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Breast Cancer Medical Experts Medical Update Article

SABCS 2022 Highlights

SABCS 2022 Highlights

Top breast cancer doctors Dr. Paolo Tarantino with Dana-Farber Cancer Institute and Dr. Lola Fayanju with Penn Medicine discuss the big highlights from this year’s San Antonio Breast Cancer Symposium.

SABCS 2022 Highlights

What’s NEW in Breast Cancer Treatment in 2023

Top Breast Cancer Docs Discuss Emerging Research

Kelly Shanahan was an OB-GYN with her own private practice. In 2008, she was diagnosed with breast cancer. Five years later, she learned the cancer was back and it was now stage 4. From that moment, she went from doctor to professional patient.

Since her diagnosis, she has been attending big medical conferences, including the San Antonio Breast Cancer Symposium, where thousands of the top minds in medicine and research from around the world discuss the latest in breast cancer research.

In this conversation, she along with top breast cancer doctors Dr. Paolo Tarantino with Dana-Farber Cancer Institute and Dr. Lola Fayanju with Penn Medicine discuss the big highlights from San Antonio Breast Cancer Symposium 2022.

The conference heavily focused on the new subcategory of patients: HER2-low.


This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Dr. Kelly Shanahan with daughter

Dr. Kelly Shanahan: [When I learned about my diagnosis I thought] I can’t die before my mom. I can’t leave my daughter. I had to stop practicing. I really felt adrift. Why am I using up oxygen on this planet?

It was crazy because I felt stupid. I’m a physician. I should know 25 to 35% of people with an early-stage diagnosis, especially hormone receptor positive, will eventually become metastatic. I’m five years out. I should be cured. It really hit me hard.

If you’re treated by a community oncologist, they might have one or two people with metastatic breast cancer in their whole practice. They’re doing everything — lung, colon, blood cancers etc. They’re not going to be up to date on what is happening.

I’m five years out. I should be cured. It really hit me hard.

Dr. Kelly Shanahan,
Metastatic Breast Cancer Patient Advocate

Dr. Paolo Tarantino: For more than 20 years, we thought that HER2 was either positive or negative. Positive was about 20% of the tumors (were very aggressive) [and] needed to be treated with chemotherapy, with many agents against HER2. The other 80% [were] treated very differently.

But what happened is that in that 80%, we knew that even if we called it negative, there was some HER2, just not enough to call it positive.

Nowadays, more than half of all patients with breast cancer are called HER2-low because they have an expression of 1+ or 2+ non-amplified.

What was impressive to see is that in this very large population of patients, delivering chemotherapy with this new class of drugs that we call antibody drug conjugates — and with trastuzumab deruxtecan in particular, T-DXd or Enhertu — was very effective, much more effective than traditional chemotherapy.

Dr. Paolo Tarantino with US mentor Dr. Sara Tolaney at SABCS 2022
Dr. Paolo Tarantino with US mentor
Dr. Sara Tolaney at SABCS 2022

This drug has been approved and is now available. We use it to treat many patients with metastatic breast cancer.

The impact has been very large, not only because this has improved the shrinkage or the duration of the response but also the survival of patients with metastatic breast cancer.

For more than 20 years, we thought that HER2 was either positive or negative… Nowadays, more than half of all patients with breast cancer are called HER2-low.

Dr. Paolo Tarantino
Dr. Kelly Shanahan

Dr. Shanahan: HER2 was originally cancer that is so aggressive and people just don’t do as well. Then Herceptin came along, Perjeta came along, and now these antibody drug conjugates.

They have made a huge difference to the point where those of us that have ER-positive disease are going, “I wish I was HER2 positive,” because there [are] so many more options and things that are working really, really well.

I think what we’re learning in some of the data from these trials is if you have a really high level of HER2 — your HER2 positive, HER2 3+ — for a lot of people, it’s going to work really, really well.

If it’s 2+, it’s still going to work but maybe not quite as well. Then 1+ and 0, there might be some efficacy. It might work even in people who have no HER2 overexpression.

In this setting, metastatic breast cancer, we really need options because so many times, patients run out of treatment options.

Dr. Tarantino

Dr. Tarantino: In metastatic breast cancer, we really need options because so many times, patients run out of treatment options.

We use all the most effective treatments that we have — endocrine treatment, taxane, capecitabine, biologic agents, anthracyclines — and in the end, we really don’t have any more effective options.

Sometimes, we have to recycle chemotherapies. We really would like to use a drug that is proven to be efficacious and even to improve survival in HER2-low patients.

Dr. Shanahan: One of the things important for patients to know is that you can look back on biopsies from your original breast cancer diagnosis or if you were diagnosed with mets from the get-go, de novo metastatic disease, that can be looked at to see, “Do I have a little bit of HER2? Do I have none at all?”

That opens up this whole avenue of these new antibody drug conjugates as a treatment option. I think that’s really exciting because the more options we have, the better.

Dr. Paolo Tarantino at work in Boston

Many of the Black women who aren’t participating in clinical trials… need to have faith in the healthcare system that has let down Black people for generations

Dr. Lola Fayanju
Dr. Lola Fayanju operating
Dr. Lola Fayanju performing a double mastectomy at Duke

Dr. Lola Fayanju, Penn Medicine: I’m part of a panel on patient-reported outcomes, which are opportunities for patients to describe how they’re feeling, what symptoms they’re experiencing, [and] what psychosocial challenges they might have that might prevent them from optimizing their breast cancer journey.

There’s diversity across different communities. Many of the Black women who aren’t participating in clinical trials [don’t] necessarily need more socioeconomic help. It’s that they need to have faith in the healthcare system that has let down Black people for generations.

Many of the women who choose not to participate in clinical trials who are African American, [don’t participate] not because they can’t afford to do so. It’s that they have a justified mistrust in the system, a system that has not earned the trustworthiness of people of color.

I think that descriptions of trial results matter. Words matter.

Descriptions of trial results matter. Words matter.

Dr. Lola Fayanju

Dr. Shanahan: I had a conversation that some of these trials cost a billion dollars!

If you don’t have advocates involved early to make sure your design is going to be palatable to patients, that the questions you’re asking make sense to provide treatments, to make lives not only longer but better, you’re wasting time, you’re wasting money, [and] you’re wasting lives.

You’re an advocate. You’re an advocate for yourself.

If you were that PTA mom that raised money through bake sales to get a new playground for your kid’s school, you’d be great at fundraising for support groups [and] for research.

If you’re that person that goes to the city council meetings who’s going, “Why are you putting a stop sign here?” then maybe legislative advocacy, trying to get bills passed locally or nationally to help benefit the metastatic community is your place.

Dr. Kelly Shanahan hiking

You’re an advocate. You’re an advocate for yourself… Everybody has a place and everybody has a role.

Dr. Shanahan

Breast Cancer Patient Stories

Amelia

Amelia L., IDC, Stage 1, ER/PR+, HER2-



Cancer details: IDC is most common kind of breast cancer.
1st Symptoms: Lump found during self breast exam
Treatment: TC chemotherapy; lumpectomy, double mastectomy, reconstruction; Tamoxifen

Rachel Y., IDC, Stage 1B



Cancer details: IDC is most common kind of breast cancer. Stage 1B.
1st Symptoms: None, caught by delayed mammogram
Treatment: Double mastectomy, neoadjuvant chemotherapy, hormone therapy Tamoxifen
Rach smiling against fall leaves

Rach D., IDC, Stage 2, Triple Positive



Cancer details: IDC is most common kind of breast cancer.
1st Symptoms: Lump in right breast
Treatment: Neoadjuvant chemotherapy, double mastectomy, targeted therapy, hormone therapy
Caitlin

Caitlin J., IDC, Stage 2B, ER/PR Positive



Cancer Details: ER/PR positive = estrogen and progesterone receptor positive
1st Symptoms:
Lump found on breast
Treatment:
Lumpectomy, AC/T chemotherapy, radiation, and hormone therapy (Lupron and Anastrozole)

Joy R., IDC, Stage 2, Triple Negative



Cancer details: Triple negative doesn’t have any receptors commonly found in breast cancer making it harder to treat
1st Symptoms: Lump in breast
Treatment: Chemo, double mastectomy, hysterectomy

Callie M., IDC, Stage 2B, Grade 2, ER+



Cancer Details: ER positive = estrogen receptor positive
1st Symptoms:
Dimpling/lump found on breast
Treatment:
Mastectomy, AC/T chemotherapy, hysterectomy, reconstruction
Monica

Monica H., IDC, Stage 2B



Cancer details: IDC is most common kind of breast cancer.
1st Symptoms: Tightness and lump in left breast
Treatment: Chemotherapy, radiation, surgery

Stefanie H., IDC, Triple Positive, Stage 3



Cancer details: IDC is most common kind of breast cancer. Triple positive = positive for HER2, estrogen receptor (ER), progesterone receptor (PR)
1st Symptoms: Lump in breast
Treatment: chemotherapy, lumpectomy, radiation
Doreen

Doreen D., IDC, Stage 2A, Triple Positive



Cancer details: IDC is most common kind of breast cancer. Triple positive = positive for HER2, estrogen receptor (ER), progesterone receptor (PR)
1st Symptoms: Lump in left breast
Treatment: Neoadjuvant chemotherapy (TCHP), lumpectomy, radiation
Melissa sitting in her car

Melissa H., Stage 2B, Triple Negative



Cancer details: Triple negative doesn’t have any receptors commonly found in breast cancer making it harder to treat
1st Symptoms: Lump in left breast
Treatment: Mastectomy, chemotherapy, 2nd mastectomy
Genoa

Genoa M., Stage 2, HER2-Positive



Cancer details: HER2-positive tends to be more aggressive than HER2-negative cases
1st Symptoms: Nausea
Treatment: Chemotherapy, radiation

Andrea A., IDC, Stage 2B/3, ER+



Cancer details: Found cancer while pregnant
1st Symptoms: Divot in breast
Treatment: Chemotherapy, radiation, surgery

Stephanie J., Stage 3, Triple Negative, BRCA1+



Cancer details: Triple negative doesn’t have any receptors commonly found in breast cancer
1st Symptoms: Lump in left breast
Treatment: Chemotherapy, surgery

Renee N., IDC, Stage 3, HER2+



Cancer details: IDC is most common kind of breast cancer.
1st Symptoms: Lump in breast
Treatment: chemotherapy, bilateral mastectomy, radiation

Shari S., Stage 4, Metastatic, Triple Positive



Cancer details: Triple positive = positive for HER2, estrogen receptor (ER), progesterone receptor (PR)
1st Symptoms: Lump in breast
Treatment: Surgery, chemotherapy, radiation
Erin

Erin C., IDC, Triple Negative, Stage 2B/4 Metastatic



Cancer details: Triple negative doesn’t have any receptors commonly found in breast cancer making it harder to treat
1st Symptoms: Pain in breast
Treatment: Surgery, chemotherapy, radiation
Margaret A. feature

Margaret A., IDC & DCIS, Stage 2B



Cancer details: IDC is most common kind of breast cancer. DCIS means cancer has not spread into surrounding breast tissue
1st Symptoms: Pain in left breast, left nipple inverting
Treatment: Double mastectomy, chemo (AC-T), Radiation

Abigail J., Stage 4, Metastatic



Cancer Details: HER2-low, node negative, PIK3CA mutation



1st Symptoms: Back and leg pain, lump in breast



Treatment: Surgery, chemotherapy, radiation, CDK4/6 inhibitors
Bethany W. feature profile

Bethany W., Stage 2, ER+



Symptoms: Lump in breast and armpit
Treatment: Chemotherapy, double mastectomy, radiation
Bethany W. feature profile

Bethany W., Stage 4 Metastatic



Symptoms: Lower back pain
Treatment: Chemotherapy, radiation, maintenance treatment
Margaret A. feature

Margaret A., IDC & DCIS, Stage 2B



Cancer details: IDC is most common kind of breast cancer. DCIS means cancer has not spread into surrounding breast tissue
1st Symptoms: Pain in left breast, left nipple inverting
Treatment: Double mastectomy, chemo (AC-T), Radiation

Alison R., Partially Differentiated DCIS, Stage 4 Metastatic



Cancer details: Triple positive = positive for HER2, estrogen receptor (ER), progesterone receptor (PR)
1st Symptoms: Lump in underarm/breast
Treatment: Chemotherapy, surgery, radiation, targeted therapy
Natalie
Natalie W., Ductal Carcinoma In Situ, Stage 0, ER+; Paget’s Disease



Cancer Details: Only 1-4% of breast cancer cases also includes Paget’s
1st Symptoms: 2cm lump found in right breast
Treatment: Lumpectomy, double subcutaneous mastectomy, hormone therapy
Margaret A. feature

Margaret A., IDC & DCIS, Stage 2B



Cancer details: IDC is most common kind of breast cancer. DCIS means cancer has not spread into surrounding breast tissue
1st Symptoms: Pain in left breast, left nipple inverting
Treatment: Double mastectomy, chemo (AC-T), Radiation
Tina C., Ductal & Lobular Carcinoma in Situ, Stage 3A, ER+



Cancer details: Both ductal and lobular, estrogen receptor positive. Different than breast cancer Tina’s mom was diagnosed w/ twice.
1st Symptoms: Sunken in nipple of right breast
Treatment: Double mastectomy, chemotherapy, radiation, hormone therapy

Cat L., IDC & DCIS, Stage 2B



Cancer details: IDC is most common kind of breast cancer. DCIS means cancer has not spread into surrounding breast tissue
1st Symptoms: Pain in left breast radiating from lump
Treatment: Bilateral mastectomy, chemotherapy

Alison R., Partially Differentiated DCIS, Stage 4 Metastatic



Cancer details: Triple positive = positive for HER2, estrogen receptor (ER), progesterone receptor (PR)
1st Symptoms: Lump in underarm/breast
Treatment: Chemotherapy, surgery, radiation, targeted therapy
Bethany W. feature profile

Bethany W., Stage 4 Metastatic



Symptoms: Lower back pain
Treatment: Chemotherapy, radiation, maintenance treatment
Erin

Erin C., IDC, Triple Negative, Stage 2B/4 Metastatic



Cancer details: Triple negative doesn’t have any receptors commonly found in breast cancer making it harder to treat
1st Symptoms: Pain in breast
Treatment: Surgery, chemotherapy, radiation

Shari S., Stage 4, Metastatic, Triple Positive



Cancer details: Triple positive = positive for HER2, estrogen receptor (ER), progesterone receptor (PR)
1st Symptoms: Lump in breast
Treatment: Surgery, chemotherapy, radiation
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