Ryan Haumschild, PharmD, MS, MBA: Dr. Dent, we are considering many innovative therapies. There are many exciting things. But I want to know from you first, and then I’ll get back to Dr. Moore. What are the most promising developments you see on the horizon for HR [hormone receptor]–positive, HER2-negative patients? It could be screening, genomic markers you’re excited about, or general treatments.
Susan Faye Dent, MD, FRCPC, FICQS: That is a good question. We have multiple therapies and we’ve talked about different therapies. It is important to understand which therapy will work best for that person. For example, with CDK4/6 inhibitors, we don’t really understand who would benefit the most or who would develop resistance. Wouldn’t it be great if we had a marker that could tell if a person will benefit the most from a CDK4/6 [inhibitor] or are they less likely to develop resistance? We are learning more about markers, but we still have a long way to go.
Likewise, wouldn’t it be great if we could predict who could stay on the backbone of a CDK4/6 inhibitor by just changing the endocrine therapy? That would also be great to keep patients on that therapy for as long as possible. Understanding that when you say markers, we’re still in the early days of understanding who will respond best to which therapy. That’s what it’s all about: maximizing the therapy in the patients who benefit the most, and then getting a little more insight into the different pathways and the upper regulation of pathways.
We’ve heard about different goals, but how do we rank those goals? Much more needs to be done in clinical research on the optimal sequencing of those therapies, [ideally] based on markers that can predict who will benefit. We have a lot of therapies, which is great, but now we have to figure out who they work best for and how we follow up on those therapies.
Heather N. Moore, PharmD, BCOP, CPP: I totally agree. We have many great therapies, but like Dr. Dent said, it goes back to the optimization of those therapies. We have efficacy, but how do we create or improve those lasting responses to get therapy that lasts longer? Something that’s also fun and has been a bit of a transition is looking at quality of life. Many studies have looked at not only efficacy but also the quality of life of the patients participating in those clinical trials or therapies, recognizing that if a patient is unable to stay on therapy or if their quality of life is significantly does this reduce the benefit as great as we think it is based on efficacy alone? We also circle back to the general toxicity of those therapies and let some of these studies look at how we can improve that. I essentially agree with everything Dr Dent said and the overall optimization.
Ryan Haumschild, PharmD, MS, MBA: This was such an informative and inspiring discussion about HR positive, HER2 negative breast cancer patients and the different therapies. I learned a lot and enjoyed our discussion of toxicity management, the best way to rank patients, future literature and future FDA approvals that we can [take advantage of to] better treat these patients. Before we finish, I want each of you to walk me through the key focuses around the unmet needs and future directions for an HR positive, HER2 negative patient and what some of those key concerns should be for those watching [and] say, “What should I pay attention to? What are the most important things to think about?” Dr. Dent, let’s start with you, and then we’ll end with Dr. Moore.
Susan Faye Dent, MD, FRCPC, FICQS: That is the question of 2022, because as clinicians we want to maximize the benefit. If we can take a therapy like CDK4/6 inhibitors and maximize the duration of benefit to that person while also controlling and minimizing toxicity, that would be great. Can we keep them on any longer? Then, if they make progress, switch to a therapy that they will respond to, [ideally] based on a target that we can measure, while at the same time managing and keeping their quality of life as high as possible and minimizing toxicity. What should we look for in 2022? More and better therapies as we build on the backbone we already have and keep in mind that it’s about quality of life, not always about quantity, and that we need to keep that in mind for our patients.
Heather N. Moore, PharmD, BCOP, CPP: I don’t know if I can add anything to that. That’s pretty concise. I agree with all those comments. It is moving more from standard chemotherapy to more targeted therapies to optimizing therapies and making them more patient-specific. It’s about how we fit this drug to this patient and vice versa. The goal… in the coming years is more targeted therapies that specifically suit these patients that we’ve determined can reap the best benefit.
Ryan Haumschild, PharmD, MS, MBA: Thanks to all of you for this rich and informative discussion. I want dr. Moore and Dr. Thanks to Dent for all the information you showed as it was very helpful. We thank our viewership. We hope you found this Pharmacy times® panel discussion will be useful and informative.
Transcription edited for clarity.