St Gallen Breast Cancer Conference
Over the last 15 years, our knowledge of breast cancer has evolved. Availability of targeted treatments and diagnostics has substantially improved the survival for patients with advanced breast cancer. In the early breast cancer setting, whilst the goal of treatment remains, as it always has been, to reduce the risk of the cancer returning, the new treatments have the potential of bringing us as close to ‘cure’ as we ever have been. However, as the mounting evidence from clinical trials is significantly changing the treatment pathway for patients with early breast cancer, making treatments more tailored to individual patient needs, determining the optimal treatment for early breast cancer has become a topic of continual debate, with guidelines and consensus often varying between countries and even individual treatment centres.
A key forum for discussion on the optimal treatment of early breast cancer is the St Gallen International Breast Cancer Conference, which invites experts from a number of major cooperative groups and centres worldwide to present and critically review the latest data. This year’s theme is ‘Evidence, Controversies, Consensus’, which recognises the publication of the updated St Gallen consensus statement that traditionally closes the meeting and looks to provide recommendations based on the latest evidence showcased at the congress.
Here, we ask Veronica Hersberger, Group International Medical Director and Global Medical Affairs Team Leader, Breast Cancer, and Martin Morrissey, Commercial Director, HER2 Franchise, how they envisage the future of treatment for early breast cancer, the importance of evidence-based thinking and what we can expect from the 14th St Gallen Breast Cancer Conference.
What are you excited about at St Gallen this year?
MM: St Gallen is solely focused on early breast cancer, which is a rarity for such a big congress, and the contributions made to the debate and the number of experts in attendance providing new evidence and research highlights the importance placed on tackling the disease. At each biannual meeting it is always interesting to see what changes make it into the widely acknowledged St Gallen consensus statement, as there is a focus on real world application, with opinions sought from global experts on practical issues for the management of patients with early breast cancer outside of clinical trials.
VH: We are excited to be presenting a number of posters in early breast cancer from across our portfolio, with particular emphasis on patients’ quality of life. In HER2-positive breast cancer, Roche has collated evidence from nearly 1.7 million patients treated worldwide and we recognise the importance of continuing that research in order to better understand how we can keep improving outcomes. We remain committed to exploring not just new treatments, but also working in collaboration to create new technologies that support patients with early breast cancer.
Is there always consensus when it comes to making treatment decisions?
VH: Not always, and that is what makes developing clear guidelines on the treatment of early breast cancer so difficult. More than 100 questions made up the previous St Gallen consensus statement, which focused on personalising the treatment of women with early breast cancer, and only one commanded 100% agreement in response, and that was on the optimal duration of adjuvant therapy for patients with HER2-positive disease.
MM: Evidence-based thinking often informs a wider consensus, but deciding on the best course of treatment for an individual patient often involves interpretation and judgment of more complicated data sets. Just looking through the amount of clinical trial papers published on early breast cancer can be challenging, and Roche is exploring new technologies, tools and programmes to keep up with and analyse new information.
Why is early breast cancer a continued focus for Roche?
MM: Roche has considerable heritage in the development of medicines for breast cancer, in particular for HER2-positive disease, but also in HER2-negative disease and various other subtypes. Early breast cancer is a disease area that remains a focus for us, as when diagnosed and treated in the early setting, evidence has shown that there is the potential for cure.
VH: With every new bit of research and every new discovery made, our understanding of breast cancer grows. Our researchers have many years of experience and they continue to push the boundaries of our knowledge. We have one of the largest clinical trial programmes for breast cancer and we are supporting a large number of trials across many countries, as, despite the many significant advances made in the treatment of the disease, we believe there is more that can still be done for patients.
What improvements have been made in the last ten years?
MM: As a result of continuous new data being made available, consensus of opinion and guidelines on treating early breast cancer are evolving. For example, treatments are now being made available to patients faster than they were previously, through consideration of newer clinical trial endpoints such as PFS and pCR. In the U.S. we have seen the development of new accelerated approval pathways which has resulted in approval of treatments for breast cancer in the early setting sooner than has been seen previously. Because of continued progress, the outlook for patients diagnosed with breast cancer is better than ever before and those with the disease are now living for longer than they used to. That is a huge step.
VH: Indeed breast cancer has now been recognised as not one, but multiple diseases, which really has been a revolution in thinking, and has led to the introduction of more targeted therapies. This has significantly changed the treatment pathway for patients with early breast cancer as now clinicians are individualising treatment regimens to the patient. However, with increasingly individualised treatment comes considerable debate on what the optimal patient pathway looks like and this year’s congress will encourage discussion on various topics including assessing different patient populations, real-world application of therapies and areas of controversy in surgery.
What is the future of treatment?
MM: The future of treatment is always about addressing the unmet medical needs of the patient. Continuing to improve prognosis and outcomes and to keep taking steps towards the ultimate aim of cure. The treatment landscape is changing in early breast cancer, and even in the next year there are a number of important milestones that will hopefully result in even better options for patients. Progress continues to be made.
VH: There are many avenues of research that hold promise for improving outcomes even further for people with breast cancer, and Roche has an expanding portfolio and pipeline of breast cancer medicines that we hope will address the unmet need. PI3K inhibition, SERDs and immunotherapy are just three areas in which new research is coming through and it is a very exciting time to be involved with breast cancer research. In the next 30 years we are confident that the research we are currently conducting will see similar advances made in a number of subtypes of breast cancer.