On July 30, 2022, the 2nd Academic Conference of the Breast Professional Committee of the Chinese Women’s Physicians Association will be held online held in a combined manner. Adhering to the concept of “not forgetting the original intention, inheriting the classics, and creating the future”, this conference brought together well-known experts in the field of breast cancer in China to discuss hot topics and strategies for breast cancer diagnosis and treatment, with a view to promoting the development of female physicians and promoting breast cancer in my country. Clinical diagnosis and treatment and research development. During the meeting, Yimaitong was honored to invite Professor Li Huiping, Chairman of the Breast Professional Committee of the Chinese Association of Women Physicians, and Professor Li Huiping of Peking University Cancer Hospital, to interpret the updated key points of the “Consensus Guidelines for Advanced Breast Cancer in China” for us.
Department of Breast Oncology, Peking University Cancer Hospital
Chief Physician, Professor, Doctoral Supervisor, MD
Texas, USA University M.D. Anderson for 2 years
Chairman of the Breast Professional Committee of the Chinese Women’s Physician Association
Deputy Chairman of the Clinical Oncology Committee of the Chinese Women’s Physician Association
Member of the Standing Committee of the Breast Cancer Professional Committee of the Chinese Anti-Cancer Association
Co-leader and author of the Chinese consensus guidelines for advanced breast cancer
Member of the Expert Group of the Asian Breast Cancer Collaborative Group (ABCCG) p>
Guidelines update iteratively with highlights
Professor Li Huiping: The “China Consensus Guidelines for Advanced Breast Cancer” provides an important reference for doctors engaged in breast cancer. As more and more new drugs become available, the clinical outcomes of breast cancer patients have been greatly changed, and the content of the guidelines should also keep up with the pace of drug development. Therefore, whether it is hormone receptor-positive breast cancer, HER2-positive breast cancer, or three For negative breast cancer, the relevant recommendations of the guidelines have been updated.
The first is the update of the treatment concept. As the choice of breast cancer treatment drugs becomes more and more abundant, the curative effect of breast cancer is getting better and better. Although we cannot say that breast cancer is completely cured, we have proposed a new concept, that is, three-year cure or five-year cure. It can help patients establish a positive and optimistic attitude, enhance treatment confidence, and relieve the psychological pressure of treatment for patients and their families.
Secondly, in the field of hormone receptor-positive breast cancer, we affirmed the importance of CDK4/6 inhibitors. The advent of CDK4/6 inhibitors has completely changed the clinical outcome of hormone receptor-positive breast cancer. Clinical studies have confirmed that CDK4/6 inhibitors are far more effective than aromatase inhibitors (AI) in first-line therapy, and are progression-free survival (PFS). ) brings more than double the extension. Therefore, the guidelines recommend that CDK4/6 inhibitors combined with endocrine therapy drugs are the first-line treatment for hormone receptor-positive breast cancer. In terms of second-line treatment, we have also made some important updates. For example, we recommend that patients be guided to receive targeted therapy based on specific mutations detected by ctDNA. Patients with PI3K mutations can choose PI3K inhibitors, and patients with BRCA mutations can choose PARP inhibitors. In addition, we will further evaluate the application of novel antitumor drugs such as antibody drug conjugates (ADCs) in hormone receptor-positive breast cancer, which will be further reflected in future guideline updates.
An important update point in the field of HER2-positive breast cancer is the treatment options after trastuzumab resistance. The current main strategies include small molecule tyrosine kinase inhibitors, TDM-1 or new ADC drugs. Triple-negative breast cancer is a difficult treatment. In the past, there were no more options than chemotherapy. Currently, it is recommended that patients with triple-negative breast cancer be diagnosed with BRCA gene testing immediately. There is evidence for the use of PARP inhibitors in BRCA-mutated triple-negative breast cancer, and these patients can benefit from targeted therapy. In addition, PD-L1 inhibitors also have a good effect on PD-L1-positive triple-negative breast cancer patients, so PD-L1 detection is also recommended for triple-negative breast cancer patients.
Remarkable research results, innovating breast cancer clinical practice
Professor Li Huiping : Although the incidence of breast cancer is relatively high, fortunately, there are many breast cancer research teams. Many new drug researches start from breast cancer, and many treatment concepts are also updated and promoted from breast cancer. In recent years, CDK4/6 inhibitors have become a rising anti-cancer rookie. The clinical research results of many domestic original and imported CDK4/6 inhibitors are very impressive. Compared with endocrine therapy alone, CDK4/6 inhibitors combined with endocrine therapy have advantages Stronger therapeutic advantages are rapidly changing the treatment landscape for hormone receptor-positive advanced breast cancer.
For HER2-positive breast cancer, ADC drugs “stand out” in recent years and have achieved breakthrough clinical efficacy. ADC drugs are a class of targeted biological agents that connect cytotoxic drugs to monoclonal antibodies through linkers. They have both the powerful killing effect of traditional chemotherapy and the tumor targeting of antibody drugs. Cells also have anti-tumor activity, which we call the “bystander effect.” Based on the blockbuster results of key clinical studies such as DESTINY Breast03 and DESTINY Breast04, the next-generation ADC drug T-DXd has improved the current drug treatment landscape for HER2-positive breast cancer.
ADC drugs have also brought revolutionary progress to triple-negative breast cancer treatment. The ASCENT study confirmed that the first ADC drug targeting Trop-2, goxatuzumab for metastatic triple-negative breast cancerWith the comprehensive benefits of short-term and long-term efficacy such as objective response rate (ORR), progression-free survival (PFS), and overall survival (OS), more and more triple-negative breast cancer patients will usher in a new dawn of treatment.
Based on evidence-based medicine, it is reasonable to recommend new anti-tumor drugs
Li Hui Prof. Ping: The results of drug clinical trials are the most important basis for supporting the launch of new drugs. The Center for Drug Evaluation (CDE) of the State Drug Administration encourages overseas originator drugs to start clinical trials simultaneously in China from the early clinical development stage. Clinical studies without Chinese patients should carry out relevant bridging clinical trials to provide efficacy and safety data for the Chinese population. We generally do not recommend new anti-tumor drugs that have been marketed abroad but have not yet been validated by clinical research in China. Secondly, we must also consider the medical insurance policy. Many patients cannot afford the treatment costs of new anti-tumor drugs that are not covered by medical insurance due to economic reasons.
Editor: Jiang Zhou
Reviewer: Professor Li Huiping
< p>Typesetting: Jiang Zhou