Advanced Breast Cancer Smart Drug Combos Promising for Patients Refractory to Endocrine Therapy
Mark Fuerst

Oncology Times
September 2012 
Volume 34  Number 18
Pages 16 - 17
  PDF Version Available!

CHICAGO-Smart drug combinations that target specific pathways provide hope for hormone receptor-positive (HR2+) advanced breast cancer patients whose disease has failed to respond or become refractory to endocrine therapy, with active second-generation combinations waiting in the wings. The following is a roundup of such approaches reported at this year's ASCO Annual Meeting.The combination of the aromatase inhibitor (AI) exemestane and the inhibitor of mammalian target of rapamycin (mTOR) signaling pathway everolimus showed significant improvement in progression-free survival (PFS)."We now have new novel treatments for HR-positive breast cancer patients," Denise Yardley, MD, Senior Investigator in the Breast Cancer Research Program at Sarah Cannon Research Institute, said in an interview.The updated data from the BOLERO-2 trial confirm that exemestane combined with everolimus delays time without tumor growth for women with ER2-positive advanced breast cancer. She also pointed to the investigational agent trastuzumab emtansine, the combination of a monoclonal antibody and a cytotoxic drug, as promising for this patient population."The options for these patients have been limited. About half of them do not respond to initial treatment with endocrine therapy, and almost all initial responders develop resistance," she said.Stephen Johnston, MA, PhD, Professor of Breast Cancer Medicine and Director of Clinical Research and Development at the Royal Marsden and the Institute of Cancer Research in London, said, "The BOLERO-2 trial told us these types of combinations can be effective. Newer drug combinations may be better, more specific inhibitors."He predicted that other BOLERO-2-like studies will show more advances with AIs since mTOR appears to be the dominant pathway in endocrine therapy-refractory patients.At the ASCO meeting, Martine Piccart-Gebhart, MD, PhD, Head of the Medicine Department at Institut Jules Bordet in Brussels, Belgium, presented an 18-month analysis

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