An NCI Expert’s Breast Cancer Takeaways From ASCO 2019

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Rebecca Seago-Coyle:

Hey, everyone.  I'm here with Dr. Larissa Korde from the NCI. Thanks so much for joining us today.  

Dr. Korde:

Thank you for having me. 

Rebecca Seago-Coyle:

So I know you from a long time ago working at Seattle Cancer Care in the breast oncology clinic.  Can you tell us a little bit about your background and then how you came to the NCI?   

Dr. Korde:

Absolutely.  So I actually did my medical oncology training at the NCI and then worked there for a few years and was in a position that was not sort of completely patient-care oriented, and I really felt like that is what I needed to do.  And so I ended up moving to the University of Washington Seattle Cancer Care Alliance for a position that was an academic breast cancer position, so taking care of patients and doing clinical research.  

And over that course of time, being involved in clinical research really became a passion.  And then when I had the opportunity to come back to NCI to move further along in my career doing—overseeing clinical research it was really something that I couldn't pass up.  

Rebecca Seago-Coyle:

I can totally understand that. So we're here at ASCO.  So from an NCI standpoint why do you come to ASCO?  

Dr. Korde:

So for a multitude of reasons. So I would say one of them obviously is to hear about all the exciting things that are being presented.  A second thing is that we fund a lot of the cancer clinical trials that are done.  The group that I work in which is the cancer therapy—cancer therapeutics evaluation program or CTEP, oversees and funds the NCI-run Cooperative Group Network, which are groups of investigators that are both academic and community investigators that run large randomized Phase II and Phase III clinical trials. So, often when we're come here we're seeing work that we were involved in.  

And so all of it is really just to get more insight into things that are going on, to get more insight into things that we want to bring into the larger Phase III trials and then also to hear the fruit of all of our labors.  

Rebecca Seago-Coyle:

And you not only focus on breast cancer but you focus on a lot of cancers, correct?  

Dr. Korde:

Absolutely. Absolutely.  So NCI funds research for all sorts of cancers.  My focus particularly is in breast cancer. Actually we have the breast cancer portfolio for CTEP and also now oversee the melanoma studies.  

Rebecca Seago-Coyle:

Oh, very nice.  So coming here to ASCO this year, has there been any late-breaking news that you think that maybe our community members might be interested in hearing about?  

Dr. Korde:

So for breast cancer I would say—so we haven't heard the abstract sessions from breast cancer yet. Those are coming tomorrow and the day after.  I wouldn't say that there's anything that sort of stop the press, we have a new drug, we have a new breakthrough.  

But I think there are sort of incremental improvements in things that we've been seeing already. Data from the Mona Lisa study, looking at using CDK4/6 inhibitors.  Specifically in premenopausal women we have had data suggesting that these drugs work well in premenopausal women.  I think we have some confirmation of that.  There is an update to data from the IMpassion130 study looking at the use of atezolizumab (Tecentriq) in patients with triple-negative breast cancer treated for first?line metastatic disease, and so I think that is important information to get out to our patients.  

There is an update on patient-reported outcomes in cosmesis from one of the large NCI?sponsored trials that looked at partial breast radiation versus whole breast radiation. So I think these are all sort of exciting additions to studies that we've already seen some information from. 

Rebecca Seago-Coyle:

Great.  And so what's going on at the NCI today?  

Dr. Korde:

Well, so in terms of the studies that I'm involved in, so again the studies that we oversee are the larger randomized phase IIs and Phase III clinical trials that are done in the cooperative groups.  We have a number of exciting studies that are ongoing.  

We have several studies that are focused on a population of women that have early-stage triple-negative breast cancer that receive neoadjuvant chemotherapy but still have some residual disease when they go to surgery.  So there are some studies looking at using different types of chemotherapy in that setting and one study looking at using a PD-L1 inhibitor in that setting.  

We have some studies looking to sort of hone in on the best surgical techniques and local therapies for patients who have had neoadjuvant chemotherapy.  We have one study which has recently completed accrual looking at post??sorry, presurgery endocrine therapy.  We have a new study that's just opened up for HER2-positive metastatic breast cancer looking at adding a checkpoint inhibitor, a PD-L1 inhibitor to the standard therapy of chemotherapy plus targeted therapy.  

So really lots of exciting things going on, lots of studies that we're very, very excited about.  

Rebecca Seago-Coyle:

So we have a lot of folks in our breast community that might be watching this.  What advice do you have for them for what's coming out of ASCO? How do they talk to their providers about some of these things?  

Dr. Korde:

I mean, I think the most important thing is really being educated about knowing about your disease. And maybe one other thing is really thinking about kind of what's important to you.  So as we learn more about treatments we learn about efficacy of treatments, meaning, you know, how well they work, we also learn about side effects of treatments and toxicities and what to expect from those treatments. And we also know that sort of learning a lot about the tumor helps us to really target the tumor in the best way possible.  

So I think for patients sort of trying to take in this huge amount of information that comes every year from a large clinical meeting, I think for each individual patient sort of knowing what type of tumor you have, knowing what sort of treatments would be potentially offered to you, learning and asking your doctor about the side effects of those treatments.

And then I think the last thing is really just having a conversation about what's the most important thing to you and what do you want to get out of your treatment.  And if that is sort of I want to do something that has the least side effects or I want to do something that is the most aggressive treatment possible, you know, what's out there for me.  Really just having that informed discussion with your doctor but thinking about how do these things affect me.  

Rebecca Seago-Coyle:

So can you tell us about any other studies that might have come out that might have an impact on some of our communities?  

Dr. Korde:

Absolutely.  So at the plenary session today one of the studies that was discussed was in the field of sarcoma.  Sarcomas are quite rare tumors and difficult-to-treat tumors, so finding new drugs in treatment of sarcomas is hugely important and hugely exciting. There was a previously reported randomized Phase II comparing standard therapy to chemotherapy with a targeted agent that was a positive study and showed significant improvement, and that led actually to FDA approval of the targeted therapy.  

The FDA has a pathway called accelerated approval where based on very early trial results they will approve a drug with the caveat that they need confirmatory data.  And so that's what happened here.  It was an accelerated approval, and a subsequent Phase III was planned and enrolled that would then hopefully confirm the results of the earlier phase studies.  And what was presented today at ASCO was actually that the confirmatory study was negative, meaning that it did not show a benefit for this additional drug.  

And I think it really just??I think it stresses the importance of, you know, we absolutely want to get excited about early data, we absolutely want to be able to bring these things out to the community as quickly as possible, but we have to be a little bit tempered and realize that sometimes we do the confirmatory studies we don't actually get the same result.  And so it really just goes to show that you have to have definitive clinical trial data. It's just so important to do those large randomized Phase III trials that give us that level of evidence that we can then say for sure this drug is something we want to get out to our community. 

Rebecca Seago-Coyle:

Well, and I think that's actually an interesting message too.  It kind of goes along with the theme of ASCO.  We care about every patient but we're also learning from every patient, and even though we may not have learned what we had hoped to learn, it's still knowledge.   

Dr. Korde:

It's knowledge.  It's incredibly important that that gets out there. It was incredibly important that every single patient that participated in the trial gave that gift to the community because now we really do have definitive data.  So I think you're absolutely right.  It just really does underscore that this year's theme is incredibly important.  

Rebecca Seago-Coyle:

Well, thank you so much for joining us today, Larissa, Dr. Korde.  And thank you so much for all the information that you've provided us and the great work that you're doing at the NCI and supporting patients in that way.  

Dr. Korde:

My pleasure.  

Rebecca Seago-Coyle:

And one thing that we always say to our audience is knowledge can be the best medicine.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.