How Breast Cancer Treatment and Care Approaches Are Changing

Laura Beth Ezzell:

And what about maybe new and emerging therapies or clinical trials? What can you share about those?

Dr. Daniel Silbiger:

Absolutely. And I think that’s why it’s so important to really – this is where folks can maybe benefit at times, depending on where they’re at, from second opinions to see what trials are out there.

At Cleveland Clinic, we just had finished an early-stage study on looking at breast cancer vaccines that look at harnessing the immune system to try and fight off a recurrent triple-negative breast cancer, for instance, or new breast cancer from developing. So, there’s a lot of research and opportunity in that space and setting for that. I think also what we’re seeing now as well as is using the immune system called immunotherapy, and one of the drugs called pembrolizumab (Keytruda) is now approved for awakening the immune system in triple-negative breast cancer. And there’s a whole host of new endocrine- or estrogen-blocking therapies that are out there now. We just had a recent meeting publication in San Antonio of what’s called oral selective estrogen receptor degrader, using those types of medicines early on to try and reduce our changes of metastatic disease as well.

There’s also a whole other class of these cyclin DK 4/6 inhibitors that help to reduce chances of metastatic disease that are now coming to earlier stage setting. And we’re really excited to be offering so many of these treatments to patients. I always tell folks it’s a good thing when an oncologist who trained 10 years ago has a whole new set of medicines to use than we had at that point. And I think that’s exciting and promising for our patients as well.

Laura Beth Ezzell:

Why should patients feel hopeful about where we are with breast cancer care?

Dr. Daniel Silbiger:

I think many of the things that – and this is a great way to summarize, too.

I think we’ve learned where can we do less and get equal or better outcomes? We are in an era now where our breast oncology community is not settling for, how much can I throw at the breast cancer and pay no attention to the side effects? No, no. Quite the opposite. We are looking now, our research sites are looking at, can we do as little as possible to get the best outcome? And when we do the least amount possible, we often get many less side effects. And so, that is one area we’re really looking at, it’s called deescalation of care.

And I want the audience to recognize that just because we say, “Hey, we might be able to spare this aggressive breast surgery. We may be able to spare chemotherapy from your plan,” even if a lymph node’s involved in certain situations like hormone-positive postmenopausal patients, that’s not a bad thing, that’s a good thing. We’re suggesting that you’ll do just as well but with less side effects if we have to do less treatments.

At the same time, Laura Beth, we’re also looking at where can we do more treatments for the most aggressive breast cancers? And that’s where the excitement and promise of vaccines are out, immunotherapy, newer age drugs that I’d mentioned before such as Verzenio and Kisqali and some of these other estrogen receptor targeted therapies. And so, there is a lot of hope, not just merely for better outcomes with more treatments, but equal or better outcomes with less treatments for the same outcome.

And I think that’s the big excitement that I share and that’s why I’m so passionate and excited to be a breast medical oncologist in this time, and I hope that the audience recognizes that too. And this is why I’m very passionate that folks get to breast specialists because the data has evolved tremendously and I think it will continue to evolve at three-to-six-month paces that we’re adding treatments and guidance to this area.