Concluding their discussion on PARP inhibition in BRCA+ breast cancer, the experts consider future directions for therapy in this setting.
PUBLISHED April 10, 2019
Kristin E. Fleischmann-Rose, NP: From your perspective, how has breast cancer management changed over the years and how do you see it changing over the next five years?
Nadine M. Tung, M.D.: I think the biggest change in the last five to 10 years is that the therapy has become more precise and more targeted. We know that breast cancer is not one disease, so there’s not going to be a one-size-fits-all treatment for all patients with breast cancer. The more we can divide breast cancer into meaningful smaller groups or subtypes, the more the therapy for that subtype will be very specific and precise for a particular breast cancer rather than all breast cancers. So, for the future, I see targeted therapies increasing. Today we’ve been talking about PARP [poly ADP ribose polymerase] inhibitors.
The future questions would be how we can make PARP inhibitors more effective. Perhaps combinations of a PARP inhibitor plus another medication to increase the efficacy, or increasing the duration of the PARP inhibitors’ efficacy. Another goal for the future with PARP inhibitors would be how we can identify a broader group of patients who can benefit from this therapy. We know it works for BRCA carriers. What about patients who’ve inherited — or their tumors have acquired — abnormalities in other genes, genes that work with BRCA1 and BRCA2? So those would be important goals. I think in the future we’re going to see a lot more use of immune therapy; the concepts of how we can teach our own immune system and harness it to treat breast cancer is so attractive.
What about combining PARP inhibitors with immune therapies? There are already many trials ongoing. Will this be better than using PARP inhibitors alone? I would think the final difference going forward would be that we are learning that breast cancers evolve. They are not stagnant. So a therapy that works for a while often stops working. It’s important to sample the tumor repeatedly to see how the tumor is changing, so that perhaps we can get some information about how to overcome resistance to that therapy that used to work. Maybe we have new information about a targeted therapy that should be used at a different point in time with that breast cancer. It is hard to keep biopsying the tumor in different places where it has spread, so one of the exciting areas for the future are liquid biopsies, as they’re called, using the blood to try to get to the genetic information of the tumor to see how it’s changing over time. So with that, Kristin, let me ask you, do you have any final comments or thoughts?
Kristin E. Fleischmann-Rose, NP: A new diagnosis of breast cancer is a really overwhelming experience, so I would encourage you to write down any and all questions that you have and bring them to all of your appointments. If possible, bring a friend or a loved one with you who can help write down some of these answers. The information that you write down that you can review later will help empower you throughout this process.
Nadine M. Tung, M.D.: Well, thank you, Kristin, for joining me today. And thank you for joining us for this Cure Expert Connections® program on the use of PARP inhibitors in BRCA-mutated breast cancer. See you next time.