NCCN 2023: Update on Management of Metastatic Breast Cancer

By: Lauren Velentzas
Posted: Monday, April 24, 2023

William J. Gradishar, MD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, discussed the latest updates to the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) at the NCCN 2023 Annual Conference. He focused particularly on the management of estrogen receptor (ER)-positive, HER2-positive, and triple-negative subtypes.

“The introduction of newer therapies and combination treatments has allowed for a more nuanced approach to treating breast cancer, leading to improved patient outcomes,” Dr. Gradishar commented.

The role of combination therapies and personalized medicine for these subtypes has grown in recent years, as the treatment landscape shifts away monotherapy options, he noted. The NCCN Guidelines now include endocrine therapy paired with palbociclib, abemaciclib, and ribociclib as treatment for ER-positive metastatic breast cancer. These combinations have consistently improved progression-free survival over monotherapy. Elacestrant, a selective ER degrader and recent addition to the NCCN Guidelines, is another option for patients with ESR mutations.

In HER2-positive breast cancer, fam-trastuzumab deruxtecan-nxki is being considered for how it may influence future NCCN Guidelines and clinical practice, according to Dr. Gradishar. It is currently being studied in the DESTINY-Breast09 trial to evaluate whether it could replace the CLEOPATRA regimen as a first-line treatment option. It has already contributed to a median progression-free survival of 28 months, as opposed to 7 months with ado-trastuzumab emtansine in previous trials.

NCCN Guidelines for triple-negative breast cancer now consider multiple factors, such as a patient’s eligibility for immunotherapy, BRCA mutation status, and HER2 levels. Pembrolizumab in combination with chemotherapy as a first-line treatment for PD-L1–positive disease has been shown to be a potentially effective first-line treatment in the KEYNOTE-355 study, with the combination leading to a clinically relevant improvement in overall survival for patients with higher combined positive scores. Meanwhile, PARP inhibitors such as olaparib and talazoparib have shown activity in triple-negative breast cancer with BRCA mutations, and sacituzumab govitecan-hziy has proven effective in patients who have received at least one chemotherapy regimen.

Disclosure: For full disclosures of Dr. Gradishar, visit nccn.digitellinc.com.

NCCN 2023 Annual Conference

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