Breast Cancer | Matthew Goetz, MD

Research To Practice | Oncology Videos

Breast Cancer Update, Issue 3, 2019 — Part 1: Our interview with Dr Goetz highlights the following topics as well as cases from his practice:

• Case: A woman in her mid-30s with de novo ER-positive, HER2-negative metastatic breast cancer (mBC) achieves a complete clinical response to palbociclib, letrozole and ovarian suppression (00:00)
• Importance of providing support to patients and their families coping with a diagnosis of mBC (01:15)
• Therapeutic options for patients with de novo ER-positive, HER2-negative mBC (03:45)
• Activity and tolerability of gonadotropin-releasing hormone agonists (05:35)
• Selection of patients for treatment with CDK4/6 inhibitors in combination with endocrine therapy (09:07)
• Mechanism of action of CDK4/6 inhibitors (12:13)
• Role of everolimus and alpelisib in the management of ER-positive mBC (14:30)
• Implications of ESR1 mutations for the management of ER-positive mBC; use of selective estrogen receptor degraders (SERDs) (16:15)
• Activity of the selective estrogen receptor modulators endoxifen and lasofoxifene for mBC with ESR1 mutation (19:48)
• Tolerability profiles of the CDK4/6 inhibitors palbociclib, ribociclib and abemaciclib; dose reduction to mitigate side effects (21:21)
• CNS penetration of abemaciclib; management of abemaciclib-associated diarrhea (25:26)
• Effects of site and extent of metastases on outcomes with CDK4/6 inhibitors (27:02)
• Efficacy of CDK4/6 inhibitors in combination with endocrine therapy for ER-positive mBC (29:29)
• Survival outcomes with CDK4/6 inhibitors and endocrine therapy for ER-positive mBC (31:28)
• Response to palbociclib and endocrine therapy in patients with ER-positive mBC (34:17)
• Selection of therapy for patients with locally advanced ER-positive, HER2-negative breast cancer (36:41)
• Therapeutic approach for patients who experience disease progression on a CDK4/6 inhibitor (39:33)
• Activity of alpelisib for ER-positive advanced breast cancer with a PIK3CA mutation (47:02)
• Side-effect profile of alpelisib (49:41)
• Case: A woman in her late 60s with high-grade, ER-positive, HER2-negative breast cancer and a 21-gene assay Recurrence Score (RS) of 52 receives adjuvant chemotherapy (52:54)
• Role of bone-modifying agents for patients with ER-positive breast cancer and bone metastases (58:04)
• Ongoing investigations of CDK4/6 inhibitors in the adjuvant setting (59:40)
• Effects of CDK4/6 inhibitors on immunity; potential for combination with immune checkpoint inhibitors (1:01:14)
• TAILORx trial: Adjuvant chemotherapy guided by a 21-gene expression assay for women with ER-positive, HER2-negative, node-negative breast cancer (1:06:19)
• Impact of clinical risk on prognosis and prediction of chemotherapy benefit by age and RS in the TAILORx study for patients with early breast cancer (1:07:46)
• Perspective on the use of gene expression assays to determine risk of recurrence and guide adjuvant decision-making (1:14:30)
• Cancer cell dormancy and risk of late recurrence (1:16:47)

CME information and select publications