Tracks 1-10

Track 1 TransATAC analysis of distant recurrence risk using the Oncotype DX® assay for postmenopausal patients treated with anastrozole or tamoxifen Track 2 Role of Oncotype DX for postmenopausal patients with ER/PR-positive, node-positive early breast cancer (BC) Track 3 Efficacy and side effects of the irreversible pan-HER tyrosine kinase inhibitor (TKI) neratinib in patients with trastuzumab-pretreated and trastuzumab-naïve, HER2-positive metastatic BC (mBC) Track 4 Incorporation of lapatinib into the treatment of HER2-positive mBC Track 5 Use of lapatinib in overcoming resistance to endocrine therapy in patients with HER2-negative, ER/PR-positive BC Track 6 Phase II study of trastuzumab- DM1 (T-DM1), a first-in-class HER2 antibody-drug conjugate, in HER2-positive mBC Track 7 Case discussion: A patient with BC refractory to anthracyclines, taxanes, trastuzumab, lapatinib and capecitabine who had a significant response to T-DM1 Track 8 BIG 1-98: Sequential tamoxifen and letrozole versus up-front adjuvant letrozole Track 9 Developing individualized therapeutic strategies for patients with BC based on tumor biology Track 10 Evolving base of evidence for the selection of chemotherapy to combine with bevacizumab in the treatment of BC in the metastatic and adjuvant settings

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Tracks 1-2

DR LOVE: Would you discuss the TransATAC analysis data presented at the 2008 San Antonio Breast Cancer Symposium (1.1)?

DR BURSTEIN: The ATAC investigators in collaboration with Genomic Health analyzed data from a subset of approximately 1,200 patients who received endocrine therapy only. This was not a randomly selected subset of patients. However, it was a large, representative subset from the ATAC study. They reported that the trends, in terms of using the Oncotype DX Recurrence Score^® to predict the likelihood of distant metastatic disease through nine years of follow-up, were similar with tamoxifen and anastrozole (Dowsett 2008). Dr Burstein is Assistant Professor of Medicine at the Harvard Medical School Breast Oncology Center at Dana-Farber Cancer Institute in Boston, Massachusetts.

That is to say, you can utilize the Oncotype DX assay to determine the risk estimates for patients being treated with aromatase inhibitors and for patients being treated with tamoxifen.

DR LOVE: What about the issue of quantitative assessment of ER and HER2, which is being reported in the Oncotype DX assay?

DR BURSTEIN: Quantitative HER2 testing has not yet yielded subsets of patients who should or should not receive HER2-directed therapy. For ER testing, we have known for 40 years that more ER in a tumor translates into increased sensitivity to endocrine therapy.

In Giuseppe Viale’s papers from the BIG 1-98 study, patients whose tumors were strongly ER-positive fared well with either tamoxifen or letrozole (Viale 2007), whereas those who had tumors with lower levels of ER and/or high Ki-67 did not fare quite as well (Viale 2008). Similarly, patients with ER-positive, HER2-positive disease demonstrated poorer outcomes, but patients treated with letrozole fared better than those treated with tamoxifen (Rasmussen 2008). So these are important biomarkers and the Oncotype DX is built around all of them, which is an appealing aspect of this assay since it resonates with all of this other biomarker literature.

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EDITOR
Neil Love, MD

INTERVIEWS

Harold J Burstein, MD, PhD
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Jack Cuzick, PhD
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Howard A Burris III, MD
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Mark D Pegram, MD
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Breast Cancer Update:
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