Real-World Analysis Shows Low Use of Ovarian Suppression in Premenopausal HR+/HER2+ Breast Cancer

Mary Lustberg, MD, MPH

Mary Lustberg, MD, MPH

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A single-institution retrospective review of real-world data showed that the use of ovarian suppression was uncommon in premenopausal patients with hormone receptor (HR)-positive, HER2-positive breast cancer. Additionally, patients aged 35 years or older were less likely than their younger counterparts to have received ovarian suppression therapy in addition to HER2-targeted therapy. According to Mary Lustberg, MD, MPH, this suggests that age may be the only treatment factor with ovarian suppression therapy, possibly excluding patients with other risk factors who may require intensive endocrine therapy. can benefit from.

Data from this study, presented at the 2022 San Antonio Breast Cancer Symposium (SABCS), showed that 87% of patients 50 years or younger with premenopausal HR-positive, HER2-positive breast cancer (n = 818) were prescribed tamoxifen monotherapy compared to 12.6%. Among patients who received ovarian suppression alone or in combination with endocrine therapy. Furthermore, high-risk clinicopathologic features such as node positivity, advanced clinical stage, and high tumor grade were not predictive of treatment with ovarian suppression.1

“There is insufficient data to suggest that patients with triple-positive breast cancer have less severe endocrine disease,” said Lustberg, MD, an associate professor of medical oncology at Yale School of Medicine and director of the Center for Breast Cancer at Similow Cancer Hospital. Therapy is needed.” Chief of Breast Medical Oncology at Yale Cancer Center in New Haven, Connecticut. “[We need] to look at various clinicopathological factors and other predictive biomarkers, such as the breast cancer index, to decide on the duration and type of endocrine therapy for these patients.”

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In an interview with The enclave®, Listberg expanded on the key findings of the retrospective review, the importance of assessing real-world practice patterns in breast cancer patients, and the need for continued study of other predictive biomarkers for endocrine therapy in this population. of

The enclave®: Please discuss the rationale for your research on real-world endocrine therapy in premenopausal HR-positive, HER2-positive breast cancer.

Lustberg: We wanted to look at real-world data in triple-positive patients with HR-positive and HER2-positive disease. There is a lack of clarity. [regarding] Endocrine therapy is increasingly used in this population, and we have seen a great deal of variation in terms of what type of endocrine therapy is being chosen for these patients in clinical practice. We decided to query a large, real-world database called CancerLinQ, [which is a subsidiary of] ASCO program, to further explore how endocrine therapy is being delivered to patients with these tumor types.

What needs did the study aim to address in order to meet this patient population?

We are [already] are aware of what is the best HER2-targeted therapy for the HER2-positive population, but [we don’t know] The best type of endocrine therapy agent for this population. Assumption [of this study was] Many clinicians believe that the HER2 biomarker is the most important. [to target] in this population, and they may not view HR positivity as an important part of cancer site biology. We wanted to interrogate this further in the real world.

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What key data from this study was shared at SABCS this year? Were any results particularly surprising?

Results from [study]led by Jasmin Sukumar, MD, showed that most patients with HR-positive, HER2-positive breast cancer also had node-positive disease. Most of these patients received tamoxifen alone and did not experience ovarian suppression [alone] or ovarian suppression with tamoxifen or aromatase inhibitors.

This was a surprising finding, as earlier data had shown that if patients were high enough risk to receive chemotherapy, they would benefit from ovarian suppression. However, our results showed that patients with HER2-positive disease were less likely to have ovarian suppression. [Instead] They were often treated with tamoxifen alone because clinicians believed that [regimen] was sufficient for HER2-positive disease.

What do these data indicate about the future of adjunctive endocrine therapy and ovarian suppression in this population?

This is an area that requires additional study as the population is at risk for late recurrence, and optimization of endocrine therapy is essential. The only clinical factor predicting the use of ovarian suppression in this population was age younger than 35 years. [or] Older adults may still benefit from optimization of endocrine therapy. We need to look more closely at additional biomarkers in this population to truly determine who may benefit from acute ovarian suppression or other types of endocrine therapy.

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What important message would you like to convey to your colleagues from this research?

As a community, it is important that we look beyond clinical trials to real-world data to see how data is applied. [in practice]. I encourage my colleagues to look at these rich databases and identify different practice patterns that we can all learn from.

What other research did you learn from the meeting?

[There’s a] Lots of interesting data on antibody-drug conjugates as well as targeted therapies like PI3K inhibitors. This is a big year for these new therapies, and I’m excited that our patients will have additional options for disease management.

I will [also] Largely referring our audience to HER2-low sessions, [which featured a] Extensive discussion on the complexity of HER2 testing and determination of HER2 deficiency [status]. How we think about HER2-deficient breast tumors will have tremendous implications for years to come. The entire session was full of insights on how we need a reliable biomarker to determine the best management of these tumors.

Reference

Sukumar JS, Sardesai S, Nee A, et al. Real-world treatment patterns of adjuvant endocrine therapy and ovarian suppression in premenopausal HR+/HER2+ breast cancer. Presented at the 2022 San Antonio Breast Cancer Symposium. December 6-10, 2022; San Antonio, TX Abstract P1-02-03

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