Drs Alexandra Thomas and Virginia Kaklamani discuss highlights in breast cancer research from the ASCO 2024 Annual Meeting.
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-- TRANSCRIPT --
Alexandra Thomas, MD: Good afternoon. I'm Alexandra Thomas, a breast medical oncologist at Duke Cancer Institute in North Carolina. Joining me this afternoon is Virginia Kaklamani, professor of medicine at UT Health San Antonio. We are here today to talk to you about what we're really excited about at the 2024 ASCO Annual Meeting here in Chicago. There are some exciting new presentations of data in breast cancer. What are the things that you're most excited about?

Virginia Kaklamani, MD, DSc: I'm excited about looking at the data from postMONARCH. This is a study looking at a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor after a CDK4/6 inhibitor. Many of us had incorporated that strategy already, on the basis of data from phase 2 trials such as the MAINTAIN trial, but are these data really panning out in a phase 3 setting and what is the advantage of adding a CDK4/6 inhibitor after progression on a CDK4/6 inhibitor? That'll be pretty interesting to look at.

Thomas: I think that would be really interesting. Also, thinking about whether we need to change the CDK inhibitor or if we can stay on the same CDK inhibitor. Regardless of what the data show when Dr Kalinsky presents, it will generate many questions that should alter our practices and hopefully help those patients.
I know that when I think about what I am going to do differently on Monday morning, I'm excited about the information that's going to be presented looking at anti-Müllerian hormone (AMH) levels of premenopausal patients who were treated in RxPONDER to identify who might benefit from chemotherapy. We have the preliminary data in the abstract, and they show that this test that gynecologists typically use, which is a marker of ovarian function reserve, indicates who's going to benefit from chemotherapy more than patient-reported menopausal status or other hormone levels.

Kaklamani: I think what's important about that is that we've always struggled about the benefit of chemotherapy. Is it really the ovarian suppression of what chemotherapy does, or is it another cytotoxic effect of chemotherapy that's really helping our premenopausal patients? AMH, as you mentioned, is such an easy to test to do. It's being done by fertility experts. If it's zero, it means that there's no ovarian reserve. If it's more than that, it means that there's some ovarian reserve. That'll answer many questions for us.

Thomas: I feel like I'm seeing many women who are 49 and their last menstrual period was 6 months ago. Should I give them chemo? This really feels like it's going to discriminate for those patients and those difficult questions are going to be easier.

I'm also excited about some abstracts that may not be practice-changing but help us think about where the field is going. There's going to be circulating tumor DNA detection in the monarchE patients. We're seeing this blossoming of different assays, and this one may not be exactly the one we're going to use, but I think it'll give us a hint of how we're going to be able to discriminate in the future in the adjuvant space.

Kaklamani: That's I don't know if you have had the same experience, but I have so many patients now coming in and asking for me to perform this assay. My response has always been, no, if you want this done, you're going to have to go somewhere else because I don't know what to do with the results. I don't know how to interpret these results. Analyses like this are going to shed some light on how to use these results, which will hopefully change treatment in the future and really impact our patients.

Thomas: I couldn't agree more. We're seeing this already. Some of the other solid tumors are further along and utilizing this tool. I feel like these presentations here are going to move breast in that direction.

Similarly, there is an abstract that there may not be much discussion about. It wasn't presented in the breast session, but it was presented this morning, about using artificial intelligence to look at the histology of a slide for prognostication. Again, it's not going to change my practice Monday morning, but it gives me a flavor of what we're going to be doing in 2-5 years. Then you start to think about the implications globally. Oncotype DX is an expensive test. We can't use it globally, but could we have a histologic picture and have artificial intelligence to give us some prognostic and, hopefully, ideally, predictive information at a much lower cost and much more available to a broader population?

Transcript in its entirety can be found by clicking here:
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