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ASCO 2022: Highlights and Other Notable Updates

By BCRF | July 14, 2022

BCRF’s recap of the largest annual meeting of clinical oncologists and researchers

This year’s American Society of Clinical Oncology (ASCO) meeting—among oncology and cancer research’s most important annual conferences—was packed with breast cancer research updates and groundbreaking studies, top among them the practice-changing DESTINY-Breast04 trial. BCRF investigators and others joined tens of thousands of fellow oncologists and researchers, along with industry representatives and patient advocates, to share findings and hear the latest.

Of note, BCRF investigator and Scientific Advisory Board member Dr. Eric Winer—who also recently became director of Yale Cancer Center—officially started his tenure as ASCO’s 59th president at this year’s meeting. Dr. Winer, a longtime clinician, chose “Partnering With Patients, the Cornerstone of Cancer Care and Research” as his presidency’s theme and will focus on improving patient-clinician communication and relationships, closing disparities, and reducing physician burnout, among other issues.

BCRF investigators once again took home many of the conference’s top honors for their outstanding contributions to cancer research: Drs. Jedd Wolchok, Electra Paskett, and Kathy Albain received awards and gave lectures, and Meredith Regan was elected into the ASCO Fellows.

Read on for notable updates from this year’s ASCO meeting and links to more in-depth coverage of the conference from BCRF.

Major updates in HER2-positive breast cancer

The biggest news to come out of this year’s meeting was in metastatic breast cancer—most notably results from the DESTINY-Breast04 phase 3 clinical trial. Presenting this trial’s stellar results, Dr. Shanu Modi of Memorial Sloan Kettering Cancer Center reported that a subset of HER2 tumors called HER2-low can be treated effectively with the HER2-protein specific antibody-drug conjugate, trastuzumab durextecan (Enhertu®/T-DXd). Prior to this study, HER2-low tumors were classified as HER2-negative and poor candidates for the current HER2-directed therapies.

The culmination of years of research and collaboration, these results for treatment-resistant metastatic breast cancers, including HER2-low, constitute truly practice-changing findings and provide hope for these patients who have few options.

Read more about DESTINY-Breast04 and other metastatic research updates from ASCO here and HER2-low breast cancer here. And watch an interview with Dr. Modi here.

Developments in early-stage breast cancer

This year’s ASCO meeting also included a variety of notable updates and developments in early-stage breast cancer research.

Among the highlights:

  • A test developed by BCRF investigator Dr. W. Fraser Symmans was shown to reliably predict chemotherapy benefit in patients with estrogen receptor (ER)–positive breast cancer. This test, called SET2,3, measures estrogen-induced gene activation in breast cancer cells.
  • Tumor molecular profiling predicted therapy response in patients with early-stage HER2-positive breast cancer.
  • In older (over 70) estrogen receptor (ER)–positive/HER2-negative breast cancer patients, adding adjuvant chemotherapy to endocrine therapy did not significantly improve their outcomes.
  • An affordable osteoporosis drug was found to reduce bone fractures and improve outcomes in women with ER-positive breast cancer who are taking aromatase inhibitors.
  • A type of immunotherapy called checkpoint blockade showed benefit in some people with triple-negative breast cancer.

Read more early-stage breast cancer updates from ASCO here.

Using liquid biopsy to predict breast cancer recurrence

Dr. Marla Lipsyc-Sharf from Dana-Farber Cancer Institute presented a study—co-authored by BCRF investigators Drs. Winer, Ian Krop, and Nancy Lin—that suggested the presence of circulating tumor DNA (ctDNA) in liquid biopsies could alert oncologists that a patient’s cancer is coming back, thereby serving as a sentinel for small tumors that go undetected by traditional diagnostics.

Some people with hormone receptor (HR)–positive/HER2-negative breast cancer will experience disease recurrence more than five years after initial diagnosis. Unfortunately, clinicians cannot precisely predict who will have a recurrence or when it will happen. “Liquid biopsy” is gaining traction in this arena. Through this simple blood draw, clinicians can monitor tumor progression during treatment. Importantly, liquid biopsies contain ctDNA, genetic material released from tumor cells that is detectable in the blood.

In this small study of 83 patients, Dr. Lipsyc-Sharf reported that six of the eight with detectable ctDNA in their blood experienced recurrences. All six of those patients were ctDNA-positive before their cancer returned. This study will be expanded to confirm its findings, and it could lead to new strategies for intercepting recurrence before it takes hold.

Commenting on the findings, Dr. Ben Park, a BCRF investigator and pioneer in liquid biopsy’s clinical use, said it best: “That type of information and study would really give us a lot of opportunities to intervene and potentially cure more patients if we had enough lead time.”

Strategies to promote equity in clinical trials

Addressing disparities in cancer care was a major focus at ASCO, where presenters discussed global and national efforts to improve prevention, treatment, and outcomes for underrepresented groups. BCRF investigator and Scientific Advisory Board member Dr. Lori Pierce led the “Strategies to Advance Equity in Cancer Clinical Trials” session touching on a major priority in breast cancer research. In the opening talk, Dr. Pierce discussed how clinical, institutional, and patient barriers that limit diversity in trials are being addressed.

Along with cultural biases, inadequate communication between doctors and patients regarding enrollment and trial availability is exacerbated by a lack of cultural awareness and diversity in the clinical workforce. Dr. Pierce stressed the importance of doctors’ encouragement—noting that 95 percent of patients say this is critical for building trust and getting them to join clinical trials.

Other barriers are inherent in some clinical trial designs, like those that have narrow eligibility criteria and exclude patients without a scientific reason. Overall, researchers need to design—from the get-go—more streamlined and pragmatic trials that: are accessible, affordable and equitable; allow remote administration of treatment to reach a larger range of patients; leverage current technology tools; and are perhaps even conducted virtually.

Institutions and pharmaceutical sponsors are deploying new strategies to advance equity in trials such as conducting implicit bias training with staff, using community outreach tools, including patient advocates in everything from trial design to patient support and education, and utilizing matching services and software so that more patients can be paired with clinical trials that focus on their breast cancer characteristics.

Much more work remains but researchers are committed to finding innovative ways to decrease barriers and increase representation and diversity across clinical trials.

This year’s takeaways

These highlights and other sessions at the conference are further proof that, thanks to research, progress is rapidly accelerating.

From the DESTINY-Breast04 trial results to innovative approaches to tailoring treatments and predicting outcomes, this year’s ASCO meeting was, in a word, inspiring.