1. DiGiulio, Sarah

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This year's San Antonio Breast Cancer Symposium agenda will feature coverage of the increasing focus on global issues in breast cancer, the evolving understanding of the management of the various breast cancer subtypes, breast cancer genetics, and breast cancer immunotherapies, in addition to-as usual-the latest clinical updates for the field. That is the word from the meeting's co-chairs, asked for some early information about the meeting in time for this issue.

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"Clinicians, basic scientists, oncologists, medical oncologists, surgeons, and everyone involved in breast cancer care will find issues that are relevant to their practice," Symposium Co-chair Ismail Jatoi, MD, PhD, FACS, Professor and Division Chief of Surgical Oncology at the University of Texas Health Sciences Center, said in a phone interview in late-October. "We want a very comprehensive discussion on the subject-which we aim to achieve by including a wide range of experts who present a wide range of views and perspectives and points of view."


The meeting will be held December 9-13 at the Henry B. Gonzalez Convention Center in San Antonio.


The focus on breast cancer as a global disease-in particular, the opportunities and challenges of managing it in developing countries-will be more noticeable at this year's meeting than ever before, Jatoi noted. "We're seeing more and more participants coming from developing countries, and we want to discuss issues that are relevant to them-both the opportunities and the challenges."


An education session, "Breast Cancer is a Global Disease-Biology, Environment, and Health Care Delivery," includes speakers covering global patterns of breast cancer, health care disparities, and challenges and opportunities for treating breast cancer in developing countries (Tues., Dec. 9, 5:30 pm).


Also, a new SABCS Special Satellite Symposium has been added to the program, presented in collaboration with the Association of Radiotherapy and Oncology of the Mediterranean Area: "Minimal requirements and radiation therapy standards for breast cancer in countries with limited resources" (Fri., Dec. 12, 7:30 pm).


"The fact that the disease may have some differences in biology or in presentation in different parts of the world-that's an issue that will be discussed, as well as the disparities in breast cancer treatment in different parts of the world, as well as within our own country," Jatoi said. "This is an important topic.


"That Satellite Symposium [on global radiation therapy standards] addresses an issue that's particularly relevant to doctors who practice in developing countries."


Understanding Breast Cancer Subtypes

Another important aspect of this year's meeting-across education sessions, the clinical agenda, and all parts of the meeting-is the focus on the various breast cancer subtypes, Jatoi said. "We're learning more and more that breast cancer is not a single disease, and are identifying targeted therapies for various subtypes is an important goal for the future."


In particular, he pointed to the "Molecular Heterogeneity" education session, which includes updates on plasma tumor DNA as biomarkers for breast cancer therapy and epigenetic heterogeneity (Tues., Dec. 9, 5:30 pm), as well as the poster discussion "Intratumoral Heterogeneity" with co-discussants Charles M. Perou, PhD, of the University of North Carolina Chapel Hill, and Fabrice Andre, MD, PhD, of Institut Gustav Roussy (Thurs., Dec. 11, 5 pm).


Also, one noteworthy subtype to pay attention to, Jatoi continued, is triple-negative breast cancer. "There's considerable research now in triple-negative disease because we don't have targeted therapy for it."


A Tuesday education session is dedicated to the topic, which will cover the clinical significance of heterogeneity in triple-negative disease, targeted therapies for triple-negative disease, and adjuvant and neoadjuvant therapies (Tues., Dec. 9, 5:30 pm).


Also on the schedule is a basic science forum that includes a discussion of DNA repair in triple-negative disease-presented by Alan D'Andrea, MD, of Dana-Farber Cancer Institute (Wed., Dec. 10, 1 pm); and a Satellite Symposium, "PARP Inhibition for BRCA 1/2 Mutation-Associated and Triple-Negative Breast Cancer-Advances in Risk Reduction & Treatment" (Thurs., Dec. 11, 7:30 pm).

ISMAIL JATOI, MD, PH... - Click to enlarge in new windowISMAIL JATOI, MD, PHD, FACS. ISMAIL JATOI, MD, PHD, FACS: "We're seeing more and more participants from the meeting coming from developing countries, and we want to discuss issues that are relevant to them-both the opportunities and the challenges."

Breast Cancer Genomics

Commenting for this article, SABCS Co-chair and AACR President Carlos L. Arteaga, MD, Professor of Medicine & Cancer Biology at Vanderbilt-Ingram Cancer Center of Vanderbilt University and Director of the Center for Cancer Targeted Therapies and the Breast Cancer Program, said that tumor genomics will also be an important topic discussed at the meeting: "Tumor genomics are important because they can identify in many cases potential therapeutic vulnerabilities of cancers that can be exploited with targeted therapies-they are a main basis for personalized cancer treatment."


Two award lectures will also delve into that topic: James N. Ingle, MD, of Mayo Clinic, will deliver the William L. McGuire Memorial Lecture, "Pharmacogenomics in the Quest for Precision Endocrine Therapy of Breast Cancer," on the management of hormone-dependent breast cancers (Wed., Dec. 10, 11:15 am). And Mary-Claire King, PhD, of the University of Washington, will deliver the AACR Distinguished Lectureship in Breast Cancer Research, "Genomic Analysis of Inherited Breast and Ovarian Cancer," which will focus on germline DNA mutations (BRCA1 and BRCA2) and cancer risk.


One such abstract to pay attention to, Arteaga said, is: "The FERGI phase II study of the PI3K inhibitor pictilisib (GDC-0941) plus fulvestrant vs fulvestrant plus placebo in patients with ER+, aromatase inhibitor (AI)-resistant advanced or metastatic breast cancer-Part I results" (S2-02, Dec. 10, 3:30 pm). "This is the first report of a blinded, randomized clinical study evaluating a PI3K inhibitor in patients with ER-positive metastatic breast cancer-making it highly relevant."


Other sessions with key updates on the topic, Arteaga noted, include:


* "HER2 T cell dependent bispecific antibody (HER2-TDB) for treatment of HER2 positive breast cancer," (S1-07, Wed., Dec. 10, 10:15 am);


* "Reduced tumor lymphocytic infiltration in the residual disease of post-neoadjuvant chemotherapy triple-negative breast cancers is associated with Ras/MAPK activation and poorer survival" (S1-08, Wed., Dec. 10, 10:30 am);


* Mini-Symposium: "Breast Cancer Predisposition: Germline and Risk," moderated by Laura J. van't Veer, PhD, of UCFS Helen Diller Family Comprehensive Cancer Center (Wed., Dec. 10, 2:45 pm);


* "Identification of a notch-driven breast cancer stem cell gene signature for anti-notch therapy in an ER+ presurgical window model," (S4-03, Wed., Dec. 10, 4:14 pm); and


* Poster Discussion 5: "Targeting the PI3K Pathway," with co-discussants Todd W. Miller, PhD, of Dartmouth Medical School, and Elizabeth Claire Dees, MSc, MD, of the University of North Carolina at Chapel Hill (Fri., Dec. 12, 5 pm).




Another important topic at this year's meeting will be clinical trials with immunotherapies and associated biomarkers predictive of response, Arteaga noted. Though breast cancer is somewhat behind compared with melanoma, lung cancer, and bladder cancer, in terms of identifying effective immunotherapies, early data suggest this therapeutic modality does hold promise for some subtypes of breast cancer. The topic will be discussed in several symposia and education sessions at SABCS this year. "The challenge now [in breast cancer] is to identify the biomarkers that would allow the identification of those patients who should respond to this type of intervention."


Key sessions on the topic, he said, are:

CARLOS L. ARTEAGA, M... - Click to enlarge in new windowCARLOS L. ARTEAGA, MD. CARLOS L. ARTEAGA, MD: "Tumor genomics are important because they can identify potential therapeutic vulnerabilities of cancers that can be exploited with targeted therapies-the basis for personalized cancer treatment."

* "Stromal tumor-infiltrating lymphocytes(S-TILs): In the alliance N9831 trial S-TILs are associated with chemotherapy benefit but not associated with trastuzumab benefit," (Wed., Dec. 10, 10 am); and


* "A phase Ib study of pembrolizumab (MK-3475) in patients with advanced triple-negative breast cancer," (Wed., Dec. 10, 10:45 am).



Mix Up Your SABCS Routine...

These other sessions on this year's agenda cover particularly interesting material, said SABCS Co-chair Ismail Jatoi, MD, PhD, FACS:


* Stay Informed: Tuesday's education sessions will cover updates on key topics in breast cancer: reconstruction, HER2-positive breast cancer, neoadjuvant treatment of ER-positive breast cancer, breast cancer irradiation, breast cancer survivorship, immunotherapy, and others. Although held on Tuesday-before Wednesday's official start of the meeting-the education sessions "are always very interesting, very informative, and tend to get high marks from meeting-goers," he said.


* Join the Discussion: A Wednesday Clinical Science Forum will cover the current topic of contralateral prophylactic mastectomy (Dec. 10, 1 pm). Jatoi is moderating the session, which will also include perspectives from Ann Partridge, MD, MPH, of Dana-Farber Cancer Institute, and Andrea L. Pusic, MD, MHS, of Memorial Sloan Kettering Cancer Center. "We've seen a dramatic increase in the use of contralateral prophylactic mastectomy in women with unilateral breast cancer-so this issue will prompt some interesting discussion," Jatoi said.


* Get Feedback: Two Case Discussion sessions will allow attendees to talk about specific cases, provide their points of view, and get feedback from the panelists on how to manage those patients (Thurs., Dec. 11, 1 pm, and Fri., Dec. 12, 1 pm). "There's always good interaction, discussion, and feedback. Those sessions tie together what is discussed at the meeting with actual patient care."