21IN - Is there a role for new cytotoxic agents in TNBC?

Date 30 September 2012
Event ESMO Congress 2012
Session How to integrate new drugs in the current therapeutic landscape of metastatic triple negative breast cancer
Topics Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Metastatic
Presenter Javier Cortes Castan
Authors J. Cortes Castan
  • Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, 08035 - barcelona/ES

Abstract

Triple-negative breast cancer (TNBC), which accounts for 15% to 20% of all cases of breast cancer, is characterized by having estrogen-receptor (ER)-negative and progesterone-receptor (PR)-negative and has no overexpression of human epidermal growth factor receptor 2 (HER2). It is an aggressive subtype of breast cancer marked by higher rates of visceral and central nervous system metastases and poor disease-free survival compared with hormone receptor-positive sybtypes. In recent years, an increasing appreciation and identification of somatic mutations and other genetic aberrations that drive human malignancies have led us within reach of personalized cancer medicine. However, after a high expectation with iniparib, a non optimal PARP inhibitor, final data from a randomized phase III trial did not demonstrate this drug to improve outcomes in combination with chemotherapy in patients with advanced TNBC and bevacizumab is the only “targeted” agent which has shown to improve outcomes in combination with chemotherapy in patients with metastatic TNBC. Thus, chemotherapy continues to be the standard of care in these patients. Although taxanes and anthracyclines are still the most important compounds for patients with metastatic TNBC, the majority of them will progress and patients will need new chemotherapeutic drugs. Thus, new cytotoxic drugs are being studied in patients with TNBC in late-line. Among them, new antimicrotubule agents such as eribulin mesylate have shown to increase survival versus the treatment of physiciańs choice and seems to be active also in this tumor type. Other agents which seem to play a role are vinflunine and KNTR-102, a new polymeric conjugate of irinotecan, both in phase III trials. NKTR-102 has shown an impressive response rate in patients with very heavily pretreated TNBC, including taxanes, anthacyclines and capecitabine.

Disclosure

J. Cortes: Consultant: Roche, Novartis, Celgene Honoraria: Roche, Celgene, Novartis, Cephalon/Teva