de-escalation and escalation treatment of early breast cancer—Interview with Giuseppe Curigliano at SGBCC 2023

At this SGBCC(18th St. Gallen International Breast Cancer Conference 2023, 15-18 March,Vienna), We were very glad to interview Professor Giuseppe Curigliano, from European Institute of Oncology, IRCCS, Milan, Italy. He shared with us his views on de-escalation and escalation treatment of early breast cancer

 

Oncology Frontier: Is there any prospect neoadjuvant systemic treatment de-escalation, especially chemotherapy de-escalation?

 

Giuseppe Curigliano：Yes，I believe we should really consider omitting the use of anthracycline. The first de-escalation is set to do more TCHP without anthracycline. This will not reduce the rate of pathological complete response and will save many patients for cardiac adverse events.

 

Oncology Frontier: Which breast cancer population may benefit from the intensive therapy of tyrosine kinase inhibitor (TKI) after 1 year of treatment?

 

Giuseppe Curigliano：This is a very important question ,wo do not forget the ExteNET trail——An excellent trial demonstrated that there is a potential benefit in nature of neratinib in HER2 positive disease after completion of 1 year of adjuvant trastuzumab and trastuzumab plus pertuzumab.

 

The limitation of the study with the neratinib was that the assignment of the drugs in a year up where still pertuzumab and trastuzumab was not a standard of care, and where still T-DM1 in the post adjuvant setting was not the standard of care.

 

Oncology Frontier: Is there any possibly valuable investigation of adjuvant trastuzumab emtansine (T-DM1) plus pertuzumab？

 

Giuseppe Curigliano：The KATHERINE trial was an example. I am not so sure that combining an ADC (herein referred to T-DM1) with pertuzumab can have a major role. Actually, we have one study in neo-adjuvant setting in which this strategy is explored in combination with pertuzumab. We have to wait the data, but if you consider that the mechanism of endocytosis, finally with down regulator to expression, how pertuzumab can potentially inhibits the dimerization. So this is an open question. And I believe that the trial with T-DM1 will give us their response.

 

Oncology Frontier: Will trastuzumab deruxtecan (DS-8201) challenge trastuzumab plus pertuzumab in early breast cancer treatment?

 

Giuseppe Curigliano：What we know, at least in the second line, is that median progressive free survival of trastuzumab deruxtecan that looks longer than pertuzumab plus trastuzumab in the first line with the taxane.So it will potentially beat pertuzumab plus trastuzumab.