Would you choose oncology again? Plus, breast cancer research: HER2CLIMB, KEYNOTE 522, and DESTINY BREAST01 with Dr. Bill Gradishar 

David H. Henry, MD, answers the question, "Would you choose oncology again?" This question was asked of oncologists surveyed for the Medscape Oncologist Compensation Report 2020, and 96% of oncologists said they would still choose oncology as their specialty.

Later, William J. Gradishar, MD, of Northwestern University in Chicago, joined Dr. Henry to discuss recent developments in breast cancer. Dr. Gradishar reviewed three trials presented at the 2019 San Antonio Breast Cancer Symposium (SABCS), two of which will be updated at the ASCO Annual Meeting.

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SABCS highlights

HER2CLIMB trial:

This trial led to the recent U.S. approval of tucatinib in combination with trastuzumab and capecitabine. The phase 2 trial enrolled patients with heavily pretreated, HER2-positive, metastatic breast cancer (N Engl J Med. 2020 Feb 13; 382:597-609). Patients who received tucatinib plus trastuzumab and capecitabine had superior progression-free and overall survival, compared with patients who received placebo plus trastuzumab and capecitabine. Tucatinib even improved outcomes in patients with brain metastasis, Dr. Gradishar noted. Additional results from HER2CLIMB are scheduled to be presented at ASCO in Abstract 1005.

DESTINY-BREAST01 trial:

This trial led to the U.S. approval of trastuzumab deruxtecan. Trastuzumab deruxtecan produced durable responses and a median progression-free survival of 16.4 months in patients with HER2-positive, metastatic breast cancer who had previously received trastuzumab emtansine (N Engl J Med 2020; 382:610-621). A key side effect of trastuzumab deruxtecan is interstitial lung disease, which led to deaths in the trial and a black box warning for the antibody-drug conjugate. A subgroup analysis of data from DESTINY-BREAST01 is scheduled to be presented at ASCO in Abstract 1036.

KEYNOTE-522 trial:

The phase 3 trial enrolled patients with early triple-negative breast cancer (N Engl J Med 2020; 382:810-821). The rate of pathologic complete response (pCR) was significantly higher in patients who received pembrolizumab plus neoadjuvant chemotherapy than in patients who received placebo plus neoadjuvant chemotherapy. Although it is clear that pembrolizumab improves pCR, it isn’t clear if the checkpoint inhibitor will improve long-term outcomes, Dr. Gradishar said.

Disclosures:

Dr. Henry reported having no financial disclosures relevant to this episode.

Dr. Gradishar reported financial relationships with AstraZeneca, Celltrion, Genentech, MacroGenics, Merck, Pfizer, and Seattle Genetics.

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