Takeaways from ASCO, 2022

The American Society of Clinical Oncology (ASCO) had its annual meeting during the first weekend in June 2022, and there was a lot of information and data shared that pertains to breast cancer.  

I'm sharing this information as a patient advocate, not a doctor, and would highly recommend if you have questions about these results or the information, take them to your doctor!  I can't give medical advice and would never presume to know more than your doctor about treatment or interpreting this data.

With that disclaimer, here are my top 5 takeaways:

Takeaway 1

We will start with the biggest news, which had a 5-minute standing ovation at the meeting. The trial Destiny--Breast04 looked at Fam-Trastuzumab Deeruxtecan-nxki a/k/a T-DxD a/k/a Enhertu compared with the standard of care.  

Overall, Enhertu showed a 10-month progression-free survival (PFS) for triple-negative MBC and an improvement of 5 months for those of us who are ER+ and HER2 low. In fact, so many different people got more PFS on Enhertu that many are thinking everyone may benefit.  That's too soon to know for sure, but the mTNBC results are huge for that subtype and also significant otherwise.

Now, you may be asking how do you know if you are HER2-low, which is one of the other big things to come out of the conference.  For many, IHC (which stands for immunohistochemistry) staining is how HER2 status is defined.  Some pathologists also use ISH (in situ hybridization) or FISH (Fluorescence in situ hybridization) testing in addition to IHC staining.  ISH or FISH testing simply gives a positive or negative for HER2 status, whereas IHC testing will give a number.  

For those of us who have a negative overall HER2 status but a +1 or +2 in parenthesis after IHC, we are likely HER2 low.  HER2 low isn't a new subtype but appears to be something that can be targeted differently than completely negative or overexpressed a/k/a positive.  This is something we will likely be hearing a lot about going forward and this should definitely be something to look at when you get your next biopsy.

As a patient, getting that excited about 5 months (for those of us who are ER+) may seem a little over the top, but I do think the combination of the mTNBC results and the fact that there is now a treatment for Her2-low demonstrates a difference that will affect clinical practice immediately for the better.

Takeaway 2

The second big news was the results of the Tropics-03 trial, which looked at Sacituzumab Govitecan a/k/a Trodelvy (previously approved for mTNBC) in ER+/Her2- MBC.  The results were very good in that 30% of the patients had positive results and increased progression-free survival (PFS).  

The overall survival (OS) data isn't mature yet, but the expectation is that both mTNBC and ER+/HER2- MBC will see a similar benefit.  Since Trodelvy is the first in its class, I suspect we will see other Pharma companies jumping on this bandwagon and developing their own meds in this category.

Takeaway 3

As the third piece of news, a general move towards developing more Anti-body Drug Conjugates (ADCs) has been a big discussion since the ESMO (European Society of Medical Oncology) early this year. Ado-Trastuzumab emtansine (T-DM1) was the first in this class to be approved by the FDA, and it seems that we will hear a lot more about ADCs in the future.  An article to learn more can be access here.

Takeaway 4

The fourth trial that was anticipated was the Maintain trial, which looked at ongoing CDK4/6 medication (Ibrance, Kisquali or Verzenio) when changing the accompanying endocrine therapy.  No surprise, for those of us who are ER+, it's better to be on both.  Ibrance has failed to reach the expected overall survival numbers now that we have data spanning more than 10 years. In clinical practice, I wonder how this will affect those patients who have been on Ibrance for some time, so be sure to discuss this with your doctor if you have been on Ibrance for longer than its expected effectiveness.

Takeaway 5

The fifth and last takeaway was the trial looking at patritumab deruxtecan, a HER3-directed antibody-drug conjugate (ADC).  In phases I and II, the results look promising, and it appears that the study will move into phase III.  The side effects of this one will be key to watch as the data matures.

Sound like Greek to you?

I've tried to translate the interesting findings from the medical jargon to something more understandable but if you are as confused at the outset as I was, you are in good company.  It's hard as a patient advocate to interpret what the doctors and scientists are learning, and the posters and studies are very slow to move to more plain language.

Outside of just reading everything a million times, I would highly recommend participating in the poster discussions with GRASP, which stands for Guiding Researchers and Advocates to Scientific Partnerships. The small group sessions bring poster authors, scientists, and advocates together in zoom meetings to discuss the outcomes of various selected posters and trials.

Now it's your turn. Anything from ASCO I overlooked?