a lot of other questions that we are addressing in trials - can this drug work even if the tumor has maybe no HER2 expression, what about HER2-0, what about HER2-ultra low, meaning a little bit of staining but not quite 1+. And so these are questions that I think we will need to address and there are studies that will help us address that. On the flip side, we saw sacituzumab govitecan get developed in breast cancer. Initially, we saw very impressive results from a single arm study of sacituzumab in metastatic triple-negative disease where we saw response rates of a little over 30%. These are patients who were very heavily pretreated with metastatic triple negative breast cancer where, unfortunately, response rates end up being in a 5% range so it was a home run in that setting. So that led to the ASCENT trial, which compared sacituzumab govitecan to treatment of physician's choice therapy and that study really enrolled people who were, in essence, second line and beyond in the metastatic triple-negative setting and showed almost triple progression free survival, in essence, doubled overall survival. So again, very robust efficacy leading to confirming its approval. And then we saw data from TROPiCS-02, which looked at sacituzumab in metastatic hormone receptor-positive disease and also showed improvements in both progression free and overall survival. And this was in pre-treated populations of 2 to 4 prior lines of chemotherapy. These agents, again, have established robust efficacy, and so now the idea is can we move these drugs earlier in development into earlier line settings and can we even move these agents into the early disease setting and potentially cure more patients? So hopefully, we'll figure out ways to make that happen. Dr. Hope Rugo: Yeah, that was a great summary of this exciting data. And I think we really got an idea of what waterfall plots could tell us from DESTINY-Breast01 where you could count the number of patients whose cancers grew with therapy on one hand. It's been a huge advance. I think it's where we get this “revolution” even in patients with a median of 4 lines of prior chemo, and, in the ASCENT trial, we were able to see this improvement and survival in the hardest-treated subset of metastatic breast cancer triple negative disease. And then the remarkable data in HER2-positive and HER2-low breast cancer hormone receptor positive disease. We're really covering all of the subset of breast cancers.   When we introduce new therapies though, and of course, our interest is moving them earlier as lines of therapy in the metastatic setting, we really have to think about the adverse events and how those are going to affect their patients, and balancing the risk benefit ratio. Obviously when the benefit is so huge, we're more thinking about how do we proactively manage these side effects, educate our patients, use prophylaxis when possible. Can you share with us some of your insights on management strategies for toxicities?  Dr. Sara Tolaney: You bring up a very good point, and I will say the ADCs were designed with the idea being that we could deliver a ton of chemotherapy into a cancer cell. So obviously, my hope had been that we weren't going to see a lot of chemotherapy-like side effects because the goal was to try to spare normal cells of these side effects. But unfortunately, we do see that these agents do have real toxicities, and I think that is an important message. So, for example, with sacituzumab, for people who have hair going into it, they will lose their hair during the course of treatment, and so that's important to make patients aware of. It can lower blood counts, and about 50% of patients who are on sacituzumab will end up needing growth factor support while they're on treatment. So, that is again something that needs to be monitored and managed. But usually, we're pretty good at managing neutropenia, and with the growth factor support, I find that it actually works really well.  Another thing with sacituzumab is the potential risk of diarrhea, but most of the diarrhea is low-grade diarrhea. It's rare that you get someone who has high-grade diarrhea with sacituzumab. Usually, I find it works to just instruct patients to use loperamide as needed. And again, usually that works well. And certainly when needed, dose modification can also help with these side effects and so it is important to keep in mind that this is another option. With T-DXd, one thing that we do have to keep in mind as an unusual side effect is the potential risk of interstitial lung disease. We see that in about 10% to 15% of patients getting T-DXd. That is something that we do have to be very mindful of. For the most part it is low-grade ILD. But there are rare occasions where there have been deaths from ILD. And we're seeing with some of the newer trials, the death rate is usually under 1%, but it is a real potential risk. And so it is really important to counsel patients when getting T-DXd about this potential side effect, that way they are good about communicating with you if they get any new symptoms, such as shortness of breath or dry cough, to get you aware of it and can work it up and get imaging certainly if that occurs.  And then I think the management for ILD is a little unique and a little different truthfully than the way we manage pneumonitis from other drugs. Normally, when I am treating patients who develop pneumonitis, even if it is mildly symptomatic, we often will hold treatment, give steroids, and rechallenge them when it gets better. But with T-DXd, if anyone develops symptomatic pneumonitis, you actually have to permanently discontinue the T-DXd per the guidelines because we just don't know the safety of being able to rechallenge that patient once that pneumonitis resolves. For grade 1 ILD, meaning someone who has, for example, ground glass changes seen on imaging but doesn't have any symptoms, you have to hold the drug and wait until those imaging findings resolve and then you can restart. I usually do treat grade 1 ILD patients with steroids with the hope being that maybe it will allow for the pneumonitis to resolve more quickly, although in truth I don't know if that's the case. I have just taken that approach because I don't like leaving patients off the drug for too long if not needed. Again, I typically treat them with steroids, reimage in three to four weeks, and see if I'm able to restart. If they resolve within 28 days, you can restart at the same dose. If it takes longer to resolve, you need to dose modify.  And then I think the other big thing with T-DXd is to know that it is categorized as a highly emetogenic agent. Most of us are using three-drug prophylaxis, which I think works really well. It is also important to realize that there can be some delayed nausea, which is a little unusual with some of our other agents. And so to warn patients about that and I find that use of olanzapine or ondansetron for the delayed nausea tends to work pretty well.  Hope, do you have any pearls for us? Obviously, you are very experienced in using these agents; are there any things you would recommend for the management of ADCs?  Dr. Hope Rugo: Yes, it's such a great question and an important area because, particularly as we are using these agents earlier, we really need to have strategies for both how long to continue as well as manage the toxicities. I agree with the nausea, olanzapine has been really a great addition, and using a triplet as initial premedication makes a big difference for T-DXd and other deruxtecan ADCs that are in the pipeline. And then I think that the ILD issue, we're really learning more about the risk factors as well as retreatment. And hopefully, we'll have more data this year at ESMO Breast and maybe ASCO on retreatment for grade 1. We certainly now do not have any data on the safety of retreatment for grade 2, so that is really not accepted now. For sacituzumab, I think the interesting area is the metabolism and the impact. So with neutropenia, as we move the drug earlier, it's easier and easier to manage, we see less severe neutropenia. We can give growth factors, which we are all good at in oncology. But I think the question about managing diarrhea and who is at risk still exists. Understanding pharmacogenomics and UGT1A1 is an interesting area where patients who have diarrhea could be tested to see if they are poor metabolizers which affects a little under 10% of the overall population. Because in that group, you could give less drug and get the same benefit with less toxicity. So I think this is all very interesting. It is important for providers and patients to be educated so that we can manage this appropriately. And I think you gave an excellent overview.   We have new agents in the pipeline also and maybe we'll talk about those next, and then we'll talk a little bit about sequencing and resistance, as well as the unmet need for brain metastases. So lots of areas to talk about. There are a number of TROP-2 ADCs that are in the pipeline, and one that has presented phase III data, datopotamab deruxtecan. But other studies are being developed with new TROP-2 ADCs as well. But then there are a huge number of ADCs there with new targets, for example, immune effector targets, and new payloads, even immunotherapy and two different payloads or bispecific antibodies. And then there is interest in combining ADCs with immunotherapy and PARP inhibitors. We saw data in bladder cancer, I think it was bladder cancer, with combined 2 different ADCs at ESMO in 2023. So a lot of new approaches. How are we going to manage this moving forward? And where do you think we are going to position some of these next sort of "me-too" drugs?  Dr. Sara Tolaney: It's an excellent question, and you're right, the field is exploding with new antibody- drug conjugates. So, it's going to leave us with this conundrum of what to do. And you brought up the really interesting example of the fact that we have an approved TROP-2 ADC, we have as sacituzumab govitecan, and for example, we've recently seen some really exciting data come out from TROPION-Breast01 looking at another TROP-2 ADC, datopotamab deruxtecan or Dato-DXd where that ADC performed better than chemotherapy in a head-to-head trial in terms of progression-free survival in a hormone receptor-positive population. Then there's another TROP-2 ADC, moving forward in development moving to phase III that Merck is developing MK-2870. All three of these ADCs are targeting TROP-2 and have a TOPO 1 payload. So, it leaves you with the question of how do you think about that? Is there going to be a role for using serial TROP-2 ADCs? Could one work after the other, even when they have very similar payloads? How are we going to incorporate them? How do you pick one over the other? So, it is going to be tricky for us as we get more and more of these agents. I think we're all excited about seeing ADCs that may have different targets and different payloads, where maybe we will see that sequential utilization will have robust efficacy if we swap things out. Again, we don't have data here yet, but I think there are other agents in development. For example, you could think of like, disitamab vedotin targets HER2 and has an MMAE payload. So, could it be that someone progresses on T-DXd for HER2-low, but then could go on to disitamab vedotin? How will that work? So, we have a lot to learn, but it's really nice to have so many options.  Dr. Hope Rugo: Yeah, it'll be interesting to see whether or not we select the ADC based on a rational understanding of the tumor and the patient, or whether it's simply what's easier to give and has the right toxicity for that patient.  So, that sort of brings us to our next topic, which is how are we going to sequence these agents? How are we going to understand the mechanisms of ADC resistance? At San Antonio in 2023, we saw a presentation where there was a top-alteration, and the patient had a really long response to a top-directed ADC, or an agent that carried a topoisomerase inhibitor. And that really struck me that we're going to see these alterations. There was a fresh autopsy study that suggested that the alterations may be different in different organ sites of disease. How are we going to figure this out? Dr. Sara Tolaney: Yeah, I also was really puzzled to see those data from San Antonio where we've sort of simplified ADC resistance in our heads to say, well, maybe someone becomes resistant because they lose target expression, or maybe someone becomes resistant because they've developed resistance to the payload, kind of like the way we think of someone developing resistance to getting chemotherapy. But obviously, it's probably far more complex than that. With these ADCs, they need to be able to internalize the ADC and could there be mechanisms of resistance related to the internalization process? So, I think there are lots of potential areas where resistance could be occurring. I think, we don't understand it very well. We've seen patients, for example, who have responded. This is just anecdotal, but we have data, for example looking at, Dato-DXd in the phase 1 triple-negative study where there were some patients who responded despite having progressed on sacituzumab. Well, why is that? You would think if it's target resistance or payload resistance, it would be the same target and a very similar payload. So, why would those drugs work one after the other? And that's why I think we just don't understand this well enough at this point in time.   So, it's clearly an area where more research is needed because it does have significant implications on how we think about using these drugs sequentially. We will need to understand these resistance mechanisms because there do seem to be some rare patients who benefit from these sequencing strategies and then others who don't. So, it would be nice to be able to figure this out and hopefully in the future, we'll be able to test patients and know what drugs to give them. But I think we're far off from that, unfortunately, right now. Dr. Hope Rugo: Yeah, it does seem to be a relatively elusive approach, and I think, in part, it's due to the heterogeneity of cancer. And maybe, as we're better and better at analyzing tumor cells in the blood, which are a rare group, and ctDNA, which, of course, we do now to look for mutations, maybe that'll be an approach that we'll be able to take. And also, of course, moving the drugs earlier into the disease setting with less heterogeneity and mechanisms of resistance might help as well.  I was fascinated by the fact that although the PFS to the first ADC seems to be overall much greater than the PFS to the second ADC, when you sequence them, there are a few patients who have a longer PFS with the second, even if these are just sacituzumab T-DXd sequencing in various directions. So, it's clearly very complex. And right now, I think we're just sequencing and we don't really know how to do it. We just choose what we think is best for that patient first and go on to the next one later, which is interesting. And one of the choices might be treating brain metastases, which of course remains a huge unmet need. And if we could find effective treatment for brain metastases, maybe we could also prevent them in some patients more. What do we know about the central nervous system (CNS) penetration of ADCs and the clinical results? Dr. Sara Tolaney: At first, we were not optimistic that these drugs would have activity in the brain because we thought that these were very large agents that probably couldn't penetrate into the blood-brain barrier. But in fact, I think we were all very excited to see that there is actually data suggesting that these drugs can actually have robust efficacy in the CNS in patients who have active brain metastases. And so what we've seen so far is data with trastuzumab deruxtecan or T-DXd, there have been some trials that have been done, including studies like DEBRA and TUXEDO, which have looked at T-DXd in patients who have active brain metastases and are showing very robust response rates within the CNS. So, we're seeing intracranial response rates on the order of 40% to 50%. And clinically, this is what we're seeing as well. These are smaller studies and there's a larger trial, DESTINY-Breast12, which will hopefully validate the robust efficacy in the CNS with T-DXd. So, again, it's really nice to see this.  To your point, though, one area that I'm curious about, as you were alluding to, is will these drugs be able to prevent CNS disease? And I think that is a very different question because here the blood-brain barrier is not intact when patients have progressive brain metastases, and so these ADCs are causing robust activity. But if you look, for example, and I'll be curious to see what happens, DESTINY-Breast05 is looking at T-DXd in the post preoperative setting for patients who have residual disease and comparing it to T-DM1. And unfortunately, we saw that T-DM1 was not able to prevent brain metastases when looking at data from KATHERINE, where in fact, rates of CNS as the first site of recurrence were similar with T-DM1 and trastuzumab. So, now we'll be interested to see, will it be any different with T-DXd? Will T-DXd be able to have any role in prevention? I think we haven't seen anything like that with ADCs to date, so that would be a paradigm shift in our way of thinking.  Right now, there are strategies being taken from a prevention standpoint of trying to add a tyrosine kinase inhibitor in that early-stage setting, such as what is being done in the COMPASS-RD trying to add tucatinib to T-DM1 to see if that would do it. But again, we really need to understand, again, how these drugs work, particularly when the blood-brain barrier may not be intact. But again, very exciting data with T-DXd in an ongoing trial, actually through SWOG looking at sacituzumab for patients with CNS disease. And we've seen some preliminary data with sacituzumab showing that it actually does penetrate into the brain when they've looked at drug levels in the tumor in the brain, comparing it to plasma, it actually looks similar. So, we know it's getting in there and we'll have more robust efficacy data, hopefully coming soon. Dr. Hope Rugo: Yeah, that was a great summary of that data. It's been exciting also to see some responses in patients with leptomeningeal disease as well, where we've really been struggling with anything that works for more than a few weeks or months at the most. So I'm holding out great hope that we're going to see a big difference because even though TDM-1 had some efficacy, it was nothing like what we're seeing with T-DXd. So we'll see. And the same with sacituzumab with triple negative disease, where sometimes brain metastases can be an isolated site of recurrence, even in patients who have a pathologic complete response. So it has been a big challenge.  So I think that what we've learned from you is a lot about the mechanisms and the data about these new ADCs, the tremendous hope that these are bringing to our patients, but also the really exciting new approaches with new payloads, new targets of drugs that are in development, as well as potentially some different ADCs that have the same target and similar mechanisms of action of this payload. Really fascinating to hear about this, the future work on sequencing, on mechanisms of resistance, and on brain metastases. We have, of course, 2 prospective trials that we'll be looking at sequencing, one with T-DXd and Dato-DXd, and one registry trial with T-DXd and sacituzumab govitecan in the US. So that's also going to, I think, provide us with some important information.  We could talk for a long time about this, but I just wonder if you have any closing comments to sum up your thoughts.  Dr. Sara Tolaney: I think you did a great job leading us through thinking about ADCs, and I think it'll be really interesting to see what happens in the future. While again, these agents have become a standard for us for patients with metastatic disease, I'm going to be curious to see how everything evolves and to see if we'll be able to substitute chemotherapy with ADCs in early disease settings and change outcomes. Will we be able to have novel combinations? Will we be able to sequence these drugs one after another? Will we actually have biomarker predictors to help us sort out which drug to give when? So, still a lot to learn, but clearly a very exciting field right now. Dr. Hope Rugo: Indeed. Sara, thank you for sharing your valuable insights with us today on the ASCO Daily News Podcast on your great work to develop novel therapies for breast cancer. It's always a pleasure to talk to you, and even greater to work with you on the future progress of treatment for breast cancer. Dr. Sara Tolaney: Thank you so much, Hope. Again, really nice to always discuss these data with you. I always learn a lot, so thank you. Dr. Hope Rugo: Thank you. And thank you to our listeners for joining us today. You'll find a link to all of the studies discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of a product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow today's speakers:   Dr. Hope Rugo  @hoperugo  Dr. Sara Tolaney @stolaney1     Follow ASCO on social media:   @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:   Dr. Hope Rugo:  Consulting or Advisory Role: Napo Pharmaceuticals, Puma Biotechnology, Mylan, Eisai, Daiichi Sankyo Research Funding (Inst.): OBI Pharma, Pfizer, Novartis, Lilly, Genentech, Merck, Daiichi Sankyo, Sermonix Pharmaceuticals, AstraZeneca, Gilead Sciences, Astellas Pharma, Talho Oncology, Veru, GlaxoSmithKline, Hoffmann-LaRoche AG/Genentech, Inc, Stemline Therapeutics Travel, Accommodations, Expenses: Merck, AstraZeneca   Dr. Sara Tolaney: Consulting or Advisory Role: Novartis, Pfizer, Merck, AstraZeneca, Genentech, Eisai, Sanofi, Bristol-Myers Squibb, Seattle Genetics, CytomX Therapeutics, Daiichi Sankyo, Immunomedics/Gilead, BeyondSpring Pharmaceuticals, OncXerna Therapeutics, Zymeworks, Zentalis, Blueprint Medicines, Reveal Genomics, ARC Therapeutics, Umoja Biopharma, Menarini/Stemline, Aadi Bio, Artio Biopharmaceuticals, Incyte Corp, Zetagen, Bayer, Infinity Therapeutics, Jazz Pharmaceuticals, Natera, Tango Therapeutics, Systimmune, eFFECTOR Therapeutics, Hengrui Pharmaceutical (USA), Sumitovant Biopharma Research Funding (Inst.): Genentech/Roche, Merck, Exelixis, Pfizer, Lilly, Novartis, Bristol-Myers Squibb, Eisai, AstraZeneca, NanoString Technologies, Seattle Genetics, OncoPep, Gilead Travel, Accommodations, Expenses: Eli Lilly, Sanofi, Gilead Sciences

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Stephanie Graff, MD Guest: Pavani Chalasani, MD, MPH When treating patients with metastatic breast cancer, it's important to repeatedly conduct liquid biopsies to look for acquired ESR1 mutations when patients progress after endocrine therapy, even if initial testing was done. That's why Dr. Charles Turck is breaking down best practices for utilizing liquid biopsies to detect ESR1 mutations with Drs. Stephanie Graff and Pavani Chalasani. Dr. Graff is the Director of Breast Oncology at the Lifespan Cancer Institute in Providence, Rhode Island, and Dr. Chalasani is the Division Director of Hematology-Oncology at the GW Cancer Center in Washington, DC.

For people with breast cancer, the time spent receiving treatment, coordinating care, and traveling to doctor's appointments can be overwhelming. These burdens can take away from the patients' valuable time, adding to the stress and anxiety of a diagnosis. On today's show, I will be talking with Dr. Julie Nangia Medical Director, Breast Oncology, Baylor College of Medicine and Monica, a breast cancer survivor. After that, I will have radio and television personality and founder of Kidz Table, Inc. Lynette Burton.

Dr. Julie Nangia, Medical Director of Breast Oncology at Baylor College of Medicine, and Monica Ellis, a breast cancer survivor, talks about choosing your treatment of breast cancer.

Dr. Julie Nangia, Medical Director of Breast Oncology at Baylor College of Medicine, and Monica Ellis, a breast cancer survivor, talks about choosing your treatment of breast cancer.

Israel has agreed to allow humanitarian aid into Gaza – and US President Joe Biden is now back on American soil after a whirlwind visit to the warzone. We get the latest on the conflict from Christian Leuprecht, Professor at the Royal Military College and Editor of the ‘Canadian Military Journal'. 1 in 8 - that's the number of Canadian women who will be diagnosed with breast cancer in their lifetime. We discuss the importance of self-advocacy - and early detection of the deadly disease – with Dr. Amy Comander, Director of Breast Oncology at the ‘Mass General Cancer Centre' in Boston. Finally, it's hard to come by ‘good news' these days with headlines focused on military conflict – economic struggles - and more. We get some tips on how to deal with ‘heavy' news headlines - and the impact they can have on us – with Karen Gallagher-Burt, Mental Health Advocate & Social worker with The Distress Centre.

In this interview for Breast Cancer Awareness Month, Dr. Jason Mouabbi, Assistant Professor in the Department of Breast Oncology at the University of Texas MD Anderson Cancer Center, provides insightful answers to frequently asked questions and debunks common myths surrounding breast cancer diagnosis, screening, and treatment.

Dr. Amy Comander is a breast oncologist at the Massachusetts General Hospital Cancer Center. She is Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham and at Newton Wellesley Hospital, and Medical Director of the Mass General Cancer Center in Waltham. Dr. Comander is Director of Lifestyle Medicine at the Mass General Cancer Center, which is the first cancer center to have a dedicated lifestyle medicine program. As an Instructor in Medicine at Harvard Medical School, she enjoys teaching medical students and residents about oncology, as well as lifestyle medicine.Given her strong interest in cancer survivorship and lifestyle medicine, Dr. Comander is dedicated to improving the quality of life, well-being, and outcome of individuals with cancer through important lifestyle interventions, including exercise, diet, and mind/body interventions. She promotes healthy lifestyles for both her active treatment patients as well as those in the survivorship phase of care. She practices what she preaches, having run marathons, including ten consecutive Boston Marathons so far, with the goal to improve the lives of those with a diagnosis of cancer.In collaboration with Dr. Beth Frates, she has launched “PAVING the Path to Wellness,” a 12-week lifestyle medicine-based survivorship program for women with breast cancer. Along with Dr. Frates and Dr. Michelle Tollefson, she has published the “PAVING the Path to Wellness” workbook. Dr. Comander is currently proud to serve as the first oncologist on the Board of Directors of the American College of Lifestyle Medicine. She is also on the Board of the Ellie Fund, a non-profit that provides services and support to women diagnosed with breast cancer in Massachusetts. She is a medical advisor to the non-profit organization, SurvivingBreastCancer.org. She has served as a medical advisor to Oneinforty, a non-profit organization dedicated to educating people of Ashkenazi Jewish heritage about the one-in-forty chance of having inherited a BRCA mutation. She is married to Jason, a physician-scientist at Mass Eye and Ear, and is the mom of two teenagers.  Links:Learn more about Amy's PAVING the Path to Wellness Program hereFind more tips for lifestyle change in the PAVING the Path to Wellness Workbook 

Discussing Breast Cancer ASCO 2023 Highlights, focusing on practice-changing studies with Dr. Stephanie Graff, Director of Breast Oncology, Associate Professor of Medicine, Lifespan Cancer Institute, Brown University. Covering three important studies: - NATALEE Phase III study of ribociclib (RIBO) + endocrine therapy (ET) in HR+ patients - SONIA challenging the need for first-line use of a CDK4/6 Inhibitor in HR+ advanced breast cancer patients - X-7/7 trial evaluating fixed-dose capecitabine compared to standard dose capecitabine in metastatic breast cancer

In today's episode, join me and Dr. Amy Comander as we'll explore the latest developments in breast cancer research and the role that lifestyle medicine plays in reducing the risk of breast cancer. WATCH THE FULL YOUTUBE EPISODE HERE: https://youtu.be/gm6zVECQEBI  Dr. Amy Comander specializes in the care of women with breast cancer. Dr. Comander is the Medical Director of the Mass General Cancer Center in Waltham, where she also serves as Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham and at Newton Wellesley Hospital. As Director of Lifestyle Medicine at the Mass General Cancer Center, Dr. Comander has a strong interest in improving the quality of life and outcome of cancer survivors through important lifestyle interventions, including physical activity, diet, and mind/body interventions. She promotes healthy lifestyles for both her active treatment patients as well as those in the survivorship phase of care. Dr. Comander launched PAVING the Path to Wellness, a 12-week lifestyle medicine-based survivorship program for women with breast cancer. She is proud to serve as a board member of the American College of Lifestyle Medicine. Join us as we discuss how lifestyle choices can impact breast cancer risk and explore strategies for prevention and early detection. So sit back, relax, and get ready for an informative and engaging conversation on this important topic.

Today we are introducing the new Oncology Times Editorial Board Chair: Stephanie L. Graff, MD, FACP. In her new role, Graff will help Oncology Times continue to provide essential clinical news and analysis for the cancer care community. Graff is Director of Breast Oncology at Lifespan Cancer Institute and Assistant Professor of Medicine at Brown University. Oncology Times contributor Catlin Nalley sat down with Graff to discuss her career path and oncology care philosophy.

Join me for a deeper understanding of breast cancer, with Dr. Stephanie Graff, a medical oncologist who specializes in breast cancer.   Dr. Graff sheds light on what breast cancer is, why it's such a diverse disease, and the role of genetic and lifestyle risk factors. We also discuss the rise of "expert patients" and the challenges and opportunities of navigating cancer in today's complex information environment.   Dr. Graff cares for breast cancer patients at the Lifespan Cancer Institute in Rhode Island, where she is Director of Breast Oncology. She is also actively involved in cancer research and clinical trial design, and is Assistant Professor of Medicine at Brown University. Dr. Graff is passionate about empowering patient advocates, and serves as a medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research.   Connect with Dr. Graff: Twitter @drsgraff: https://twitter.com/DrSGraff Brown University: https://vivo.brown.edu/display/sgraff Lifespan Cancer Institute: https://www.lifespan.org/providers/stephanie-l-graff-md Publication - The Rise of the Expert Patient in Cancer: From Backseat Passenger to Co-navigator. https://pubmed.ncbi.nlm.nih.gov/35344398/   Resources: Cancer.Net - Oncologist-approved information about cancer (by American Society of Clinical Oncologists) https://www.cancer.net American Cancer Society Breast Cancer Resources https://www.cancer.org/cancer/breast-cancer.html Project LEAD - Science training for advocates (by National Breast Cancer Coalition): https://www.stopbreastcancer.org/what-we-do/education/project-lead/ Dr. Susan Love Foundation for Breast Cancer Research https://drsusanloveresearch.org

Amy Comander, MD, DipABLM is a breast oncologist and Director of Lifestyle Medicine at the Massachusetts General Hospital Cancer Center. She is the Medical Director of the Massachusetts General Hospital Cancer Center in Waltham, and Director of Breast Oncology and Survivorship as the Massachusetts General Hospital Cancer Center in Waltham and at Newton Wellesley Hospital. She is an Instructor in Medicine at Harvard Medical School. Michelle Tollefson, MD, DipABLM is an obstetrician-gynecologist, women's health lifestyle medicine expert, and wellness coach. She is the Secretary of the American College of Lifestyle Medicine, a professor at Metropolitan State University of Denver, author, international speaker, consultant, and breast cancer survivor. Description PAVING the Path to Wellness is a program that utilizes attitude, purpose, natural sources of energy, and taking time-outs to shift habits as well as mindset. It provides participants with lifestyle medicine tools including physical activity, healthy eating patterns, stress resilience, honoring and maximizing sleep, and cultivating high-quality connections. The program uses evidence-based guidelines and the latest research to inform the program and keep it cutting edge. During this presentation Drs. Comander and Tollefson will give an overview of the program and share some practical lifestyle medicine tips for optimizing wellbeing. They'll also share information about the PAVING the Path to Wellness Handbook, that they co-authored with Dr. Beth Frates, pioneer in lifestyle medicine, award-winning Harvard Medical School assistant clinical professor, and creator of the PAVING program. PAVING the Path to Wellness is a 501c3 non-profit organization. To learn more about the program and book, visit us on our website or follow us on social media. Website: https://www.pavingwellness.org/ E-mail: info@pavingwellness.org Twitter: https://twitter.com/pavingwellness Instagram: https://www.instagram.com/paving.wellness/ You can order the PAVING the Path to Wellness Workbook through the publisher Healthy Learning or on Amazon. All proceeds from the authors go to the 501c3 non-profit organization, PAVING the Path to Wellness.

Discussing new SERDs in Hormone Receptor Positive (HR+) from SABCS 2022 - Practice changing studies with Dr. Stephanie Graff, Director of Breast Oncology, Associate Professor of Medicine at Lifespan Cancer Institute, Brown University; Medical Advisor, Dr. Susan Love Foundation CME information and credit available at: https://integrityce.com/courses/clinical-updates-from-san-antonio-her2-advanced-breast-cancer-heavily-pretreated-patients/ Website: http://www.oncbrothers.com/ Twitter: https://twitter.com/oncbrothers Contact us at info@oncbrothers.com  

Discussing Hormone Receptor Positive (HR+) Highlights from SABCS 2022 on usage of CDK4/6 inhibitors - Practice changing studies with Dr. Sara Tolaney, Chief - Division of Breast Oncology at Dana-Farber and Associate Professor at Harvard Medical School. CME information and credit available at: https://integrityce.com/courses/clinical-updates-from-san-antonio-hr-her2-breast-cancer-cdk-4-6-inhibitors/ Website: http://www.oncbrothers.com/ Twitter: https://twitter.com/oncbrothers Contact us at info@oncbrothers.com  

Dr. Shannon Westin and Dr. Stephanie Graff discuss a revision to the famous "Simone's Maxims" and the broader nature of intersectionality. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, where we get in-depth on articles that have been published in the Journal of Clinical Oncology. I am your host, Shannon Westin, a GYN Oncologist, and Professor at MD Anderson Cancer Center, and I'm honored to serve as the Social Media Editor of the Journal of Clinical Oncology. Today, we're going to be discussing the very important work called “Understanding Modern Medical Centers: Beyond Simone—Intersectional Maxims for a New Era.” And this was published online in the JCO on September 27th, 2022. And joining me to discuss this important work is Dr. Stephanie Graff, who is the Director of Breast Oncology at the Lifespan Cancer Institute at the Warren Alpert Medical School, Brown University. Welcome, Dr. Graff. Dr. Stephanie Graff: Thanks so much for having me. It's going to be fun to talk about this piece with everyone. Dr. Shannon Westin: Yeah. It's a great piece of work. And before we start, I will just note that all participants have noted no conflict of interest for this manuscript. So, let's get down to it. I want to level set. What were Simone's Maxims, that you just revised, and why did they matter? Dr. Stephanie Graff: Yeah. So, Dr. Joseph Simone, who is a legend in oncology, and our revision of his work is truly in respect of what he did, not in any way meant to be anything less than that. So, in 1999, Dr. Simone published, in Clinical Cancer Research, this piece that would famously come to be known as Simone's Maxims, and the official title was, “Understanding Academic Medical Centers.” And that list of, you know, sayings and circulated truths have really sort of been this commonly quoted list of things that people talk about in medicine as just the truth of what it takes to sort of cut it, if you will, in the world, especially in academic medicine, but just medicine in general. Like, one of the famous ones is "Institutions don't love you back." And I think that you've probably heard these and maybe not even realized that you were quoting or hearing Simone's Maxims, but they're pretty ubiquitous in the world of academic medicine and, in particular, oncology, because Joseph Simone was an oncologist. He actually went on to write a book. There's a text called Simone's Maxims as well that's much longer than the Clinical Cancer Research piece. We didn't have a book in us yet, so we just started with updating the original manuscript. Dr. Shannon Westin: That's so great. And it's so funny when I was younger--I don't know if I'm still young or not, but there was things that we said, and I had no idea where they came from. So, I bet that a lot of our listeners are saying the same things, like, "Oh, that's a Simone's Maxim." So, I guess the question is now why did your group set out to update these? Dr. Stephanie Graff: I think if you look at the list of authors, a bunch of the authors have had recent career changes. And so, it actually started as just sort of this casual conversation about how for many of us who have recently undergone career changes, that some of these maxims don't hold true for us. The list of authors is a group of very intersectional physicians in our identities--and I know you'll ask me a question in a moment here about what exactly intersectional means. But, you know, I think that Dr. Simone wrote Simone's Maxims at a time when Medicine was more homogeneous, and so, some of the Maxims that he wrote represent the more traditional values of medicine, what medicine looked like in 1980, in 1990. And I think medicine in 2022, 2023, 2033 is just continuing to evolve and change shape. And so, it's important that we reframe the truths of what it takes to foster a successful career, create successful working environments for the modern workforce. Dr. Shannon Westin: I think this is so critical, and we're seeing it across a number of different fields, not just medicine. We're seeing it in politics and policy and other places. So, why don't you just make sure that all our listeners do understand this concept of intersectionality and how it applies, you know, in medicine and feminism and other areas? Dr. Stephanie Graff: Yeah. And that--shout out to our co-author Edith Mitchell. Dr. Mitchell very quickly said, "Well, we have to start the manuscript by defining intersectionality if we're going to include it in the title because a lot of the readers won't even be familiar with the concept of intersectionality." So, it's included there in the maxims. Intersectionality was first introduced in 1989, and the definition is this nature of social categories, like race and class and sex and gender and the way that they overlap, so that I'm not just white or Christian or a farmer's daughter or a woman, but I'm all those different things, and that creates my intersectional identity. And obviously, there are millions of different intersectional identities, because we have all of these different facets of our personality, of our identity, that come together. And as medicine gets more diverse, which I believe makes us stronger, we'll see more and more complexity in the intersectional personalities, intersectional identities, of the people working in healthcare. Dr. Shannon Westin: Thank you. I couldn't have said it better myself. You know, the other question that comes up as we start seeing more diversity in our workforce, and I mean, frankly, in our patient population, how do you think that that understanding about diversity and the accentuation of our diversity helps improve the success of medical organizations? Dr. Stephanie Graff: Oh, gosh. There's like a million examples. I think that-- ah, Shannon, there's so many different examples I can quote. So, I think that you know, there's a study that looked at patients coming into the emergency department having heart attacks. And if they were female patients cared for by female doctors or female patients cared for by male doctors, that had an impact on their risk of death. Not surprisingly, it was the women patients cared for by male doctors that were the most likely to die and the female patients cared for by the female doctors that were the most likely to live, telling us that when there's this concordance, this understanding between patient and physician, that it improves outcome. But that could be corrected if the male physicians had more female partners. So, just that understanding of relationships, that exposure to more people, more female physicians, increased male physicians' ability to care for female patients or communicate with female patients, it just increased confidence, our collective confidence. And that's been proven in other settings too. But that's just one sort of great example. The McKinsey group has shown how financial performance improves with gender diversity and ethnic diversity. And that's been shown, not just in healthcare, but in numerous different business environments. And if we think about, you know, as an oncologist, as a clinical researcher, if I imagine that innovation is improved by diversity, imagine that translating into better clinical trial outcomes with a more diverse workforce. And the outcomes that the McKinsey group show, ethnic diversity drove a 35% improvement in financial performance, which is huge. And again, that's at a time when the oncology workforce is really struggling with everything from, you know, recruitment to trials, staffing, revenues. That would be enormous if we could derive that sort of performance. So, I think that there's a million different ways to illustrate what diversity could do, whether it's make us better or stronger or more confident or provide better care, and it's been shown in a million different ways, in a million different contexts. Dr. Shannon Westin: Well, you're convincing everyone, I know. I think we'll get into some of the kind of more nitty-gritty details of the manuscript. I want to be very clear; I think all our listeners should absolutely 100% read the entire manuscript because it's so critical. But let's try to hit some of the major high points. And I say this all the time, and I'm going to take your line, but which one's your favorite? What do you think is the most important one? Just like you would totally tell me which of your children is your favorite, right? Dr. Stephanie Graff: I can't possibly pick a favorite. That's completely impossible. I really like--one of the Maxims that we have is, "Everyone's time and voice is valuable. Institutional leaders must respect time and encourage diversity of thought." Originally, Dr. Simone had a maxim that said, "Members of most institutional committees consist of about 30% of people who work despite other pressures and 20% who are idiots, status seekers, and troublemakers." And we changed that to say, again, "Everyone's time and voice is valuable. Institutional leaders must respect time and encourage diversity of thought," as a way of saying that, you know, I think that in 2022 and beyond, we're getting to a place where it's important that we find better labels for people than idiot and troublemaker and that we reach beyond that to identify how we can help everyone find an environment to be successful and that we fill the working corners of our cancer centers, the working corners of our hospitals, healthcare systems, clinics, with the people that are excited about the work that needs to be done. And, you know, not all of us are gonna want to run clinical trials. Not all of us are going to want to do quality improvement projects. Not all of us are going to want to do five straight days of clinic. Not all of us are going to want to do--insert the day-to-day grind of whatever it is that needs to get done to make a cancer center function. But somebody somewhere loves that little thing. And it's important that we work together to accomplish what needs to be done for best care of the patients that we're honored to take care of. And so, we have to respect that time, respect that voice, and work to connect people with the thing that drives them. Dr. Shannon Westin: I think that one, how you just ended there, kind of touches on one of the ones that really grabbed my attention, which was the original maxim that was, "Leaders are often chosen primarily for characteristics that have little or no correlation with successful tenure as a leader." And instead, as an intersectional maxim, you all changed it to, "Leaders should be chosen for their ability to inspire." That really spoke to me because it's exactly what you said.  That leader has to work to inspire people to do what they love within each piece of that, you know, department or division or hospital or organization or whatever. You can't expect everybody to do the same cookie-cutter thing, but help inspire people to be behind the mission and do what they love as part of moving that hospital organization forward. I thought that was really perfect. Dr. Stephanie Graff: Yeah. And we've too often seen, you know, in academic medicine especially, that we equate a really high h-index or a really successful history of grant funding with leadership. And those aren't the same skills, right? Like, you could be a really fantastic researcher and not a really great person at organizing a team of people to run a cancer center. And you might have both skills, in which case, wow, congratulations. But I think that it's important that we look at the job in front of us and select for that, rather than assuming that all of the same skills fill every single job because that's just not true. Dr. Shannon Westin: I think that, again, I know I said this already, listeners, but please, please run, don't walk, to read the whole paper and get more information. On our last note, one of the things I really loved about this paper was you really provided some clear reforms really to help improve physician wellness. Can you maybe summarize some of those reforms that could improve intersectionality within healthcare organizations? Dr. Stephanie Graff: Yeah. Those are all in Table 2. So, again, I hope you guys all grab the paper and give it a download and pin them up somewhere and think about them. I think that some examples are, you know, to really promote intersectionality, which means that you've got a lot of diversity in characteristics across your cancer center, which is going to be things like gender, race, introverts, extroverts, researchers, clinicians. You really have to have very clear metrics that are shared and discussed. And so, you might need to publish benchmarks for things like median RVUs or come up with a group incentive structure, so that whether you're a person who is in clinic less and publishing more or in clinic all the time and publishing less, you can work together to be flexible collectively, and then everybody can be contributing to that greater team environment. I think it's really important that if you want to grow intersectionality, that your search committees and your leadership interview strategy undergoes unconscious bias training. There's still not really great strategies to make sure that we're 100% pursuing a no-bias environment in our workplace, but there is evidence that unconscious bias training can be effective to help us recruit a more diverse workforce. And that's the simplest strategy - is if you're going to be putting a search committee together, have everybody do an implicit bias training and work together to select candidates that don't necessarily fit what feels like your traditional mold, and then find strategies, once you've hired into your organization, to partner your new employee, new physician, new hire, for maximum success in that workplace. Another important thing is, as you're growing diversity in your organization, is to make sure that you're creating opportunities to give everybody a voice. You should be looking at who's being invited to speak and making sure that that's representative and diverse. You should be considering changing up strategies. One of the examples I often give is that, when we have a problem and we do brainstorming, where you bring everybody in a room and they shout out, "This is what I think we should do," what happens is you get the loudest extrovert or the most powerful person at the table who just gets their way. And it's far more effective to do brain writing, where you have everybody write down the three or five or 10 things that they think might work, and then you read those out in a neutral way, because then, everybody's voice and everybody's idea gets equal play in a neutral way that allows you to elevate those ideas independent of the other bizarre, irrelevant hierarchies that may exist in your system and can really elevate some of those diverse voices and ideas in your organization. Those are just some of the examples that are listed. Dr. Shannon Westin: Yeah. Listeners, there's a ton of very clear frameworks that you could potentially implement tomorrow in your organization if you want to strive to improve the intersectionality. Well, the time always goes so fast. It has been so great to speak with you, Dr. Graff. Thank you so much for being here. Dr. Stephanie Graff: It's such an honor. I hope everyone gives it a read and comes up with the next iteration and update together with us. Dr. Shannon Westin: Perfect. So, again, readers and listeners, this was, “Understanding Modern Medical Centers: Beyond Simone—Intersectional Maxims for a New Era,” published online in the Journal Clinical Oncology, on September 27th, 2022. And we are so thrilled that you came to listen to JCO After Hours. Please go check us out on the website and see what other podcasts you've missed.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

How many people diagnosed with breast cancer think about clinical trials or being part of one? In this episode of the DiepCJourney podcast we are going to discuss the importance of patients asking about participation in clinical trials and studies to improve the lives of breast cancer patients. My guest is Stephanie Graff, MD, FACP. She is the Director of Breast Oncology at the Lifespan Cancer Institute and Professor of Medicine at Brown University. Dr. Graff is passionate about connecting with her patients for personalized care and advancing breast cancer research, and breast cancer prevention. Our interview includes the process and steps involved for patients who sign up for clinical trials and studies. There are benefits for patients and Dr. Graff examines the processes. Her hope is this becomes standard of care for physicians to tell patients about clinical trials available and encourage them to sign up if they qualify. Dr. Graff is also involved with the American Cancer Society in Kansas City, The Susan Love Research Foundation, the American Society of Clinical Oncology, and other prominent organizations. She is a published author of several research papers. She was named “Woman Disrupter of the Year” at the 2022 American Society of Clinical Oncology Conference. Dr. Graff obtained her medical degree at the University of Missouri-Kansas City School of Medicine. She is active on social media sharing tweets about her research and work. We are both Kansas City Chiefs fans and occasionally share our love of the #ChiefsNation on Twitter. You can find out more about her work and interest in clinical trials and research on LinkedIn at: Stephanie Graff, MD, FACP

Discussing the management using the algorithm of Hormone Receptor Positive Breast Cancer - with Dr. Stephanie Graff, Director of Breast Oncology, Associate Professor of Medicine at Lifespan Cancer Institute, Brown University; Medical Advisor, Dr. Susan Love Foundation.

Listen to ASCO's Journal of Clinical Oncology essay, "People Like Us," by Dr. Stephanie Graff. The essay is followed by an interview with Graff and host Dr. Lidia Schapira. Graff reflects on her life experience as a female physician, farmer's daughter, mother, and pie connoisseur to connect and help her patients get through a life-altering diagnosis. TRANSCRIPT Narrator: People Like Us, by Stephanie Graff, MD (10.1200/JCO.22.01835)   I was standing in the dining room on the 15-year-old burnt sienna carpet, so heinous that it could have only been chosen because it was on sale. I remember the afternoon light from the western windows falling across the oak dining table which matched my mother's brusque, wooden tone. She remembers nothing. She does not remember saying the words that I have so often replayed, pondered. I was stung by the interaction in a way that rendered me speechless, in a way I now recognize too often in my approach to conflict in adulthood: silence assumed to represent understanding, consent, or complicity.   Weeks earlier, this same woman drove all over our small town hoping to catch the mailman before driving to my track and field meet 30 miles away. I was waiting for word from the University of Missouri-Kansas City (UMKC) School of Medicine, and I think my mom was as anxious to hear as I was. Conveniently, her brother (my uncle) was our mailman. When she arrived at the track meet, she handed me the large envelope proudly bearing the school's logo in the return address. I tore it open sitting with my boyfriend on the bleachers, seeing my prayers answered in black and white before my eyes. There is a photograph of this moment, so I can describe perfectly what I am wearing: my royal blue and white track uniform, my sprinters spikes and—I am sorry to tell you—a neon green hair scrunchy. This photograph also proves, in that instant, my mother understood that what was unfolding was a milestone moment in my life. I remember asking her later when I discovered she tracked the mailman around town to get the mail what she would have done if I had not been accepted. She replied that she knew I had gotten in from the size of the envelope, so she never had to think about it. I like to imagine my mom also had faith in me that led to the wild goose chase for the mailman, even before she saw the envelope.   Within the envelope, in addition to the acceptance letter and glossy brochure telling me all about my wonderful new life as a UMKC medical student, was a parental consent form. The 6-year combined BA/MD program at UMKC was far from inexpensive, and, as a minor, I would need my parents to sign this letter stating that they agreed that we would pay the tuition. Of course, by we what was really meant was I would be taking out student loans to cover every single cent of tuition, room, and board. But the letter, with a DUE BY date ticking ever closer, had been sitting on our dining room table since the day the acceptance arrived, unsigned. My father signed things like this. Never my mother. My mother would not even broach the subject with him. Nice families in rural Missouri just do not talk about money or politics. So, there it sat, a white paper elephant in the room.   “Mom, when is dad going to sign my acceptance letter? The deadline is soon, and we still have to mail it back,” I pleaded with her that afternoon. She turned to look at me, en route from the dining room to the kitchen and said, “Stephanie, people like us don't go to medical school.” People like us? Who is this us? Women? Mid-Missouri farmers? People from small towns? Our family specifically? Poor people? I may forever regret not asking. I may forever regret that moment of stunned silence where I only wondered if she had just said no to my dream and considered my next move very carefully so as to not make it worse or potentially close a door forever. By the time I asked her, years later, what she meant in that moment, my mother had no memory of saying it to me. This innocuous phrase, “people like us” that haunted me for most of medical school.   Eventually, of course, my father signed it. Only a day or two before the deadline as my memory recalls. He sat me down and told me it was a lot of money and asked me if I was serious about this whole doctor thing. I assured him that the one and only thing I had ever wanted to be had not changed in 10 years, after a short-lived dream of being a country western singer and that it was unlikely to change now. Then, he had signed the consent, which I had taken immediately to the post office before anyone could change their mind.   Yet, those words kept bubbling up. When I struggled with a test or subject, I wondered if people like us always had a hard time with organic chemistry or neuroanatomy. When my classmates talked about their exotic travels to tropical getaways or international hotspots, I sheepishly admitted people like us do not travel much. When patients assumed the female medical student was a nursing student rather than a medical student, I assumed that was just what happens to people like us. When I mispronounced something or exposed my total ignorance into the broader process of step examinations, residency, the road to physicianhood, I figured it was just the sort of thing people like us cannot help.   Then one day, a patient newly diagnosed with melanoma shared with me that he was worried about how treatment would interfere with farming. “Well, what kind of farming are we talking about?” I probed. He raised cattle, had some corn and hay fields. “Oh really? What breed? How many head?” We fell into the easy talk of farm life, and he shared his current toils of repairing his tractor. When he left, his wife pulled me aside and confided, “It really is nice to know that his doctor is one of them.” When I start to write a prescription, I often stop to think about the cost, about how $20 US dollars is a big deal to people like us, and I talk to patients about what is financially possible, what help they need, what resources we have. One of my breast cancer survivors always framed her chronic lymphedema symptoms in terms of how much or how little it held her back from baking pies. We shared recipes of her grand champion state fair pies and my mom's own grand champion pecan pie. I could understand the flurry of activity and pressure to bring your freshest, most beautiful pies to the fair because I shared that lived experience. Patients like this, one by one, started me thinking that maybe more people like us should be in medical school. I know the statistics for my own field of medical oncology, and few oncologists practice in rural areas, despite the community needs. I have no statistics for how many of my colleagues grew up farming or preparing for state fairs every summer. But, I have answered phone calls from my mom, asking advice about what aspects of farming are safe when you are neutropenic or how best to plan Moh's surgery around harvest. People like us are necessary to fill those gaps.   As a woman in medicine, numerous women have reached out to me to ask me questions about the duality of medicine and mothering or the intersection of work and sex. My emails, text messages, and social media feeds are filled with threads on breastfeeding at work, daycare solutions, unique challenges in leadership for women, and advice on career growth. These conversations ring with the chorus of someone like me as we connect over similarities. My mom recognizes this version of like me as well, handing out my phone number to women in the intervening years from my hometown applying to my alma mater or medicine in general. If community and connection with other women improves career experience for women in oncology, I am glad there are people like us.   And as much as I see a need in medicine for people like me, I also see all the ways I represent privilege—which of course means that there is ample space in medicine for people not like me. If the numbers of rural or female oncologists are low, the numbers of Hispanic/Latino, Black/ African American oncologists are startling. How can we collectively provide culturally and linguistically competent care if our workforce does not share the same diversity as our patients?   So, mom, 25 years later, I think we have both grown to understand medical schools need people like us, people like all of us. I think you have felt that as much as I have over the years in your own connections with doctors caring for members of our family or in the health questions you save for me. When I sit with a patient as their doctor, I am also there as a woman, farmer's daughter, mother, writer, baker of pies, and so much more. Each time one of these versions of me creates connection with a patient or colleague, my care improves. Each of our unique gifts and experiences help us connect with our patients in ways both big and small. Medicine needs people like us.   Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, brought to you by ASCO Podcasts, which covers a range of educational and scientific content, and offers enriching insight into the world of cancer care. You can find all ASCO shows, including this one at: podcasts.asco.org.   I'm your host, Lidia Schapira, Associate Editor for Art of Oncology, and Professor of Medicine at Stanford University. Today, we are joined by Dr. Stephanie Graff, Director of Breast Oncology at Lifespan Cancer Institute, and Assistant Professor of Medicine at Legorreta Cancer Center, at Brown University. In this episode, we will be discussing her Art of Oncology article, 'People Like Us.'   Our guest's disclosures will be linked in the transcript.   Stephanie, welcome to our podcast and thank you for joining us.   Dr. Stephanie Graff: Thanks so much for having me.   Dr. Lidia Schapira: It is our pleasure. So, I like to start the show by asking our authors what they are currently reading and would recommend to listeners.   Dr. Stephanie Graff: I am currently reading The Power Broker, which is kind of a funny book to be reading. It's obviously an older book, and it's the story of Robert Moses who famously, or infamously, perhaps, built New York City, and sort of wrote the power structure of city government or state government and politics in New York, and it's written by Caro and is a Pulitzer Prize winner, and I just have never read it. It's quite the tome, so it's hard to power through, but it's excellently well-written, and really insightful into political culture and the history of New York. So, I'm finally working my way through it. I'm not sure that I would recommend it for the average reader. I just finished The Sentence, by Louise Erdrich, and, Unlikely Animals, by Hartnett, and both were delightful reads.   Dr. Lidia Schapira: You are a gifted storyteller. I wonder if you could tell our listeners and share with us a little bit about your process and when you write, how you write, and what inspires you to write.   Dr. Stephanie Graff: When I write and how I write, I think the answer is, all the time. You and I may have talked about this before. I feel like writing is often how I decompress, and I find that I'm often writing in my head all the time. So, when I'm walking my dog, when I'm driving my car, when I have downtime, I'm sometimes turning over ideas or events and looking for the thread or the storyline there. I write poetry, actually mostly for myself as my form of journaling, or meditation, or rage, or sadness, whatever it is I might be feeling. And sometimes that then turns into something narrative, and that's a habit that I've had for a very long time, even as early as middle school and high school, it was a habit that I've always had. In terms of then turning that into something narrative or publishable, I think that that's more of an ‘aha' moment where an idea that I've been turning over for a while finally feels like there's a unifying theme, or thread, or a particular patient encounter, or a funny thing that one of my children said inspires it to become this sort of 360 moment that makes it feel more like thematic story that can be told.   Dr. Lidia Schapira: So, given your expertise with stories, and your appreciation of literature, and the fact that you've now lived in the world of Oncology for quite a while, what is your opinion of the role of stories and narratives in our culture and our approach to training others, and sort of sustaining that sense of vocation I think that drove us all to choose a specialty in the first place.   Dr. Stephanie Graff: Yeah. I think that story is so important for how we relate to one another, and how we relate to our patients because I think that, you know, if we're just talking to patients about a phase III randomized clinical trial and throwing at a patient a bunch of statistics, or metrics, or guidelines, it's not digestible, or understandable, or relatable. And so, being able to talk about what we do at the story is what makes that understandable, memorable, digestible for patients, but also for our colleagues, and our students, and residents, and fellows, staff, everyone that we interact with in our day-to-day experience. And so, I think that really thinking about The Art of Oncology, the practice of what we do day-to-day as parables, and stories, and looking for ways to turn that science, that data into little anecdotes is really so central to understanding.   Dr. Lidia Schapira: Let's talk about the story that you so beautifully wrote, ‘People Like Us'. Thank you for sharing that and sending it out to the world. I assume this is something that you've been thinking about for decades, and I, since you don't look like a teenager waiting for mom and dad's approval to go to med school. You know a good story, Stephanie, I'm sure you agree, allows the reader to project into, and imagine things. And there were two big themes for me, and one of them had to do with the mother-daughter relationship. So, can you talk a little bit and share with us a little bit about that aspect of the story of the words that your mother said at a very tender age that sort of stuck with you and kept on giving?   Dr. Stephanie Graff: So, for those listening, the story is that my mom said to me after I had been accepted to medical school and was kind of waiting for my parents to sign the acceptance letter, I went to the University of Missouri, Kansas City six-year program, so I got accepted to medical school, straight out of high school. And because I was 17, they had to sign this parental consent in order for me to actually start. And so, this letter was like sitting like the elephant in the room on my dining room table for, I don't know, two weeks or something, waiting for them to sign it. And my mom one day, in a moment, that to her was, I mean, she doesn't remember it.   So, like to her clearly, it was like this nothing-passing comment, like, you know, "Pick up your shoes." She said “People like us don't go to medical school.”   And at the time, I was so struck by it, but I have no idea who this "us" was that she was referencing. And I have spent decades wondering, in retrospect, "Oh, why didn't I ask questions?" You know, my mom actually was this amazing hero to me in my childhood. You know, she was a Girl Scout leader, and I got my Girl Scout Gold Award, she created all these opportunities for leadership and engagement in my community. She taught Sunday school. She graduated high school but just has a high school degree. She never went to college herself, because she was actually told by her parents that girls don't go to college, that girls get married and stay home. And so, though she wanted to go to college, her parents closed that door for her, and so she worked a factory job to earn extra money to help support the things that my siblings and I all wanted to do that, you know, kids' activities get pricey. Eventually, the factory job was physically demanding on her as she aged, and she ended up applying to become a paraprofessional in the schools, and so spent the second half of my childhood working as a para in our schools, which actually also ended up being a very physically demanding job. But really all kind of just out of determination and passion to create opportunities for us as children. So, in no way is this story meant to be a shot at my mom. She's been a really, really great mom. And again, she has no memory of saying this thing to me that has stuck with me so harshly, perhaps over the last several decades. But she said it, and at the time I was kind of like, "What does she mean by this?" I mean, obviously, I already had a lot of doubt about whether or not medical school was going to be right for me or if I was gonna fit in there, and for her to say that, I was kind of like, "Oh gosh, maybe people like me don't go to medical school." And then as I entered medical school, medical school was hard. It was hard as an 18-year-old. I struggled in classes, there were lots of moments where my peers were just more worldly than me. They had traveled, they came from backgrounds where most of their parents-- I had so many classmates whose parents were both physicians, and so they didn't struggle with the language of Medicine, the career paths of Medicine in the same way that I did. You know, my mom's words just kept coming back - people like us don't go to medical school. It was something that just sort of kept coming up over my career.   Dr. Lidia Schapira: So, who are those "People Like Us"? Have you figured it out? I certainly enjoyed reading all of the possible spins of People Like Us - people who come from farm backgrounds, people who aren't rich and worldly, perhaps women. Who are these "People Like Us?"   Dr. Stephanie Graff: Well, at the end of the day, I think all of us are People Like Us because you know, if anything I've learned in my last 20 years of this, is that everybody has those feelings of self-doubt, and feelings like, "we don't fit in." And hopefully, those are coupled with moments of feeling like you do belong, and hopefully, everybody has a network of belonging. But we're all periodically thrust into times where we don't feel like we fit in, and we don't feel like we belong. And there's so much that can be drawn from those moments. So, whether it's that you are from an underrepresented group, from your ethnic or cultural background, your socioeconomic background, your gender, your sexual identity, you know, no matter what that is, your parents' occupation, if you're the first person in your family to go to college, you are going to bring the tapestry to Medicine that helps us kind of richly relate to our patients in a way that's so cool. One of my favorite studies that I've seen in the scientific literature is actually not an Oncology study, it's a Cardiology study that looked at patients presenting to emergency departments with heart attacks, and it was a gender inclusion study. And what it looked at is in patients that have heart attacks in the emergency department, if the cardiologist caring for the patient is matched gender, like a man caring for a male heart attack patient, they have a better outcome. But if that cardiologist has a partner that is of the same gender, so like if the male cardiologist has female partners, their care of female heart attack patients improves, and that patient's cardiac mortality improves, which was so fascinating that like just having a greater exposure to female cardiologists helped male cardiologists provide better care to female patients. So, I do think that just gathering experiences of the people not like me, that surround me all day, help me relate better to my patients. There's certainly so many cultural celebrations, travel experiences, world celebrations, that I better understand through my classmates, peers, colleagues, friends, that I have encountered in Medicine, that help me connect and relate to my patients in ways that I previously didn't have access to. And there's ways that I'm sure me as a Midwestern farmer's daughter have helped my colleagues understand some of the things that our patients cope with.   Dr. Lidia Schapira: You make a brilliant case for diversity, and of course, for inclusion, which is something that everybody is really keenly trying to think more deeply about these days. And that brings me to another question or follow-up, and that is the role of empathy in communicating with people who are not like you. One of the most beautiful parts of your essay, I thought, was when you take us into the exam room with a patient, and you're actually giving us some examples of how your lived experiences as a farmer's daughter allowed you to connect with people who work the land, or who depend on the land or women who bake pies. Tell us a little bit about that - the role of the connection with a patient, and empathy, and compassion in helping us create a more welcoming environment, both for our colleagues and for our patients.   Dr. Stephanie Graff: I think everybody has had that experience before where a patient asks us, as their Oncologist, if while they're undergoing chemotherapy, undergoing radiation, if they're still going to be able to like [insert their passion here]. You know, as I reflect over my lifetime of patients, I've had patients who are professional poker players. I had a professional accordion player. I've had figure skaters. I've had everything, right? And I don't know the first thing about professional poker, okay, I would be a terrible professional poker player. But I could imagine what skills are needed to be a professional poker player and answer that question. But every once in a while, a patient asks me if they're still going to be able to do X, and whatever they fill in that blank is something that so deeply relates to my childhood experiences, that it becomes this bonding moment with my patient. So, some of the ones that I shared in the essay is a patient who spent every summer baking pies for the State Fair. For those of you who don't know, at the State Fair, you can enter your pies, cookies, baked goods, canned goods, decorated cakes, pretty much anything you can imagine, breads, and they're judged, and the winner gets ribbons - red, white and blue, and grand champion, and reserve grand champion that come with cash prizes, it's bragging rights. If you happen to also own like a bakery, or decorate wedding cakes, for example, that's something that's then marketing material, advertising material for your company that you're the Missouri Grand Champion of wedding cake decorating for 2022, or whatever it might be. So, this is a big deal, and people in my community talked about it and joked about it. And you would, at the church picnic when you're picking which pie, you know whose pie was the grand champion pie. So, she told me going into her chemotherapy, that it was really important to her that she could do the pies. We laughed, because my mom is the grand champion pecan pie baker for our county, and my mom makes a, pardon me, damn good pecan pie, I would say.  So, that patient and I spent a lot of time talking about how her pie baking was going. And I will say that the summer that she was on chemotherapy, she said that it was really fatiguing and hard for her. And so, that next year when it came time to pie season, she was really excited to tell me that like she entered two more pies than she had the prior year because she had that extra energy to like get up on the morning of the fair, and bake the extra pies, and spending all the extra time on making the crust beautiful. And I know what that's like because I've seen my mom get up at four o'clock in the morning to make a beautiful, perfect pie, and have it ready to enter at 8:00 AM when the fairgrounds open. That's so unique to perhaps rural Missouri, or the Midwest, or fair culture, and I guess probably not a lot of Medical Oncologists know what that's like. I had another patient who was, when I was still early in my career and was caring for things other than just breast cancer, who had a melanoma, and his wife asked me a lot of questions about how it was going to impact his farming. And we had this really lovely conversation about what kind of farming, and how many acres he had, and how many head of cattle, and what crops, and they were shocked at the depth of my knowledge about farming, and my ability to answer their questions in detail about what would be safe, and what would not be safe. And when they found out that it's because that's what I was raised doing, and that's what I did when I went home on weekends to visit my family, it was help out on the farm and do many of the same things that we were talking about. They saw me in this completely different light. Then they had seen me as this high-heeled wearing, white coat dawning Medical Oncologist, and it, I think helped them feel so much more comfortable in their cancer treatment, knowing that I understood where they were coming from.   Dr. Lidia Schapira: I have to ask you this question. Have you shared the essay with your mom?   Dr. Stephanie Graff: I have not shared it with her yet. I will when it comes out in print.   Dr. Lidia Schapira: What do you think her reaction will be?   Dr. Stephanie Graff: I think that she'll think it's lovely. We've had this conversation about how annoyed I am that she doesn't remember saying it, and how -- I guess it's weird because, you know, she said it and at times in my life I would say that it was hurtful that she said that people like us don't go to medical school, and that probably is the right language at different time points. I don't know that today I would describe it as a hurtful comment because I know what it was. It was just words that came out of her mouth whilst she was busy doing 100 other things, right? She doesn't remember it for a reason, which is that it wasn't a big commentary on me, or my life, or my choices. It was just words coming out of her mouth as she was going from one thing to another. So, I don't think that she'll find any hurt, or ill will in it at all.   Dr. Lidia Schapira: She may respond with a comment about what it's going to be like for you when you're in that situation with perhaps your children, and perhaps, at that point, make a comment that to you, may be forgettable, but makes a deep impression and a lasting impression in their young minds.   Dr. Stephanie Graff: That's actually something that I've spent a lot of time thinking about, both as I reflect on the comment, and, you know, at the very beginning of this, we talked about when I'm writing, and I said, always. I think about that comment a lot in the context of so much that I do - in my own parenting with my children, things that I say to them, and how those words might impact them. Things my husband says to them, and how those comments might affect them. But also, in the larger work of DEI, and how "jokes", or jabs, or sarcasm, things that aren't necessarily meant as true, can cut wrong. And that's why we have to be thoughtful, and careful because you never know who is listening, and how words are going to hit somebody on any given day.   Dr. Lidia Schapira: On that beautiful note, I want to thank you for sending us your work. Please continue to write, and I look forward to reading future stories, maybe even a poem, sometime. Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating, or review wherever you listen. Be sure to subscribe so you never miss an episode.   JCO's Cancer Stories: The Art of Oncology, is just one of ASCO's many podcasts. You can find all of the shows at: podcasts.asco.org.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.   Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review.   Bio: Dr. Stephanie Graff is the Director of Breast Oncology at Lifespan Cancer Institute, and Assistant Professor of Medicine at Legorreta Cancer Center, at Brown University.

While the DESTINY-Breast04 trial, which earned a standing ovation as a practice-changing study for treatment of HER2-low MBC garnered most of the headlines from the ASCO (America Society of Clinical Oncologists) annual meeting in June, it was not the only reason for optimism.  In this episode, the first of a two-part series, Our MBC Life's Victoria Goldberg and Lynda Weatherby continue to explore what the research shared at ASCO means for us, the patients living with MBC.  You'll hear from preeminent oncologists Stephanie Graff, Director of Breast Oncology at the Lifespan Cancer Institute at Brown University  and Hope Rugo (Professor, Department of Medicine (Hematology/Oncology) and Director, Breast Oncology and Clinical Trials Education, UCSF) in this deep dive into two critical studies: DESTINY-Breast04 and TROPICS-02. The latter examined a potential new line of treatment for heavily pre-treated HR-positive, HER2-negative MBC patients.  ENHERTU (trastuzumab deruxtecan) and TRODELVY (sacituzumab govitecan), the two drugs at the heart of these two trials, are both representatives of a relatively new class of drugs: Antibody Drug Conjugates—ADCs. ADCs are a class of drugs that links a potent chemotherapy drug with an antibody. Unlike traditional chemotherapy, ADCs are intended to target and kill tumor cells while sparing healthy cells. They are a kind of “smart bomb” for cancer treatment—and an extraordinarily promising development for patients.Our wide-ranging conversations with Dr. Graff and Dr. Rugo cover not only the results of these two trials, but their implications for treatment and the future of breast cancer research.More info about the show and past episodes is available on our website: www.ourmbclife.orgGot something to share? Feedback? Email: ourmbclife@sharecancersupport.orgFollow us on Facebook, Instagram, and twitter @ourmbclife

Breast cancer, behind skin cancer, is the most common cancer diagnosed in women in the United States. Statistics show that 1 in 8 women will be breast cancer patients.  While breast cancer can occur in both men and women, it's far more common in women. Breast cancer survival rates have risen thanks to factors such as earlier detection.Today on Crime Stories with Nancy Grace, we remember a friend we lost during her battle, and speak with others who beat killer cancer.  Joining Nancy Grace Today.  Barbara Shott - Ellen Killoran's Mother and breast cancer survivor John Killoran - Ellen Killoran's brother Caryn Stark - NYC Psychologist, CarynStark.com, Twitter: @carynpsych, Facebook: "Caryn Stark" and breast cancer survivor Dr. William J. Gradishar, MD - Betsy Bramsen Professor of Breast Oncology & Professor of Medicine, Chief, Division of Hematology/Oncology, Northwestern University, Twitter:@DrWGradishar Dr. Hope S. Rugo, MD - Professor of Medicine,  UCSF Helen Diller Family Comprehensive Cancer Center (San Francisco, CA) @hoperugo Kristy Mazurek - Emmy Award-winning Investigative Reporter (Buffalo, NY)  See omnystudio.com/listener for privacy information.

October is breast cancer awareness month, an annual campaign to raise awareness about the impact of breast cancer. That's especially important for women in the menopause transition and beyond because the risk of breast cancer rises with age. Most breast cancers are found in women who are 55 and older. This week we sat down with marathon runner and breast oncologist Amy Comander, MD, at the Massachusetts General Hospital Cancer Center to discuss how we can manage our risks no matter our family history, genetic makeup, or time of life.  Dr. Comander is Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham and at Newton Wellesley Hospital. She is Medical Director of the Mass General Cancer Center in Waltham and the Director of Lifestyle Medicine at the Mass General Cancer Center. She is an Instructor in Medicine at Harvard Medical School. She is board certified in Hematology and Medical Oncology, and she is also board certified in Lifestyle Medicine. Resources Katie Couric's https://katiecouric.com/news/katie-couric-has-breast-cancer/ (article) on her breast cancer. https://www.cancer.gov/news-events/cancer-currents-blog/2020/breast-cancer-survival-exercise (Research) on exercise and breast cancer survival.  Breast cancer risk https://bcrisktool.cancer.gov/calculator.html (calculator ) https://www.amazon.com/PAVING-Path-Wellness-Workbook-Frates/dp/1606795503/ref=sr_1_1?crid=190KB8EO5OYZQ&keywords=frates+paving&qid=1664378226&sprefix=frates+paving%2Caps%2C60&sr=8-1 (Link) to the PAVING workbook **Support the Podcast**  Get your tickets to the Hit Play Not Pause Summit at https://www.feistymenopause.com/hit-play-not-pause-summit (feistymenopause.com/hit-play-not-pause-summit) Tickets are just $20! InsideTracker: 20% off at http://insidetracker.com/feisty (insidetracker.com/feisty) Previnex: 15% off your first order with code HITPLAY at https://www.previnex.com/ (https://www.previnex.com/)  Bonafide: 20% off your first purchase when you subscribe to any product with code HITPLAY at  http://hellobonafide.com/hitplay (hellobonafide.com/hitplay) Nutrisense: Go to http://nutrisense.io/hitplay (nutrisense.io/hitplay) for $30 off any subscription to the CGM program This podcast uses the following third-party services for analysis: Podsights - https://podsights.com/privacy Chartable - https://chartable.com/privacy

Amy Comander, MD, DipABLM is a breast oncologist and Director of Lifestyle Medicine at the Massachusetts General Hospital Cancer Center. She is the Medical Director of the Massachusetts General Hospital Cancer Center in Waltham, and Director of Breast Oncology and Survivorship as the Massachusetts General Hospital Cancer Center in Waltham and at Newton Wellesley Hospital. She is an Instructor in Medicine at Harvard Medical School. Michelle Tollefson, MD, DipABLM is an obstetrician-gynecologist, women's health lifestyle medicine expert, and wellness coach. She is the Secretary of the American College of Lifestyle Medicine, a professor at Metropolitan State University of Denver, author, international speaker, consultant, and breast cancer survivor. Description PAVING the Path to Wellness is a program that utilizes attitude, purpose, natural sources of energy, and taking time-outs to shift habits as well as mindset. It provides participants with lifestyle medicine tools including physical activity, healthy eating patterns, stress resilience, honoring and maximizing sleep, and cultivating high-quality connections. The program uses evidence-based guidelines and the latest research to inform the program and keep it cutting edge. During this presentation Drs. Comander and Tollefson will give an overview of the program and share some practical lifestyle medicine tips for optimizing wellbeing. They'll also share information about the PAVING the Path to Wellness Handbook, that they co-authored with Dr. Beth Frates, pioneer in lifestyle medicine, award-winning Harvard Medical School assistant clinical professor, and creator of the PAVING program. PAVING the Path to Wellness is a 501c3 non-profit organization. To learn more about the program and book, visit us on our website or follow us on social media. Website: https://www.pavingwellness.org/ E-mail: info@pavingwellness.org Twitter: https://twitter.com/pavingwellness Instagram: https://www.instagram.com/paving.wellness/ You can order the PAVING the Path to Wellness Workbook through the publisher Healthy Learning or on Amazon. All proceeds from the authors go to the 501c3 non-profit organization, PAVING the Path to Wellness.

Amy Cheung was originally diagnosed with Stage II breast cancer in September 2015, at the age of 32. At that point, she was feeling the healthiest she had ever been and was training for a marathon. She happened to cough one day and in the process of clutching herself, felt a lump. Amy went to her primary doctor a few days later and from there, things moved quickly to a biopsy that confirmed cancer. She was treated then with chemotherapy, then surgery, and radiation and presumed to be cancer free. She continued with anti-hormone therapy to keep the cancer from coming back. In late 2019, Amy started experiencing some back pain that she chalked up to exercise. Then from Jan - April 2020, Amy started having regular, low-grade fevers. Finally, after feeling miserable for so long, she e-mailed her oncologist Dr. Hal Burstein and told him of her symptoms. Without delay, Dr. Burstein ordered scans for Amy, which unfortunately revealed extensive cancer metastases in her liver as well as metastases in her bones. Amy has undergone several types of treatments for her cancer including surgery, radiation, and targeted therapies. She is currently part of a clinical trial that involves a targeted therapy combined with an immunotherapy drug, which enables the body's own immune system to recognize and destroy cancer cells. Having grown up in the Boston area, Amy felt like she had always known about DanaFarber. In high school during the summers, she used to volunteer for the Jimmy Fund at movie theaters, fundraising from movie patrons.

Steve was out golfing with a few of his friends on a cold December day on the Cape. During his round, he noticed a bump on his left side that he showed to his wife when he got home. He booked an appointment with his primary care doctor shortly thereafter, just before Christmas in 2016. After a few tests, Steve was completely floored to discover he had stage 4 breast cancer. He underwent a mastectomy shortly thereafter. He also came to Dana-Farber and to Dr. Erica Mayer for a second opinion. The subsequent treatment plan that Dr. Mayer sketched out for Steve just felt right to him and he decided to switch his care to Dana-Farber. Breast cancer in men is quite rare, only 1 out of 100 cases of breast cancer in the US are found in men. While he is still living with a serious illness Steve is doing great today and “like a million bucks.” He comes to Dana-Farber from Sandwich every three weeks for treatment. Steve travels a lot now with his wife visiting national parks and other spots he wishes he got to sooner.

Leaders of the IC-OS Pharmacy Working Group Heather N. Moore, PharmD, BCOP, CPP, Clinical Oncology Pharmacist, Breast Oncology, Duke University Medical Center and Craig Beavers, PharmD, Assistant Professor of Pharmacy Science at University of Kentucky discuss the role of the pharmacist in the care of cardio-oncology patients.

This installment has been contributed by OncBrothers.  Drs. Rohit Gosain, M.D. and Rahul Gosain, M.D. are practicing medical oncologists and hematologists offering their perspectives as community leaders. They both have excelled in their respective fields, gaining outstanding achievement awards in their top educational institutions and medical residencies. Their goal is to bridge the gap between academia and community oncology by educating their peers and providing appropriate standard of care treatment for all their patients in the community. Featuring Sara Tolaney, M.D., Chief, Division of Breast Oncology, Dana-Farber

In the inaugural Twitter Spaces edition of the Oncology Peer Review On-The-Go podcast hosted by CancerNetwork®, Paolo Tarantino, MD, a clinical research fellow at Dana-Farber Cancer Institute, and Sara M. Tolaney, MD, MPH, chief of the Division of Breast Oncology and associate director of the Susan F. Smith Center for Women's Cancer at Dana-Farber as well as an associate professor of medicine at Harvard Medical School, reviewed presentations in breast cancer research from the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting.  During the live event, Tarantino and Tolaney discussed the phase 3 DESTINY-Breast04 trial (NCT03734029), of fam-trastuzumab-nxki (Enhertu) vs chemotherapy for patients with HER2-low, hormone receptor–positive metastatic breast cancer. The co-hosts also reviewed surprising results from phase 3 PALOMA-2 trial (NCT01740427), which failed to show an overall survival benefit with use of palbociclib (Ibrance) plus letrozole in patients with estrogen receptor–positive/HER2-negative advanced breast cancer vs letrozole alone.  Additionally, Tolaney discussed her presentation of the phase 3 monarchE trial (NCT03155997) that explored adjuvant abemaciclib (Verzenio) in patients with hormone receptor–positive, HER2-negative, node-positive high-risk early breast cancer.  Overall, both investigators said they enjoyed coming back to in-person conferences and how they hope the trend of practice-changing trials continues with future conferences.  Don't forget to subscribe to the “Oncology Peer Review On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

Dr. Allison Zibelli, of the Sidney Kimmel Cancer Center – Jefferson Health, and Dr. Hope Rugo, of the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco, discuss the practice-changing DESTINY-Breast04 trial as well as novel therapies in metastatic HR+/HER2- breast cancer from the TROPiCS-02 and MAINTAIN studies, all of which were featured at the 2022 ASCO Annual Meeting.   TRANSCRIPT Dr. Allison Zibelli: Hello. I'm Dr. Allison Zibelli, your host for the ASCO Daily News Podcast today. I'm a vice-chair and breast medical oncologist at the Sidney Kimmel Cancer Center, Jefferson Health in Philadelphia. My guest today is Dr. Hope Rugo, a professor of medicine and the director of Breast Oncology and Clinical Trials Education at the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco. We'll be discussing key advances in breast cancer that were featured at the 2022 ASCO Annual Meeting. Our full disclosures are available in the show notes, and disclosures of all guests on the podcasts can be found on our transcripts at asco.org/podcasts. Hope, it's great to talk to you today. Dr. Hope Rugo: Nice to talk to you, too. Dr. Allison Zibelli: Let's begin with perhaps the most exciting abstract at ASCO this year, which was the DESTINY-Breast04 study, that's LBA3, a randomized phase 3 study of trastuzumab deruxtecan versus treatment of physician's choice in patients with HER2-low, unresectable and/or metastatic breast cancer. What are your thoughts about this study? Dr. Hope Rugo: Well, of course, this is a hugely practice-changing study as was noted in the second-to-last slide by the discussant [Dr.] Pat LoRusso. So, antibody-drug conjugates are really the next step in delivering chemotherapy to cancer cells. The antibody-drug conjugates allow targeted delivery of a toxin to the cancer cell. I think we didn't understand how important this was going to be. These second, sort of, verging on third-generation antibody-drug conjugates use an antibody approach and to then have a new generation of linkers, which allow the drug to be released locally, but to then have drugs which pack a big bang for the buck. So, the way antibody-drug conjugates are constructed, you need to have a drug that actually can't be given as a naked drug because it's too toxic because you're giving just very small amounts of this drug that are delivered directly to the cancer cell. And the other really critical part of this is that the drug-to-antibody ratio of at least the successful and new antibody-drug conjugates (ADC) is quite high in the 7.5 to 8 toxins per antibody. Now, what that's resulted in is really interesting, is that there's a bystander effect. So, the toxin itself can leak out of the cancer cell that it's targeted and kill neighboring cells, but also because of the construct of these antibody-drug conjugates, what's likely happening is even if the cancer cell's a very low expression of the target, really low, you're able to actually get that ADC into the cancer cell to kill the cancer cell. So that may be a big part of the so-called bystander effect. So trastuzumab deruxtecan is biosimilar trastuzumab linked to a topoisomerase inhibitor deruxtecan, and what happened here was that of course, we saw remarkable data in HER2+ disease, unbelievable p-values in DESTINY-Breast03 compared to T-DM1, a first-generation ADC. But in DESTINY-Breast04, we targeted a population of patients largely with hormone receptor-positive disease who had a little expression of HER2, 1 plus or 2 plus by immunohistochemistry and no gene amplification. And this trial, which randomly assigned patients 2:1 and included just 58 patients with triple-negative disease. So in this trial, 480 had hormone receptor-positive breast cancer, a median of 1 line of prior chemotherapy. They were only allowed up to 2. They were refractory to endocrine therapy, a median of 3 lines of endocrine therapy. In the overall patients and in the hormone receptor-positive patients, there was actually a doubling in progression-free survival (PFS). It started very early, and it continued throughout, and at every landmark analysis, T-DXd was better than the treatment of physician choice that patients were randomly assigned to. It's also important when you're thinking about trials like this to think about what the treatment of physician choice was, and it was all chemotherapy regimens we would use. Paclitaxel, nab-paclitaxel, capecitabine, eribulin, or gemcitabine. And, so, I think that that doesn't bring up any questions. When they looked at the hormone receptor-positive group, they saw, if anything, even a bigger benefit overall. Now, the other endpoint of this trial was overall survival, and at this first analysis, they saw an improvement in overall survival that was quite dramatic. The absolute difference was 6.4 months, which is pretty amazing for an overall survival difference. And then they looked at this exploratory endpoint at the 58 patients who were valuable at triple-negative breast cancer, and then that group of patients, also saw an improvement in PFS of 5.6 months, an improvement in overall survival of 9.9 months, very small group, but amazing data. The forest plots are exactly what you want to see, all the dots line up to the left of 1, and overall responses improved. One of the concerns with this drug has been toxicity. The toxicity showed no new toxicity signals, which is really important. Nausea is the biggest issue that we deal with. It's mostly grade 1 and 2, but still something that's important to manage. A little bit of hair loss, not much in the way of bone marrow suppression, which is interesting. Interstitial lung disease (ILD) or pneumonitis continues to be an important issue to follow. 12% of patients had ILD of any grade. Most of it was grade 1 and 2, but 3 patients died, representing 0.8%. So, this really highlights the importance of monitoring and managing pneumonitis. Regardless of that, few patients had a reduced ejection fraction, but again, very, in general, low grade. This is really a new standard of care, and the standing ovation was really due to the fact that all we do is dedicate ourselves to trying to help patients live longer and better with their cancers, and in this trial, we have a huge win that has no qualifications. We can help patients not only control their disease longer but live longer with T-Dxd compared to standard chemotherapy. Dr. Allison Zibelli: So, Hope, I know as a practicing medical oncologist, I find that our metastatic triple-negative patients are often the biggest therapeutic challenges for us. Will they be doing larger studies with these patients that are HER2-low? Dr. Hope Rugo: It's a really good point. About 65% of patients with hormone receptor-positive disease or so-called HER2-low, centrally confirmed in the study. So, a fair number of people, about a quarter, did not have HER2-low disease when they were tested centrally. In the triple-negative population, who really are ER, PR, HER2- by standard definitions, about a third of the patients might have HER2-low disease. So, there's a lot of interest in further exploring that and looking at the patients who have ultra-HER2-low disease, so between and 1 plus a little bit of expression. That's been studied in the hormone receptor-positive population in DESTINY-Breast06. But there's a lot of interesting further defining that triple-negative population, so to speak, they're going to be triple-negative plus now and understanding what the benefit is in that population. So definitely will be looked at more now moving forward. Dr. Allison Zibelli: Thank you. So, let's move on to Abstract 1002. And the results from the phase 1, 2 study of patritumab deruxtecan, a HER3-directed antibody-drug conjugate, and patients with HER3 expressing metastatic breast cancer. What are your thoughts about this study? Dr. Hope Rugo: That's a really interesting, another one of these second- to third-generation antibody-drug conjugates. It's just the antibody, instead of being the usual, sort of, HER2 or TROP2 that we're used to thinking about is directed to HER3, 1 of the HER family of proteins. This is interesting. There's actually been a lot of work trying to target HER3 with naked antibodies with disappointing results, although I have to say most of the studies really didn't push it too far. So, with this antibody drug construct, deruxtecan, which is the same as in T-DXd and another TROP2 ADC Dato-DXd is used. So, I will say they do need to change the toxin in the next generation of ADCs. But they looked at, at first did a dose-finding study which has previously been presented, and then a dose expansion in both hormone receptor-positive HER2-negative disease and triple-negative disease. All the triple-negative patients had HER3 high disease by immunohistochemistry, and the hormone-receptor-positive patients were enrolled in 2 cohorts, HER3 high and HER3 low. And the median number of prior treatment regimens that patients had received in the hormone-receptor-positive group was 6 and 2 for the triple-negative group, but there was a huge range, up to 13 lines of treatment. They only had 14 patients with HER2+ disease. So, it's a little bit hard to know what to do with that patient group, but they were heavily pretreated 5.5 prior lines of therapy. The confirmed overall response rate in the 113 patients with combined HER3 high and low was 30%, very impressive, heavily pretreated patients. For triple-negative disease all HER3 high, it was 23%. Again, very nice. And there were 14 patients with HER2+ disease that also were HER3 high. It was about 43%. So those are nice responses, but we always want to know how durable is that. The duration of response ranged from 6 to over 8 months in those 3 different groups. So, these were quite durable. It wasn't any 2- to 3-month duration of response. So very impressive. And then when they looked to see, did it matter whether you had HER3 expression that was high or low in the hormone-receptor positive group, they actually did see responses in the HER3-low group, some very good responses. Overall, there were less patients in that group, but it does suggest that maybe you would still see responses in the HER3-low group, very impressive. And then 1 really interesting correlative study they did was they looked to see what happened to the HER3 expression on the tumor cell over time, and it went down. So, you treated the HER3 expression in most of the patients just dropped off completely, which is really interesting. It didn't have any association with clinical activity, but it's sort of an interesting correlative endpoint. This is a drug that overall was pretty well tolerated. They saw a similar toxicity to T-DXd with a lot of nauseous, a little bit of alopecia, a little bit more bone marrow suppression than we're used to seeing with T-DXd. So, neutropenia was seen in about 10% of patients at the lower dose and about a quarter of the patients at the higher dose. Overall, pretty well tolerated. Now, interstitial lung disease is a toxicity with this construct, and they saw ILD of 7% but most cases were grade 1 and 2. The other interesting toxicity that's unique to this agent is thrombocytopenia. So, they saw a grade 3 or greater rate of thrombocytopenia of 27% in the lower dose group, and in the larger group that received the higher dose, 39% of grade 3 or greater thrombocytopenia, so platelets less than 100,000. Turns out that when you stop the drug, the platelets do come back, so that's a good thing. Sometimes we saw long-term thrombocytopenia with T-DM1. They didn't see bad toxicity like bleeding, but it is something that needs to be managed with this drug because we're not great at managing thrombocytopenia. In any case, it has fast-track designation for another solid tumor, not breast cancer, and we'll have to see where this fits into our dizzying array of very effective ADCs now. Dr. Allison Zibelli: The practicing medical oncologist is not used to testing for HER3 in our patients with breast cancer. How common is it? Dr. Hope Rugo: HER3 expression is quite common in hormone receptor-positive disease, a little less common in triple-negative breast cancer. So, I think that we would see expression if we were going to be treating patients with this particular approach. Dr. Allison Zibelli: All right. Let's move on to Abstract 507, which reported long-term outcomes of adjuvant denosumab in breast cancer, specifically fracture reduction and survival results from 3,425 patients in a randomized double-blind, placebo-controlled ABCSG-18 trial. What are your thoughts about this study? Dr. Hope Rugo: Well, this trial, this is an update of a study that previously has been presented and published, most recent publication was in Lancet Oncology in 2019, and these patients were randomly assigned to receive denosumab at 60 milligrams, important to note the dose, subcutaneously every 6 months versus placebo every 6 months, and they did get placebo subcutaneous injections. And this treatment continued through their endocrine therapy. They showed a dramatic reduction in fracture rate, and that has been maintained over time. We were really surprised enough to suggest that maybe Austrian people didn't go into the sun, so they got more Vitamin D deficiency, hard to know, but the hazard ratio is 0.5. It's unbelievable the number of fractures, 92 for denosumab but 176 for placebo, a P value of less than .0001. So, this is a real endpoint, treating patients who are receiving endocrine therapy that, in this case, non-steroidal aromatase inhibitor therapy that can increase bone loss, have a reduced fracture rate when they received denosumab. So that is the big take-home message, and a medium follow-up of 8 years. But the secondary endpoints included disease-free survival. They had about 20% disease-free survival events and 8% deaths, and what they saw was really interesting. So, the caveat is that 16% of patients were unblinded at the first analysis and half of them got denosumab, so it messed up their results a little bit, but the disease-free survival was significantly better in patients who received denosumab, and the hazard ratio of 0.83 and the hazard ratio does not cross 1. So that's very interesting, and even overall survival, they looked at 2 other endpoints, bone metastasis-free survival, and overall survival. They also trend towards an improvement with a hazard ratio of 0.8 for both of them. And they didn't actually see toxicity. So, patients' brittle bone fractures and osteonecrosis of the jaw (ONJ) are all concerning, but they really just did not see any risks in this patient population. I think there was 1 patient that had what they thought was a brittle bone fracture. Obviously, they watched the mouth very carefully as well. Really dramatic, and I think it's kind of disappointing that we never had any registration approach in this, and also not well-understood why the D-CARE study did not show a benefit, but I think D-CARE was designed differently. This is a better design to focus on our patients and the specific issues, and I think it's intriguing and should be considered as part of our treatment regimen for patients who are at risk for bone loss and have early-stage breast cancer on an aromatase inhibitor. Dr. Allison Zibelli: I've been using DEXA scans and offering denosumab to my patients on AIs that have osteopenia or osteoporosis. Should we be considering it in women with normal bone mass? Dr. Hope Rugo: I think not yet. Unfortunately, this trial was not immediately powered for cancer outcome, although the data are very encouraging. We don't know what the relationship is to bone loss, and providing an environment that's friendlier for cancer cells. So, do you have to have bone loss in order to have the risk that you're reducing with these agents? Certainly, that's what we've seen with zoledronate. So, I think that we don't have sufficient data to use this simply to treat cancer, but I do think that we should be considering this as an agent to give patients who have bone loss, either when you're starting an aromatase inhibitor or during the course of therapy. I think it's well tolerated, and a subcutaneous injection is not difficult. One of the questions that's come up for people is do you get bone loss that increases your risk of fracture after you stop therapy. But clearly from these updated data, these patients were off therapy. They did not have an increase of fractures and the patients treated with denosumab fared much better, I mean the hazard ratio of 0.5. Dr. Allison Zibelli: Let's move on to TROPiCS-02. That's LBA1001. This is a randomized phase 3 study of sacituzumab govitecan versus treatment of physician's choice in patients with hormone receptor-positive, HER2-negative advanced breast cancer. How do you think this study will impact practice? Dr. Hope Rugo: That's a great question. I presented this data, and I think I presented it on a Saturday, and on Sunday we saw the plenary talk of DESTINY-Breast04. These patients enrolled in TROPiCs-02 had a median number of lines of prior chemo 3 with a range of up to 8 actually, compared to a median number of lines as 1 in the DESTINY-Breast04 population. We included all hormone receptor-positive HER2 negative-advanced breast cancer, not centrally confirmed. They included just the HER2 low subset that was centrally confirmed. Everybody in our study had received prior CDK4/6 inhibitors compared to about 70% in DB04. And then 95% of patients in this trial had visceral mets. So, we did really treat a patient population who had very advanced high risk hormone receptor-positive breast cancer. As you know, we saw an improvement and progression-free survival with a hazard ratio of 0.66 meeting the endpoint. We needed a hazard ratio of 0.7, highly statistically significant P value .0003, but the median difference in PFS was only 1.5 months, and overall survival data is not yet mature. So that's brought up the question about how this drug should be used because there was a big fall off in the first 2 months where patients had rapid disease progression with heavily pretreated chemotherapy-resistant disease. We did landmark analyses and there were big separations in PFS at 6, 9, and 12 months, and 12 months, it was 21% patients free of progression and death at 1 year versus 7% for the TPC arm. So, it was a tripling of patients who were free of progression at one year. I think that's clinically relevant. This drug is associated with more neutropenia. That's the primary issue to manage, and probably half of the patients need growth factors at some point. When we looked at other endpoints response to ratio response, etc., we're better with Sacituzumab. So where does this all fit into our treatment paradigm. I think there's the HER2-low patients who will now receive T-DXd up in the, I hope, second line and not in lieu of endocrine therapy, when they're ready for chemo. But there are patients who don't have HER2-low disease and then there are patients who are going to be in the later line setting. So, I do think it still has a place in the treatment department, receptor-positive metastatic breast cancer. The results show that it was better than chemotherapy, physician choice based on our national and international guidelines, and that's better for our patients to have that option. Overall survival data obviously is looked for with great interest and that will help us put this into the right paradigm. And then I also hope that real world data will help us understand how sequential treatment with these different ADCs will benefit our patients. Dr. Allison Zibelli: This is really exciting. Do you think that we're maybe coming toward the end of conventional chemotherapy, especially for women with HER2-positive disease? Dr. Hope Rugo: I wonder if we are. I think we were interested in T-DM1 for HER2-positive disease early on. We've seen some really nice pathologic complete response data as well as adjuvant data in the attempt trial in patients who had stage I disease. Now that we have these second-, third-generation ADCs, T-DXd, I think this could potentially completely replace our chemotherapy. We still have to deal with alopecia. And I will point out ADCs are still chemotherapy. They're just a much more efficient and effective way of delivering treatment, and we need to be very careful to manage the toxicity. Dr. Allison Zibelli: Next, we're going to talk about the main pain trial that's LBA1004, which is a randomized phase 2 trial of fulvestrant or exemestane with or without ribociclib after progression on anti-estrogen therapy plus cyclin-dependent kinase 4/6 inhibition in patients with unresectable or hormone receptor-positive HER2-negative metastatic breast cancer, in other words CDK4/6 after CDK4/6. What are your takeaways here? Dr. Hope Rugo: First, just amazing that an investigator-initiated trial could do this well and be placebo-controlled. So, kudos to the principal investigator (PI) [Dr.] Kevin Kalinsky. This trial is a small phase 2 trial. A reasonable number, 119 patients were randomly assigned and evaluable patients could have received up to 1 line of prior chemotherapy for metastatic disease. If you had received prior exemestane, you received fulvestrant, if you received prior fulvestrant, you received exemestane, and actually if you looked at the number of patients who had received fulvestrant, it was 99 versus only 20 with exemestane. So important to keep in mind. If you looked at the overall population where the primary endpoint was progression-free survival, the hazard ratio is 0.57, just median PFS of 2.8 months in patients receiving endocrine therapy and placebo and 5.3 months for patients receiving endocrine therapy and ribociclib. So was this ribociclib after ribociclib or ribociclib after something else. 86% of patients had received palbociclib as their prior CDK4/6 inhibitor, and only about 10% to 14% had received prior ribociclib. So, there's a predominance of palbociclib followed by ribociclib. The other thing that's important to keep in mind is how sick this patient population was. Very few had received prior chemotherapy in the less than 10% range, visceral metastases in about 60%. So that's helpful. Only 19% or so had received 2 or more endocrine therapies from metastases. So, most people did this as their second line treatment. The PFS, when you looked at fulvestrant or exemestane, looked like the benefit was relatively similar, but you know you got 20 patients in the exemestane arm. The hazard ratios, looking at the subgroup analyses, all looked pretty similar, and the overall response and clinical benefit rate were better with continuing the cyclin dependent kinases (CDK) inhibitor. There was interesting sub-analysis looking at mutations and how that affected things. And they looked at patients who had ESR1 mutations or had wild-type ESR1. 42% had ESR1 mutations at study entry, very similar to what we've seen. In that group of patients, remember it's only 33 where they had this analysis, they saw a lot of other mutations. So p53, PIK3CA, FGFR, CCND1—those patients did not benefit. Only 33 patients. No benefit at all, very short PFS, about 3 months. The patients who had ESR1 wild type seemed to benefit a lot, 45 patients going from about 3 months to a little over 8 months. So, this is all hypothesis-generating data. I wouldn't run out and use this as your standard of care now because it is small data. But when the patient doesn't have other good options, I certainly would consider switching the CDK and going on, add that to the next line endocrine therapy. It's important to switch the endocrine therapy. I think we really need to look at the ongoing phase 3 trials to give us better evidence basis and understand the impact of mutations and prior therapy on who might benefit from continued CDK inhibitors after progression on a CDK inhibitor. Dr. Allison Zibelli: I think this is a really exciting trial. We all have a lot of patients on palbociclib and letrozole who've been on for 4, 5 years, and would like to continue with this kind of treatment because the side effects are really manageable. So, I look forward to seeing what's coming in the future with the phase 3 trials. So, let's talk about Abstract 1015, which I thought is a great idea. It looks at the quality of life with ribociclib plus aromatase inhibitor versus abemaciclib plus AI as first-line treatment of hormone receptor-positive, HER2-negative advanced breast cancer, assessed via matching adjusted indirect comparison. Could you tell us what matching adjusted indirect comparison is and why you chose this for the study? Dr. Hope Rugo: It's an interesting question. How do you compare across trials? So, matching this kind of make analysis, we'll call it a make analysis for the purposes of this discussion, allows you to match patients and weight based on their characteristics that might affect patient reported outcomes. And that actually is a way of trying to do a fair cross-trial comparison. So basically, take the study population, you match the inclusion and exclusion criteria, and then you weigh the different criteria so that you can try and make a better association. It's the best way we know of comparing across trials. You know, a lot of people ask why we didn't have PALOMA-2 in here, and that's because they used a different patient reported outcome tool. So, you have to use the same patient reported outcome tool in order to compare. So that's why we did this analysis, and it sort of came on the heels of a survey that Fatima Cardoso presented at San Antonio in 2021, where patients identified diarrhea as a symptom they really didn't like more than everything else. And you can imagine, I think we all have that experience in practice, the unexpected nature of diarrhea and the fact that it does limit your activities and, therefore, quality of life are important. In this analysis, interestingly but not surprisingly, ribociclib favored abemaciclib in diarrhea, and there can be associated appetite loss, so ribociclib also favored abemaciclib for appetite loss. And I thought the last one was interesting—fatigue—because I wouldn't have assumed that fatigue would be different. And maybe it's associated with diarrhea. They have these funny arm symptoms that were better. We don't really know why that was, and it's hard to assess again. We're really not clear based on the differences between the drugs. So, there are limitations to the analysis, but I think that it helps us really in individual patients try and match patients' underlying symptoms with the best treatment to offer them the best quality of life as they're being treated in the metastatic setting. Dr. Allison Zibelli: I thought this study was great because it really centered the experience of the patient and the wishes of the patient. You don't see that designed into many clinical trials, the way this was. So, I thought that was a great feature of this study. Dr. Hope Rugo: I will say that all of the 3 studies that looked at CDK inhibitors, all those 3 studies included patient-reported outcomes. That's an important new approach that is really being focused on. Dr. Allison Zibelli: Do you consider the CDK4/6 inhibitors equivalent in efficacy, and could you substitute them to try to get the side effect profile that you want? Dr. Hope Rugo: Well, I think that we saw in the early stage setting that there are differences. Now, across the different trials, there are big differences in patient populations and inclusions as we saw in the PALOMA-2 results that were presented at ASCO [Annual Meeting], whether the patients had prior chemotherapy like in PALOMA-3, whether they had a short disease-free interval, the higher risk patients in PALOMA-2. The PALOMA trials were more broadly inclusive than the other 2 studies, the MONALEESA and MONARCH series of trials. So, we do have to be a little bit careful about comparing apples to oranges, but we have the early-stage results of MONARCH E showing a clinically important difference in outcome whereas the PALLAS and Penelope-B trials didn't. So that sort of puts us into a little bit of a question period. Are these all patient populations or are there differences between the agents? The PFS and the metastatic setting, all the hazard ratios line up. So, in truth, although I know the activity against cyclin-independent kinases are different between agents, we don't still really understand the clinical differences in efficacy, but I think we all are practicing using evidence-based medicine. I wouldn't, for example, substitute a different CDK4/6 inhibitor for abemaciclib in the treatment of early-stage breast cancer. We have to just learn how to manage the diarrhea and use prophylaxis and dose reduce early to manage this and make it tolerable for our patients. And in the metastatic setting, I think we need to follow evidence-based guidelines and use the best data available to decide on the right treatment approach and sequencing for our patients. Dr. Allison Zibelli: Thank you, Hope, for coming on the podcast today. This was a really interesting review of one of the most exciting ASCO [Annual Meetings] I've been to. And thanks for sharing your valuable insights with us and helping us make sense of all this really new exciting data. We really appreciate it. Dr. Hope Rugo: Thank you. And thank you so much for inviting me. Dr. Allison Zibelli: And thank you to our listeners for joining us today. You will find the links to all the abstracts discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. That really helps other listeners find us. Thank you.   Disclosures: Dr. Allison Zibelli: None disclosed. Dr. Hope Rugo: Honoraria: Puma Biotechnology, Mylan, Samsung Bioepis, Chugai Pharma, Blueprint Medicines Consulting or Advisory Role: Napo Pharmaceuticals Research Funding (Inst.): OBI Pharma, Pfizer, Novartis, Lilly, Genentech, Merck, Odonate Therapeutics, Daiichi Sankyo, Sermonix Pharmaceuticals, AstraZeneca, Gilead Sciences, Ayala Pharmaceuticals, Astellas Pharma, Seattle Genetics, Macrogenics, Boehringer Ingelheim, Polyphor Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

On this episode, PrecisCa speaks with Dr. Sara Hurvitz, medical oncologist & the Director of Breast Oncology at the David Geffen School of Medicine at UCLA. Dr. Hurvitz answers the following: What are the biggest advances in breast cancer in 2021? What is your current approach to metastatic triple negative breast cancer? How do you choose between CDK4/6 inhibitors in both the curative and metastatic settings? How do you treat metastatic HER2 positive breast cancer with organ dysfunction through various lines of therapy? Did we learn any new information about T-DXD (Enhertu) in 2021? How do you envision the future development of T-DXD (Enhertu)? Sara A Hurvitz, MD, is Professor of Medicine at the University of California, Los Angeles (UCLA); co-director of the Santa Monica-UCLA Outpatient Oncology Practice; Medical Director of the Clinical Research Unit of the Jonsson Comprehensive Cancer Center at UCLA; and Director of Breast Oncology. Dr. Hurvitz received board-certification in internal medicine, hematology, and medical oncology. Dr. Hurvitz has won numerous awards over the past few years, among them the Marni Levine Memorial Breast Cancer Research Award 2008 through 2015. Visit www.precisca.com for more resources, content, and access to our entire catalogue of educational content. There you will have access to our complete library of educational videos. New episodes of the PrecisCa Oncology Podcast are released weekly. Please consider sharing our podcast, subscribing & turning on notifications to be the first to know about new releases. Together, we can raise the level of cancer care from diagnosis to recovery.

On this episode, PrecisCa speaks with Dr. Joyce O'Shaughnessy, a medical oncologist and the Director of Breast Cancer Research Program at Baylor University Medical Center in Dallas, Texas.    Dr. O'Shaughnessy sits down with us to answer the following questions: Which breast cancer patients are eligible for preoperative pembrolizumab in the curative setting based on the KEYNOTE-522 trial? What about adjuvant pembrolizumab? How is trastuzumab deruxtecan optimally utilized for HER2+ metastatic breast cancer? Which CDK 4/6 inhibitor is recommended for treatment of HR+ HER2- metastatic breast cancer based on available survival data? Can you discuss the data from the MonarchE Trial that led to FDA approval of abemaciclib in October 2021? Joyce A. O'Shaughnessy, M.D. focuses on breast cancer prevention and treatment. She is Co-Chair of Breast Cancer Research and Chair of Breast Cancer Prevention Research at Baylor-Sammons Cancer Center and for The US Oncology Network and is a member of the Scientific Advisory Board for US Oncology Research Network. In 2009 D Magazine elected Dr. O'Shaughnessy as one of the best hematology oncologists in Dallas, Texas.    Dr. O'Shaughnessy received her M.D. from Yale University Medical School. Her internship and residency in internal medicine were completed at Massachusetts General Hospital in 1985. She concluded a fellowship in medical oncology at the National Cancer Institute in 1987 and was a Senior Investigator there until 1995. Dr. O'Shaughnessy is a member of American Association for Cancer Research; American Society of Clinical Oncology; American Medical Women's Association; American Medical Association; American College of Physicians; and Women in Cancer Research. Dr. O'Shaughnessy is an Associate Editor, Clinical Breast Cancer Journal; founder, The School of Breast Oncology. Visit www.precisca.com for more resources, content, and access to our entire catalogue of educational content. 

In this episode, Amy Comander, MD, DipABLM, Beth Frates, MD, FACLM, and Michelle Tollefson, MD, FACOG, DipABLM, discuss their journeys in the breast cancer treatment and awareness space, the importance of wellness and lifestyle support in both patients and specialists and their new personal well-being resource PAVING the Path to Wellness Workbook. Welcome to another exciting episode of Oncology Overdrive :13 About Dr. Amy Comander, Dr. Beth Frates and Dr. Michelle Tollefson :24 The interview 3:06 What was Dr. Comander's path to the wellness and lifestyle space of medical care? 3:36 How did Dr. Frates enter the wellness and lifestyle space of health care? 5:40 Tollefson's path into the wellness and lifestyle space 8:10 The challenges faced in the wellness community and “wellness” as a buzzword 12:10 The importance of evidence-based lifestyle medicine in caring for mind and body 15:02 The origins of PAVING the Path to Wellness Workbook 19:21 Approaching wellness in patients compared with specialists 25:55 What are the most important “bite-sized” takeaways from this episode? 33:40 Thanks for listening 42:13 Amy Comander, MD, DipABLM, is the Medical Director and Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham, as well as at Newton Wellesley Hospital and is an Instructor in Medicine at Harvard Medical School.  Beth Frates, MD, FACLM, is a Clinical Assistant Professor at Harvard Medical School's Department of Physical Medicine and Rehabilitation. Michelle Tollefson, MD, FACOG, DipABLM, is an Associate Professor at Metropolitan State University of Denver and a Physician at St. Luke's Medical Clinic. We'd love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Follow us on Twitter @HemOncToday and @ShikhaJainMD. Commander can be reached on Twitter @DrAmyComander. Frates can be reached at www.bethfratesmd.com and on Twitter @BethFratesMD. Tollefson can be reached on Twitter @DrMTollefson. Disclosures: Jain reports she is a paid freelance writer for Lippincott. Comander, Frates and Tollefson report no relevant financial disclosures.

In this episode, Dr. Slavin speaks with breast surgeon Dr. Allison DiPasquale, Director of Breast Oncology at Medical City Dallas and Board President of the Susan G. Komen Dallas County Chapter. They discuss the role of genetics in breast cancer treatment and prevention. 

Dr. Sara Tolaney is chief of the Division of Breast Oncology and associate director of the Susan F. Smith Center for Women's Cancers at the Dana-Farber Cancer Institute, as well as associate professor of medicine at Harvard Medical School. The 2021 San Antonio Breast Cancer Symposium featured four days of presentations on the latest research on breast cancer. Dr. Tolaney joined us to discuss the research that is most immediately applicable to people who've been diagnosed with the disease. Listen to the episode to hear Dr. Tolaney explain: results of an early study looking at how effective the experimental medicine datopotamab deruxtecan was in treating metastatic, triple-negative breast cancer a study comparing Enhertu (chemical name: fam-trastuzumab-deruxtecan-nxki) to Kadcyla (chemical name: T-DM1 or ad-trastuzumab emtansine) for metastatic, HER2-positive breast cancer that had spread to the brain the studies that she thinks are practice-changing

Dr. Jayanti Thumsi is one of the very few lady surgeons specializing in Breast Oncology Surgery and women-related surgical problems. She has 21 years of experience in complete breast care with impressive training from some of the most prestigious institutions in India. Dr. Thumsi completed her MBBS and MS (General Surgery) from Grant Medical College and JJ group of Hospitals, Mumbai. She has also received Breast Oncology training from the Tata Memorial Hospital, Mumbai (Breast Unit) and training in Breast Reconstruction Surgery. Her current area of focus remains in Breast related diseases and has performed over 3500 Breast surgeries till date including procedures like Breast Conservation Surgeries, Mastectomies, Non-palpable Breast Cancers, Microdochectomy, Benign (non cancerous) Breast Diseases, LD Flaps, Implant based and Breast Reconstruction Surgeries, Sentinel Lymph node biopsy, etc. Listen to her here! --- Send in a voice message: https://anchor.fm/gmbwithkay/message

The Road to a Cure series heads to Boston to have Senior Producer and Co-host, Victoria Goldberg and co-host Dr. Paula Jayne speak with Dr. Nancy Lin and Dr. Heather Parsons about the possibilities and the current barriers to considering a cure for HER2+ MBC. Dr. Parsons and Dr. Lin are medical oncologists and professors at Harvard Medical School. Dr. Lin is also the Director of the Metastatic Breast Cancer Program and the Associate Chief of the  Division of Breast Oncology at Dana Farber Cancer Institute. In addition to other pressing topics, they talk with Victoria and Paula about the national study they are about to launch, entitled STOP-HER2. It is a study to answer a burning question - is it possible for some HER2+ MBC patients, who are currently NED and have been on anti-HER2  therapy for at least 3 years, to discontinue their treatments entirely and not relapse?  While an amazing gift, long-term survival among some HER2+ patients can also sometimes bring special challenges.  Given the higher prevalence of brain metastases among HER2+ patients, Drs. Lin and Parsons also discuss current research on brain mets, along with areas of promising overall MBC research for each subtype. 

On this episode we have a very special guest, my friend, Dr. Amy Comander who is:*Board certified in Hematology, Medical Oncology & Lifestyle Medicine*Breast oncologist at the Massachusetts  General Hospital Cancer Center*Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center at Waltham & Newton Wellesley Hospital*Co-Medical Director of the Mass General Cancer Center in Waltham*Instructor at Harvard University Medical SchoolOn this episode, Dr. Comander discusses her insight and expertise on the relationship between stress and cancer:Stress does not directly cause cancer but leads to many harmful behaviors that increase the risk of cancer such as smoking, overeating, drinking alcohol and decreases the function of your immune system's ability to fight off cancer Her whole person approach includes an 8 week stress management and resiliency program for her patients including yoga and meditation are great tools to manage stress Lifestyle Medicine principles optimize the health, well-being and outcome from cancer and help reduce the risk of cancer as well -- top modifiable risk factors include smoking and obesity Alcohol is a risk factor for breast cancer-limit to 1 alcoholic drink/day  Developing a program called Paving the Path to WellnessEarn CME: Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/3pGu8nInfo for Dr. Comander:Her Book: PAVING the Path to WellnessInstagram: https://www.instagram.com/dramycomander/Twitter: https://twitter.com/DrAmyComanderBook mentioned: Yoga for Cancer---------------------------------------------------------------------------------Info for Dr. Robyn Tiger & StressFreeMD:Register for Rx Inner Peace: A Physician's Guide for Self-Care (25 CME):https://mahec.net/event/65278For more info and to sign up for free self-care tips and videos, check out StressFreeMD:https://www.stressfreemd.net/Physicians schedule your FREE 30 minute Stress Relief Strategy Call:https://go.oncehub.com/StressReliefStrategyCallPhysicians: join our free private physicians-only Facebook group:https://www.facebook.com/groups/thephysiciansselfcarecommunityFollow me on Instagramhttps://www.instagram.com/stressfreemd/Connect with me on LinkedInhttps://www.linkedin.com/in/robyntigermd/Follow me on Facebook:https://www.facebook.com/robyntigermdSelf-Care Shop--accredited programs for healthcare and open to everyonehttps://www.stressfreemd.net/selfcareshopPrivate 1:1 Coachinghttps://www.stressfreemd.net/coachingContactinfo@stressfreemd. netPodcast website:https://www.podpage.com/the-stressfreemd-podcast/

This week, Dr. Louis Meyers talks about breast cancer with Dr. Amy Comander who is the Co-Medical Director of the Mass General Cancer Center in Waltham as well as the Director of Breast Oncology and Cancer Survivorship. He also talks with Tiffany Hogan, who is the Director of the Speech and Language lab at Mass General, and was a patient of Dr. Comander.

In recognition of Breast Cancer Awareness Month, Caris Precision Oncology Alliance™ Chairman, Dr. Chadi Nabhan, sits down with Dr. Stephanie Graff, Director of Breast Oncology at the Lifespan Cancer Institute at Brown University. Together they discuss the latest advances in breast cancer. For more information, please visit: www.CarisLifeSciences.com

Dr. Hope Rugo, professor of medicine and director of Breast Oncology and Clinical Trials Education at the University of California, San Francisco Helen Diller Comprehensive Cancer Center, highlights key studies in breast cancer featured at the 2021 ASCO Annual Meeting.   Transcript: ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. My guest today is Dr. Hope Rugo. She is a professor of medicine and the director of Breast Oncology and Clinical Trials Education at the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco. Dr. Rugo joins me to discuss key advances in the breast cancer field featured at the 2021 ASCO Annual Meeting. Dr. Rugo has received research support for clinical trials through the University of California from Pfizer, Merck, Novartis, Lilly, Roche, and other organizations. Her full disclosures are available on the transcript of this episode at asco.org/podcasts. Dr. Rugo, it's great to have you on the podcast today. Dr. Hope Rugo: Oh, it's great to be here. ASCO Daily News: There were many interesting studies in breast cancer featured at the Annual Meeting. Thank you for being here to highlight some of them. Let's start with the OlympiA trial. This is LBA1. This remarkable study found that adjuvant olaparib extends disease-free survival in BRCA-mutated early stage HER2-negative breast cancer. What can you tell us about this trial? Dr. Hope Rugo: Well, this is really such an amazing study, in terms of the results and its practice-changing impact. The study actually kind of interestingly was published in the New England Journal [of Medicine] 2 days before it was presented. And even though we had all seen the data, it was really such a, I think, moving presentation in terms of really changing the face of treatment for women and men with BRCA1 and BRCA2 associated breast cancer. Of course, olaparib and talazoparib are both PARP inhibitors that are approved to treat metastatic breast cancer associated with BRCA1 and BRCA2 mutations. And in those randomized trials, they showed improvement in response and progression-free survival, but not clear differences in overall survival. So, of course, when we have an impact in the metastatic setting, the next step is to move into early-stage breast cancer. But that's quite a challenge given the fact that you have to test and find the mutation, which is challenging in some parts of the world. And then you have to decide which group of patients need more than standard therapy. So the OlympiA trial randomly assigned patients who had pathogenic BRCA1 or BRCA2 mutations and HER2-negative, either hormone receptor-positive or triple negative breast cancer, to receive a year of olaparib or a placebo. And the patient eligibility was further defined. If you had triple negative breast cancer, you could have had any residual disease after neoadjuvant therapy, or you had to have a tumor greater than two centimeters or a positive node. If you have hormone receptor-positive disease keeping in mind the benefit of adjuvant endocrine therapy. If you didn't have a pathologic complete response to neoadjuvant therapy, you had to have a few other high-risk features using the CPS plus EG score. And if you received adjuvant therapy, you had to have four or more positive nodes, so stage III disease. All patients had to have received at least six cycles of chemotherapy, radiation as indicated, and of course, hormone therapy was given for hormone receptor-positive disease. There were over 1,800 patients randomly assigned, which was pretty, I think, impressive given the fact that everybody had to be tested. And the whole idea behind the trial is that you would enroll a group of patients who still had a high residual risk of recurrence, even though you got standard and reasonable adjuvant or neoadjuvant therapy. It's important to keep in mind when you think about the results of this trial is that having a BRCA mutation, and in particular BRCA1, increases sensitivity to chemotherapy. So the pathologic complete response rates, for example, in the neoadjuvant setting for triple negative breast cancer with the BRCA1 gene mutation, are higher than in patients who don't have a germline mutation. And so you're really looking at a group of patients who have high-risk disease because they didn't have a pathologic complete response if it was the neoadjuvant setting. Now, of the patient population, a little over 70% had BRCA1 mutations. The rest had BRCA2 mutations. And for the triple negative group, that represented a large portion of the population, about 80%. Again, the rest, a little under 20%, had hormone receptor-positive disease. As you would expect, more than 50%, about 60%, were premenopausal. And about 50% received neoadjuvant therapy. There's always a question about whether or not treatment with prior platinum-based therapy, which is also effective when you have DNA repair deficiency, such as in the germline BRCA mutations, whether or not that would affect sensitivity. A little more than a quarter of the patients had received a platinum chemotherapy agents. And the invasive disease-free survival, the primary endpoint of this trial, was really remarkable. There was an 8.8% improvement in a 3-year invasive disease-free survival rate in patients taking olaparib versus placebo, a very big p-value, and a hazard ratio 0.58. This is really dramatic. The curves separated early, and they remained separated. So that it was the IDFS was 77% for patients on placebo and about 86% in patients who were receiving olaparib, just really very impressive. And one of the things you want to find out about is are you changing the rate of distant recurrence. And indeed, not only were there less distant recurrences, but if you look at distant excluding the brain, that's where you really saw the biggest difference. There was a small difference--hard to know if it really is significant--1.5% less brain recurrence is a big issue for patients, particularly with triple negative disease. It was a little less contralateral invasive disease, but it wasn't anything significant. So really, what you were preventing was the kind of recurrence we don't want to see, which is distant recurrence. And then if you looked at the distant disease-free survival, the absolute improvement for metastatic disease was 7.1%. Again, the curve separated early and stayed separated over time. Now, overall survival, of course, is the golden endpoint that you want to look at. There were numerically less deaths in the olaparib arm, 59 versus 86 in the placebo arm. Most of these deaths were due to breast cancer. And the hazard ratio is 0.68. Although the p-value was 0.024, that didn't meet the statistical plan, which was a p less than 0.01 in terms of how the statistics can be balanced in this trial. But the overall difference was 3.7%. And of course, there were subgroup analyses done, which showed that everybody benefited. It was impossible to see a difference. And again, only a small number of patients relatively receive platinum, so it's hard to know whether or not that changed the response. In terms of the side effects--you always want to think about side effects--it was exactly what you would have expected from what we [expect] in the metastatic setting. Not a lot of grade III or greater toxicities. Mainly anemia was the most common at 9%, and 5% neutropenia, a little bit increase of grade III fatigue, but only 2%. The rest of the toxicities were all grade I and II. And of note, olaparib does cause nausea, 57% of patients versus 23% reported nausea with olaparib versus placebo. But normally, you can manage this nausea and the anemia by actually dose reducing and first holding and then dose reducing. One of the big questions, of course, with PARP inhibitors is if you're inhibiting repair of DNA, are you causing leukemia--new primary cancers? And it was very encouraging. Again, it's 3 years, so we need to be followed a little bit longer, maybe 5, but it was 0.2% or 0.3%. There was no increase in myelodysplasia or myeloleukemias with the use of the PARP inhibitor, which is really important. And the global quality of life scores were identical. So even with these side effects, they could be managed and didn't impact global quality of life. And then in terms of the paper, the additional information the paper gave is that most of the people who required a transfusion received only one transfusion of red blood cells. So I think with the caveat that there are some additional side effects, they are generally able to be managed well. Quality of life is maintained. And there's a huge early difference in the most important endpoints that we look for in these trials--invasive disease-free survival and most importantly, distant disease-free survival. So definitely history in the making. ASCO Daily News: Excellent. Thank you for sharing these fantastic results from the OlympiA trial. The ECOG-ACRIN Research Group presented EA1131, a study of platinum-based chemotherapy or capecitabine in patients with residual triple negative basal-like breast cancer following neoadjuvant chemotherapy (Abstract 605). This interim analysis really highlighted the need for better therapies for this patient population. What are your thoughts on this trial? Dr. Hope Rugo: Well, this, I think, is an important trial. Ingrid Mayer from Vanderbilt designed the trial with ECOG and actually presented the data. There will be a lot more data coming from this study because they collected tumor tissue and are doing a lot of different analyses, which might help us understand the benefits of different treatments in different subgroups of patients with triple negative breast cancer. Now, this trial really focused on patients who have the highest risk disease after neoadjuvant therapy, clinical stage II or III triple negative breast cancer diagnosis. They received the standard neoadjuvant chemotherapy. And they had to have tumors that were greater than one centimeter in the breast at the time of surgery or any positive lymph nodes. So this is actually a group of patients who we already know have a high-risk of distant recurrence. They did do an analysis of the tissue using a PAM50 assay to understand which tumors were basal or non-basal like. And patients were randomly assigned to receive capecitabine by the CREATE-X trial, which showed an improvement in overall survival when capecitabine was given to patients with residual triple negative breast cancer after neoadjuvant chemotherapy in Japan and Korea, versus carboplatin or cisplatin by treating physician discretion (DOI: 10.1056/NEJMoa1612645). The patients received four cycles every 3 weeks of carbo or cisplatin. Now, one thing that's important to keep in mind is in Japan where the CREATE-X trial was designed in Korea where it also participated, the capecitabine dose was the original U.S. Food and Drug Administration (FDA)-approved dose, where it was a little bit higher, 1,200 milligrams per meter squared twice a day, 2 weeks on, 1 week off. In the U.S., patients don't tolerate this very well. And there is a different metabolism in Asian patients, where they can tolerate a higher dose of 5FU and capecitabine with not as much toxicity due to pharmacogenomics. The patients in the ECOG-ACRIN trial received capecitabine at 1,000 milligrams per meter squared twice daily with the same schedule, which is really all that's tolerated. So the objective of this trial was to see whether or not you could do better or the same if you received a platinum versus capecitabine with the idea that DNA damaging agents work very well in basal-like triple negative breast cancer. So the patients were enrolled in this trial. 415 patients were randomly assigned. And then the data safety monitoring group who were following the results at the interim analysis ended up closing the trial because they found that based on the statistics so far that it was unlikely that the platinum arm would either be better or worse than the capecitabine arm. And they saw more toxicity in the platinum arm. So the trial was closed. And that's the data that was presented. So there was a total of 160 patients who received capecitabine, [and] 148 [patients] who received platinum. Most of the patients had basal-like disease. The age, it was about 52. It's all what you would have expected to see in this patient population. So I don't think we have any concerns about the patient population. The 3-year invasive disease-free survival in patients with basal-like triple negative breast cancer, the primary endpoint of the trial, was identical between the two arms. But actually, discouragingly, it wasn't great. So IDFS for capecitabine was 49% and platinum 42%. So this was actually very disappointing data. And I think it just highlights how we really need to provide better treatment for our patients who don't achieve pathologic complete responses to the best neoadjuvant therapy. It is true that the ECOG-ACRIN trial didn't require that patients receive anthracyclines, but 85% did. So I think that we feel really comfortable that they got good chemotherapy. They looked in the non-basal-like sub-type. And in the non-basal-like sub-type, which are cancers that are more likely to be responsive to capecitabine in the metastatic setting, actually, the outcome, although small numbers, looked better with capecitabine than with getting the platinum-type therapy. And if you looked at non-basal versus basal, regardless of therapy, the patients who had non-basal-like disease did much better than the patients who had basal-like disease, something that we would have guessed, but hasn't been shown before. So I think it was really important, [and] really helps us to identify the patients who need the most intervention. But even the basal group, the IDFS, the non-basal group, it was 55.5%. So better than basal at 46%, but still you got 45% of patients with invasive disease-free survival event over a 3-year medium follow-up. Overall survival at 3 years, also, was disappointing at about 66% for capecitabine and 58% for platinum. So I think that, really, this trial just identified, I think, in a very confirming way how we need to make progress in the treatment of these patients who have residual disease after neoadjuvant chemotherapy. In terms of toxicity, the platinum-based therapy clearly was more toxic. Most of the toxicity that was seen was grade I and II, as you would expect, but there was more grade III toxicity even with the platinum-type therapy. Again, as you would expect. You get hand-foot syndrome with capecitabine and not with platinum. But there was more of the standard toxicities that you would expect with the platinum or bone marrow suppression, primarily some thrombocytopenia, et cetera. So when they looked overall at the trial population, I mentioned that most had basal sub-type by PAM50. It was 80%. So it is a group of patients where I think even going into neoadjuvant therapy about 80% have basal-like disease. So I think it makes us very interested in the results that we expect to see in the very near future from the KEYNOTE 522 trial, where we've seen an improvement in pathologic complete response, particularly in patients with node positive disease with the addition of pembrolizumab, to standard taxane platinum and anthracycline-based neoadjuvant chemotherapy (DOI: 10.1056/NEJMoa1910549).  But a very recent press release noted that they have reached their event-free survival endpoint. And that pembrolizumab improves event-free survival. And the importance of this data, which, of course, has not yet been shared, so we have to see what it looks like and what the differences are, is that they had shown earlier at the FDA's ODAC meeting in February of this year that possibly patients who don't achieve a PCR, who received pembrolizumab before and after surgery, had a better outcome than patients who did not receive pembrolizumab and received placebo. So how we incorporate capecitabine into the post-neoadjuvant treatment or other novel agents will very much be a subject of the next few years as we sort this out. But if the pembrolizumab data is indeed exciting--and we'll talk more about the durvalumab data in just a moment--then I think the question would be, what chemotherapy do you give? And based on this trial, there is absolutely no indication for platinum postoperatively in patients with residual disease after neoadjuvant therapy. Capecitabine should be given. But clearly, we need better options for therapy. And this is also being studied with some of the new antibody drug conjugates, like sacituzumab govitecan to see whether or not we can improve outcome in these patients. ASCO Daily News: Right. Well, let's look at Abstract 506. This is the phase II GeparNuevo study. The data presented by the German Breast Group showed that neoadjuvant durvalumab improves long-term outcomes for patients with triple negative breast cancer. What is your takeaway from this study? Dr. Hope Rugo: You know, this was really interesting, and I think unexpected results based on their original presentation. This was a phase II neoadjuvant trial in patients with triple negative breast cancer. And the data by the GBG and Sibylle Loibl, who runs the GBG, had already presented the data from the primary endpoint of this smaller neoadjuvant trial, which was pathologic complete response. And what they did in this trial was they treated patients with a nab-paclitaxel followed by epirubicin and cyclophosphamide. And the patients were randomly assigned to receive the checkpoint inhibitor durvalumab versus placebo. There were 174 patients stratified by a low, medium, or high TILs. And their main endpoint, as I mentioned, was PCR. So this is a secondary endpoint of invasive disease-free survival. A group of patients received 2 weeks of durvalumab as sort of a lead-in first. And they've looked at that group separately. But it's hard to know because it's such a small trial what that means. And nobody is using a lead-in right at the moment. So their primary endpoint, as I mentioned, has been published already in Annals of Oncology in 2019 (DOI: 10.1093/annonc/mdz158). Although numerically there was a higher PCR rate in the durvalumab treated arm, this was not statistically significant. The p-value is in no way significant. And they looked at, in a forest plot, they showed that the patients who had the window seemed to have a higher PCR, but it was hard to justify exactly why that was the case in this group of patients. Now, it's important to keep in mind that the data that we have from KEYNOTE 522, the neoadjuvant trial with pembrolizumab, and IMpassion 31, the trial with the atezolizumab, showed the benefit, particularly in patients with node-positive disease. In this trial, about a third of the patients had stage zero or I breast cancer. So 61 out of the total of 174 patients did not have positive nodes. So we thought the PCR difference really wasn't seen because they had a low-risk population. But now, they're presenting their secondary endpoint of invasive disease-free survival in this group of patients. And what they saw, actually, at a median follow-up of about 44 months, they saw a 12 IDFS events in the durvalumab arm and 22 in the placebo arm. And actually, there were twice as many distant recurrences in the patients treated with placebo versus durvalumab. So 13 versus six events for distant recurrence. So I think that's actually a really important endpoint. And if you looked at the invasive disease-free survival at 3 years, it was 77% for placebo and almost 86%. So almost a 9% difference in favoring the patients who received durvalumab. Pretty dramatic, you know? A hazard ratio of 0.48. And they did have a p-value of 0.0398. So that was quite interesting. And they looked at distant disease-free survival. Numbers are small here, but I think it's a really important endpoint, and overall survival. Overall survival is early to see, but they could see--this is a long follow-up, but it's a small study rather than early--and they showed that overall survival difference was 83.5% in the placebo arm and 95.2% in the durvalumab arm. Again, secondary endpoints with a hazard ratio is 0.24 and, again, a p-value of 0.1. Distant disease-free survival, such an important endpoint, was a huge difference 78.4% versus 91.7%. Again, hazard ratio of 0.31. So pretty dramatic. And when you looked at subgroups of patients, and they looked at PD-L1 positive versus negative. Almost all of the patients had PD-L1 positive disease, so 138 versus 20 that were PD-L1 negative. So it's kind of hard to interpret any of that. And that trial was stratified by stromal TILs anyway. They did show that patients who had a PCR had a better outcome than patients who did not have a PCR. But among the patients who had a PCR, the patients who had durvalumab did better, again, with almost a 10% difference, favoring durvalumab versus placebo. Now, this is a phase II randomized trial, so it's small. And so this is really hypothesis generating. But given the fact that KEYNOTE 522 and IMpassion 31 (NCT03197935) gave the checkpoint inhibitor for a year, and in this situation patients received durvalumab only in the neoadjuvant setting, it suggests that they saw this impact in patients who had a PCR that was greater in patients receiving durvalumab placebo. So it suggests that even though the PCR improvement was not significant, that just the treatment with a checkpoint inhibitor changes long-term outcome. And we know that there's more toxicity by giving longer course checkpoint inhibitor therapy, so we expect that we might see approval of pembrolizumab based on the KEYNOTE 522 trial. And it will bring up the question of whether or not you need a whole year of treatment to improve outcome. And whether or not simply treatment preoperatively might be sufficient, particularly in the patient group who achieves a PCR. It will be, I think, very, very important to be able to evaluate this in order to reduce the toxicity, both the physical toxicity, as well as financial toxicity from use of checkpoint inhibitors in patients with triple negative breast cancer. Also, we know that a third of these patients had stage I disease. And I think we really need to look at the larger trials quite carefully to understand whether or not all patients need checkpoint inhibitors who have triple negative disease. Or whether or not we could more correctly focus on the patients who have higher risk disease, node-positive disease who've been shown to have less tumor infiltrating lymphocytes than patients who have less burdensome disease at diagnosis. ASCO Daily News: Right. So what about the subset analysis in Abstract 1011 that looked at outcomes in patients who are age 65 and older in the phase III ASCENT study of sacituzumab in metastatic triple negative breast cancer? Can you tell us about ASCENT and the toxicities associated with this antibody drug conjugate in this older patient population? Dr. Hope Rugo: Well, ASCENT, of course, is a practice-changing trial as well. It led to the final formal approval of sacituzumab govitecan for patients with metastatic triple negative breast cancer in the second line or greater earlier this year after accelerated approval was granted earlier in 2020. This antibody drug conjugate is given 2 weeks on, 1 week off. And the primary toxicity is neutropenia, and then to a lesser degree diarrhea. But overall, the drug is quite well-tolerated. In the overall parent ASCENT trial, as the listeners know, showed an improvement in progression-free and overall survival at the first analysis. Very impressive data with sacituzumab in these heavily pretreated triple negative breast cancer population, compared to treatment of physician choice with standard chemotherapy options, where about 50% of the patients received eribulin, which had already been shown to be better in terms of overall survival compared to other chemotherapy in the subset of patients treated in the past with eribulin who had triple negative disease. So at ASCO this year, Kevin Kalinsky presented on behalf of our authorship group a subset analysis looking at patients who were age 65 and older to better understand whether there was more toxicity and as much benefit in this group of patients. So important when we're looking at novel therapies. So overall, there were 44 patients treated with sacituzumab and 46 with treatment of physician choice who were age 65 or older. Most of the patients had received two to three lines of therapy. And about 40% had received greater than three lines of therapy. The median prior anticancer regimen was pretty similar to the overall group. Most of the patients had initially been diagnosed with triple negative disease, but really, interestingly, about a third of the patients had ER-positive or something else disease initially and were triple negative on biopsy in the metastatic setting. So an interesting subgroup of patients that were also looked at separately and appeared to benefit to the same degree as the triple negative patients. So we looked at progression-free survival in this group of patients looking at patients under age 65 and age 65 and older. A hazard ratio was even greater in the age 65 or older for--it's hard. These are subset comparisons, but the hazard ratio is 0.22 going from 2.4 months with standard therapy to 7.1 months with sacituzumab. The hazard ratio in the younger group was 0.46. But still a big difference in progression-free survival. And then in terms of overall survival in the age 65 and older group, it went from 8.2 to 15.3 months with a hazard ratio of 0.37. And so also really quite dramatic. And overall response was also significantly increased with, in fact, the only responses seen in the age 65 or older group seen in the sacituzumab group. There were no complete or partial responses in the treatment of physician choice group. Of course, really important to look at safety in our older patients because we know that generally there is more toxicity in that group of patients. But actually looking at grade III or greater toxicity, keeping in mind it was 49 [patients] in the older group versus 209 patients in the younger group, there was no difference in grade III or greater toxicities. There were more dose reductions. So 35% reduced their dose versus 19% older versus younger. But there was no difference in adverse events that led to discontinuation between the younger and older group. So that was really encouraging. We see this in almost all trials that older patients have more dose reductions and that was seen here as well. And we also looked at this very small subset of patients who are age 75 or older versus age 65 or older. And the rates of adverse events were similar, albeit smaller number of patients. There was, if you looked at specific treatment-related adverse events that led to dose reduction, it was a neutropenia, fatigue, diarrhea, febrile neutropenia in a small number, 6% versus zero in the treatment of physician choice and nausea. So it's helpful to know what those toxicities are when you're thinking about treating these patients in clinical practice. And in a patient who might be a little less strong, a little older, more comorbidities, so slightly more frail, I would consider starting potentially at a 3/4 of the dose and then going up if they tolerate it well, versus starting at the full dose and getting a lot of toxicity. But this was really encouraging data that showed that you can give the drug to patients who are older and even elderly at age 75 or greater. So that was good to see. And then Lisa Carey presented additional data looking at patients who were treated in the second line or greater because the formal approval by the FDA is in second or greater line. But most of the data looked at patients who were treated in the third or greater line. So you were supposed to have at least two chemotherapies for advanced disease, but you could have had one in the early stage setting if your progression occurred within 12 months. So there were 33 and 32 patients in the sacituzumab and treatment of physician arm, respectively, who had a recurrence within 12 months of neo or adjuvant chemotherapy. They got one line of chemotherapy in the metastatic setting. And then they were randomly assigned on the ASCENT trial. And as you would expect, tiny numbers, right? 33 and 32 patients. But you get a lot of events in this patient population. The PFS was much greater in patients getting sacituzumab than treatment of physician choice. Hazard ratio of 0.41. And also, if you looked at overall survival, it was double. The hazard ratio is 0.51, even in the second line setting. I think it's really interesting to look to see what the toxicity is relative to the lines of therapy. But because the numbers are so small, it's really hard to look at this now. We'll see more data on toxicity when we see data in the first line, as well as the post-neoadjuvant setting in ongoing trials. And I think that will help us a lot to understand what I think we see in the current clinical trials and in practice, which is that patients who are treated in this second line setting have less hematologic toxicity as well as GI toxicity and need less growth factor intervention, et cetera. And I expect that we'll see that in the post-neoadjuvant setting as well. These numbers are too small to really look at any differences in toxicity. But all of this data I think was incredibly encouraging for us in terms of the use of sacituzumab in patients with metastatic triple negative disease, as well as the expansion to the first line and to post-neoadjuvant setting. ASCO Daily News: Excellent. Investigators of the phase III MINDACT trial, that's Abstract 500, evaluated the survival of patients with an ultra low risk 70 gene signature. How will MINDACT inform clinical practice? And do you think this study might guide more appropriate choices of chemotherapy in women with node-negative or one to three node-positive disease? Dr. Hope Rugo: Well, how MINDACT will inform clinical practice is a very big question. And it already has informed clinical practice identifying patients who are better candidates for chemotherapy and endocrine therapy versus endocrine therapy alone who have stage I and II hormone receptor-positive early stage breast cancer based on their primary outcome results. This particular analysis was something different. So we think about using this 70 gene score and the recurrence score from the TAILORx trial (DOI: 10.1056/NEJMoa1804710) and RxPONDER to try and identify which patients need more therapy versus less therapy. Now, we also know that these scores have some prognostic impact. Clinically, we mainly have used them to decide who should get chemotherapy in addition to endocrine therapy. This trial looked at a different way to use a gene expression scoring system. It's really to identify which patients need less. Given the fact that your middle of the line therapy is endocrine therapy, which patients do we know who will do very, very well with any endocrine therapy and don't need extended duration endocrine therapy? That's really the question here. So they looked at the patients who were in the MINDACT trial and used data published by my colleague, Laura Esserman who looked at a cohort of patients retrospectively and found that patients who had an ultra low score in MINDACT. And that's a score greater than 0.355 where plus 1 is the lowest end of low risk, and minus 1 is the highest end of high-risk, so greater than 0.355. She identified a group of patients who did well, regardless of whether they received tamoxifen or not apparently in this retrospective long-term outcome where there was 15-year follow-up. So they use that data to go into the MINDACT population and to try and understand which patients benefit. And the MINDACT is a much higher risk group of patients. So if you looked at that original trial that Laura Esserman published, these patients had screen detected cancers. And in fact, the 70 gene signature low and ultra low-risk tumors are, as you would expect, over-represented in screen detected cancers. So you've got this excellent survival regardless of treatment. So how did they apply to MINDACT? So in MINDACT, patients were randomly assigned, of course, who had clinical low, genomic high, or clinical high genomic low to receive chemotherapy or not. In this situation, you're really looking at the patients who have genomic ultra low disease. So most of those patients would not be getting chemotherapy because they would already have ultra low disease. So what they found actually when they looked at the overall population of MINDACT, 6,700 or so patients, they found 15% of patients or 1,000 patients fell into this ultra low category. And if then you looked at the patients who were high-risk, it was 36%. And patients who fell into the big low-risk group, it was about 49%, so about half of the population of patients. So they looked at the different metastasis-free interval rates in patients who had genomic low and ultra low-risk disease, regardless of the treatment the patients receive. They all receive endocrine therapy, remember? So they actually found that in patients who were ultra low versus low-risk, that the hazard ratio is 0.65, showing that patients who had ultra low-risk--remember, this was 1,000 patients at 8 years--there was only 36 events. So they had a 97% 8-year distant metastasis-free interval, compared to 94.5% for low-risk and 89.2 in high-risk disease. They looked at breast cancer-specific survival rates as well. And for ultra low-risk in 1,000 patients, there were exactly eight events. 99.6% 8-year breast cancer-specific survival. So really, quite remarkable. So clinical high-risk tumors tend to have larger size, higher grade, be node-positive. We already know that. For the 1,000 genomic ultra low-risk patients, about almost 70% were greater than 50 years. 80% were node negative. 81% had tumors that were T1, so up to two centimeters. And most of them, except for 4%, were grade I and II. 97% were hormone receptor-positive HER2-negative. Only 14% of patients who had ultra low-risk disease received chemotherapy in MINDACT. And most of the rest received endocrine therapy. Some actually didn't receive endocrine therapy. 16% had no adjuvant systemic treatment at all. So if you looked at the genomic ultra low-risk patients and divided them into clinical low-risk and clinical high-risk, there was really no difference in the events overall, a little bit less 8-year distant metastases-free survival, but not much of a difference. So really, a quite remarkable outcome. Now, what you want to know, of course, then is, does it make a difference if you get endocrine therapy at all? And they looked at the patients who had chemotherapy versus no chemotherapy. And as you would expect, it made no difference. Again, it was a tiny number of patients. But if you looked at endocrine therapy versus no endocrine therapy, it was hard to tell. Because, again, no adjuvant systemic therapy was only 157 patients. There were four events. And for the patients, 685 patients who got endocrine therapy, there were 23 events. So the 8-year metastasis-free interval was identical, but there just aren't enough patients in that no adjuvant systemic therapy group to really understand. So what we know is ultra low-risk defines a group of patients who have excellent outcomes. Does it tell us that they don't need adjuvant systemic therapy? No. Eight years really isn't enough time, unfortunately, in is group because 50% of recurrences occur after five years and out to 20 plus years. We have to keep in mind the Early Breast Cancer Trials Group data showing how many recurrences occurred after five years of endocrine therapy. But in this group of patients who have ultra low-risk disease, they clearly do not benefit from chemotherapy. And I think that's regardless of their clinical risk. And it's likely that 5 years of adjuvant endocrine therapy is absolutely all those patients would ever need. If you have a small cancer that's ultra low-risk, could you get by with less than 5 years of endocrine therapy in a patient with a lot of toxicity? Potentially. And I think that's a really important bit of information to take back into clinical practice when you're talking to patients about the duration of endocrine therapy. But a stage I tumor or stage II with ultra low-risk disease, in general, I would treat for 5 years. I think it's important to keep in mind that premenopausal women, even with ultra low-risk stage II disease, have an ongoing risk of recurrence. And I still think that those patients should be treated with a varying function suppression and aromatase inhibitor if tolerated and tamoxifen otherwise because our very young patients tend to have higher risk of recurrence over time. And it's very hard to separate them out in these studies. Interestingly, there are a few young women who have ultra low-risk disease. So I think this really helps us understand yet another impact of genomic tests, which is who needs less therapy, not just who needs more. ASCO Daily News: Great. That's good to hear. Well, finally, the theme of the Annual Meeting was equity. And in Abstract 1092, you and your colleagues at University of California, San Francisco (UCSF) looked at decreased enrollment of patients with advanced lobular breast cancer compared to ductal breast cancer in interventional clinical trials. Can you tell us about this study? Dr. Hope Rugo: Yes, this was a really interesting evaluation. My colleague surgeon Rita Mukhtar at UCSF actually led this evaluation with a very good student who's working with us on some of our research trials. And the idea was that we had observed anecdotally, as have others, that patients with invasive lobular cancer tend to be less likely to meet criteria for clinical trials. So they don't have measurable disease as much. We tend to see sclerotic bone lesions, diffuse infiltration without measurable disease. And it can be much, much more difficult to meet the criteria for clinical trials. So actually, what my colleagues did in this trial is look at whether or not patients with lobular breast cancer are underrepresented in clinical trials. And so they looked at the proportion of interventional stage IV clinical trials that used RECIST in clinicaltrials.gov. And then actually looked at the patients who have RECIST measurable disease who have lobular cancer. And it's really interesting. I mean, we just have a lot less RECIST measurable disease. And in the UCSF cancer registry, patients who were enrolled in clinical trials, if you looked at invasive lobular cancer were markedly decreased if you compare it to patients with other sub-types of breast cancer. So we think that that's probably due to the requirement for measurable disease. And that what we should do in patients who have metastatic lobular cancer is develop trials that are specifically for lobular cancer that focus on the unique biology. And there's a lot of work going on now looking at that biology. And allow patients to enroll based on their disease control rates rather than response. So that we don't require RECIST measurable disease since that's hard to come by in invasive lobular cancer. So I think it's a really important area. It's about 15% of invasive breast cancers. We see a lot of lobular cancer in the metastatic setting. And I think it's unfortunate not to be able to enroll these patients in clinical trials. There is a lot of interest in the cooperative groups in the United States in Europe and in Asia, of course, in trying to do trials that are focused on addressing the needs of patients with lobular cancer, both in the early and late-stage setting. ASCO Daily News: Excellent. Thank you, Dr. Rugo. It's been great to have you on the podcast today. Thanks so much for sharing your valuable insight with us on the ASCO Daily News podcast. Dr. Hope Rugo: It was really a pleasure to participate and thank you for putting together these podcasts. ASCO Daily News: And thank you to our listeners for your time today. If you enjoyed this episode, please take a moment to rate and review us, wherever you get your podcasts.     Disclosures: Dr. Hope Rugo Honoraria: Puma Biotechnology, Mylan and Samsung Research Funding (Institution): Pfizer, Merck, Novartis, Lilly, Roche, Odonate, Daiichi, Seattle Genetics, Macrogenics, Sermonix, Boehringer Ingelheim, Polyphor, Astra Zeneca and Immunomedics. Travel, Accommodations, Expenses: Pfizer, Novartis, Mylan, AstraZeneca, Merck Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Breast cancer is not just one disease - there are many different types of breast cancer. HER2- positive breast cancer is one of the more common types, making up about 10-20 percent of newly diagnosed breast cancers. Today, we are talking to Dr. Ian Krop, Associate Chief of the Division of Breast Oncology at Dana-Farber Cancer Institute & Associate Professor of Medicine at Harvard Medical School. Dr. Krop is a physician-scientist that treats patients and conducts clinical trial research in breast cancer. He is a leading expert on HER2-positive breast cancer and a Komen Scholar. Special Guest: Dr. Ian Krop.

On October 11, 2020, our host Dr. Marianne Ritchie was joined by Dr. Kristin Brill, Associate Professor of Surgery and the Enterprise Director of Breast Oncology at Abington Health, Dr. Jason Shames, Assistant Professor of Radiology, and Associate Director of Research for the Division of Breast Imaging at Jefferson University, and Paula Green, Executive Director of the American Cancer Society of Greater Philadelphia, for a discussion about the most current information about breast cancer screening and early detection along with the latest advances in breast cancer surgery.Your Real Champion: Landing On Her Feet​Each week we highlight the #RealChampions in your life! Your family, friends, or colleagues who go the extra mile to help others in their community. For this week, Your Real Champion was Michelle Konkoly.Michelle is a 4th-year medical student with a promising future. As a college scholar-athlete, she sustained a devastating injury. Listen now to learn how focus and fortitude put her back on track to break world records, win gold medals in the Paralympics, and gain a new outlook on life.

Tune in this week as Dr. Barrett speaks with Dr. Janie Grumley M.D., a surgical breast oncologist who has expertise in treating patients with breast cancer and benign breast diseases. She specializes in novel treatments such as oncoplastic breast-conserving surgery and intraoperative radiation therapy.    In this episode, Dr. Grumley talks about breast health clinics.  Think of an urgent care for breasts where you can actually be examined by a nurse practitioner and get imaging the same day for any lump that keeps you up at night!     Traditionally, if there's a problem with your breasts and you go at the local Emergency Room, Good Luck!!  Learn why it's so important to find a board certified professional you can trust and one who can deliver specialized care custom tailored to your needs.  Dr. Grumley describes trusting relationships and the bond she creates with her patients that can last a lifetime.   Dr. Barrett and Dr. Grumley both explain why surgery should be a risk vs. benefit process in order to reduce unnecessary and possibly invasive treatments and dive into interesting subjects like futuristic technologies and Molecular Markers!  Yes, that's a thing too!   Check this episode out on our Youtube channel and be sure to subscribe, comment, and click the notifications bell for our latest!  Visit our website at www.drdanielbarrett.com for more information.   Learn more about today's guest Dr. Janie Grumley, M.D. Dr Janie Grumley, M. D. is the Director at Margie Peterson Breast Center at Providence and St. Johns and Director of Breast Oncology at John Wayne Cancer Institute. She is also the Associate Professor of Surgery at John Wayne Cancer Institute.    See full bio here: www.providence.org/doctors/profile/754715-janie-g-grumley   For more information please contact: Margie Peterson Breast Center Web: www.providence.org/locations/saint-johns-health-center/breast-center Phone: 310-582-7100   Breast Oncology at John Wayne Cancer Institute  Web: www.saintjohnscancer.org/breast Phone: 310-582-7100

Oncology Today with Dr Neil Love: Breast Cancer Edition — A virtual roundtable discussion with noted investigators Charles Geyer and Sara Tolaney for a review of recent innovations in breast cancer medicine: Design and results of the Phase III KATHERINE study investigating adjuvant T-DM1 versus trastuzumab for patients with residual invasive HER2-positive early breast cancer (0:00) Side effects and tolerability of T-DM1 compared to trastuzumab (3:00) Clinical implications of the KATHERINE trial (7:27) Case (Dr Geyer): A 53-year-old woman with a locally advanced ER/PR-negative, HER2-positive, ulcerated infiltrating ductal carcinoma (IDC) experiences neuropathy after 6 cycles of neoadjuvant TCHP (docetaxel/carboplatin/trastuzumab/pertuzumab) (12:52) Management of the axilla in patients with positive sentinel lymph nodes after neoadjuvant chemotherapy (15:36) Case (Dr Tolaney): A 56-year-old woman with a 3.7-cm ER/PR-negative, HER2-positive IDC receives neoadjuvant THP (paclitaxel/trastuzumab/pertuzumab) and adjuvant AC followed by trastuzumab/pertuzumab (20:01) Selection of (neo)adjuvant treatment for patients with HER2-positive breast cancer (22:14) Optimal treatment for early-stage HER2-positive breast cancer (28:05) Role of the recently FDA-approved subcutaneous formulation of trastuzumab alone or in combination with chemotherapy for patients with HER2-positive BC (32:01) Final results from the OlympiAD trial of olaparib versus standard chemotherapy; results from the EMBRACA trial comparing talazoparib to standard therapy for patients with germline BRCA mutations (34:52) Case (Dr Geyer): A 31-year-old woman with metastatic ER/PR-positive, HER2-negative breast cancer receives ovarian suppression, fulvestrant and abemaciclib (39:45) Use of PARP inhibitors for patients with metastatic breast cancer and BRCA mutations (41:51) Case (Dr Tolaney): A 59-year-old woman with ER/PR-positive, HER2-negative metastatic breast cancer and a BRCA2 mutation receives olaparib as second-line therapy (45:18) Sequencing of PARP inhibitors for patients with metastatic triple-negative breast cancer (TNBC) and BRCA mutations (49:52) Ongoing PARTNER/PARTNERING studies evaluating olaparib with platinum-based neoadjuvant chemotherapy or as a part of novel combination approaches; investigation of neoadjuvant talazoparib for patients with TNBC and a germline BRCA mutation (51:49) Ongoing Phase III OlympiA trial evaluating olaparib as adjuvant treatment for high-risk, HER2-negative breast cancer with a germline BRCA mutation (54:33) Efficacy and safety of atezolizumab with nab paclitaxel for advanced TNBC in the Phase III IMpassion130 trial (56:57) Choice of chemotherapy for patients with metastatic TNBC (59:49) Perspective on overall survival for patients with advanced TNBC and PD-L1-positive tumors treated with atezolizumab and nab paclitaxel (1:4:42) Case (Dr Tolaney): A 52-year-old woman develops pneumonitis while receiving pembrolizumab and eribulin for metastatic TNBC (1:7:09) Endocrine toxicities associated with immune checkpoint inhibitors (1:9:26) Ongoing Phase III NSABP-B-59/GBG-96-GeparDouze trial evaluating neoadjuvant chemotherapy with atezolizumab followed by adjuvant atezolizumab (1:10:34) Ongoing Phase III ALEXANDRA/IMpassion030 study evaluating standard adjuvant chemotherapy with or without atezolizumab for early TNBC (1:13:10) Emerging data with the HER2-selective tyrosine kinase inhibitor tucatinib for advanced HER2-positive metastatic breast cancer (1:14:48) Comparison of the activity and tolerability of tucatinib to that of lapatinib and neratinib (1:19:15) Efficacy and safety of the novel antibody-drug conjugate trastuzumab deruxtecan for HER2-positive breast cancer (1:21:46) Results of the Phase III SOLAR-1 trial evaluating the PI3 kinase inhibitor alpelisib with fulvestrant for ER-positive advanced breast cancer (1:27:4) NEO-ORB: A randomized Phase II study of neoadjuvant letrozole with alpelisib for HR-positive, HER2-negative breast cancer (1:31:47) Select publications  

Allie Young felt a lump in her breast while breastfeeding her infant son earlier this year. She was subsequently diagnosed with HER-2 positive breast cancer.Allie went to Dana-Farber where her treatment has included surgery, chemotherapy, targeted therapy, and radiation. Allie has been in treatment for seven months so far, and she has another 7 months of targeted antibody therapy to complete.Through her treatment, Allie has had husband Seamus, daughters Reagan, who is almost 5, and 3-year-old Caroline, and 11-month-old son Owen by her side. The hardest part of cancer and treatment for Allie has been worrying about the impact on her kids and balancing the need to care for herself while still being a mother and wife. Allie loves being outside and active with her family. They love to hike, ski, swim, sightsee and take advantage of all Boston and New England has to offer.Allie works as a stock trader for a mutual fund company.

On this episode of the SO files, Brad and Linda welcome Assistant Professor of Surgery at Washington University in St. Louis/ Siteman Cancer Center, and co-author of the NCCN Clinical Practice Guidelines for Breast Cancer, Dr. Amy Cyr . We will take you through both benign, pre-malignant, and malignant breast oncology, with a focus on ABSITE relevant information.

Nancy was diagnosed with breast cancer after she found a lump in 2016. Her treatment has included chemotherapy, lumpectomy and radiation therapy and she is continuing 2 of the 4 chemo drugs (“chemo light”, she calls it) through January 2018. She will then begin endocrine therapy in pill form for 5-10 years. Her hobbies include real estate development, attending theatre, traveling, and reading. She is single and has one sister.She currently works for Wilkins Management, Inc and Marsalis Music, LLC. Wilkins Management is the management entity for several acclaimed jazz musicians. Marsalis Music is an independent record label (founded by Branford Marsalis). For Wilkins Management, she handles all publishing and IP matters for the clients, and for the label, she handles financial and business affairs.Dr. Burstein's clinical research interests include novel treatments for early and advanced-stage breast cancer and studies of quality of life and health behavior among women with breast canDr. Burstein has written widely on breast cancer in traditional medical journals and on the web. He can speak to:The Breast Oncology program in the Susan F. Smith Center for Women's Cancers at Dana-FarberNew advances in breast cancer that are helping womenWhat it means to have metastatic breast cancer

The premier episode will explore The Wellness Community's founding principle of the Patient Active™ Concept, which is explained in the book, The Total Cancer Wellness Guide: Reclaiming Your Life After Diagnosis (BenBella Books, 2007), a book co-authored by Kim Thiboldeaux and Mitch Golant, PhD. Guests will discuss the benefits of patients taking an active role in managing their cancer care during treatment and beyond. They include Matthew Loscalzo, MSW, Administrative Director for the Sheri & Les Biller Patient and Family Resource Center; Lidia Schapira, MD, Oncologist at the Gillette Center for Breast Oncology, Massachusetts General Hospital and Assistant Professor of Medicine at the Harvard Medical School; and Douglas Wilkey, Jr., non-Hodgkin's Lymphoma survivor and participant at The Wellness Community-Arizona.

The premier episode will explore The Wellness Community's founding principle of the Patient Active™ Concept, which is explained in the book, The Total Cancer Wellness Guide: Reclaiming Your Life After Diagnosis (BenBella Books, 2007), a book co-authored by Kim Thiboldeaux and Mitch Golant, PhD. Guests will discuss the benefits of patients taking an active role in managing their cancer care during treatment and beyond. They include Matthew Loscalzo, MSW, Administrative Director for the Sheri & Les Biller Patient and Family Resource Center; Lidia Schapira, MD, Oncologist at the Gillette Center for Breast Oncology, Massachusetts General Hospital and Assistant Professor of Medicine at the Harvard Medical School; and Douglas Wilkey, Jr., non-Hodgkin's Lymphoma survivor and participant at The Wellness Community-Arizona.