Young investigator session
Moderator: Jacqueline van Laarhoven, surgical resident, Jeroen Bosch Hospital
O.01 Subtype discordance rates and initial systemic treatment choices in patients with advanced breast cancer in 2007-2018: a study of the SONABRE Registry
Marissa Meegdes, Phd Student, MUMC+
The growing knowledge on the occurrence of conversion of the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) during the disease course of breast cancer emphasises the importance to obtain a biopsy of a metastatic site before treatment decisions are made (1, 2).
All 2854 patients diagnosed with advanced breast cancer from 2007-2018 in seven hospitals were selected from the Southeast Netherlands Advanced Breast cancer (SONABRE) registry to assess the biopsy rate at initial diagnosis of metastatic disease. Subtype discordance rates were determined for patients with a known subtype of the primary tumour and initial metastatic site. Next, multivariate logistic regression analyses were performed to identify factors influencing biopsy rate and discordance. Finally, initial systemic treatment choices per concordant and discordant subtypes were evaluated.
The overall biopsy rate is 60%. Factors associated with obtaining a biopsy are the period of diagnosis since 2010, an unknown subtype of primary tumour, a metastatic site of soft or visceral tissue, and a metastatic-free interval (MFI) beyond three months. The overall discordance rate is 18% (Figure 1). Receptor subtype discordance is found to be associated with the HR+/HER2+ subtype of primary tumour (vs. HR+/HER2- subtype, OR=8.47; 95% CI:5.10-14.09), and a MFI of 3-24 months (vs. MFI <3 months, OR=2.52; 95% CI:1.15-5.52). None of the given adjuvant therapies were associated with a higher risk for subtype discordance. Following loss or gain of a receptor status a different pattern for the use of endocrine and HER2-targeted therapies are seen.
The findings of this study highlight the importance of obtaining biopsy of metastatic disease, especially in the HR+/HER2+ subtype and in patients with a MFI of 3-24 months, as the possibility of subtype discordance has implications for treatment options.
1)Schrijver et al, 2018, JNCI, DOI:10.1093/jnci/djx273
2)Dutch Breast Cancer Guideline,NABON2012.
O.02 Trends of care in axillary treatment of sentinel node positive cT1-4 breast cancer patients
Eline Verreck, MSc Student Medicine, Utrecht University
To evaluate patterns of care in axillary treatment of Dutch patients – who were diagnosed with stage I-IV primary invasive breast cancer, underwent amputation and were found positive by sentinel lymph node biopsy (SLNB) – in the years following the publication of the American College for Surgeons Oncology Group (ACOSOG)-Z0011 and After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) trials.
Data from females diagnosed between January 1st 2009 and December 31st 2018 were obtained from the Netherlands Cancer Registry (NKR). Trends in completion axillary lymph node dissection (cALND), administration of adjunctive radiotherapy and, inversely, of omission of any kind of axillary treatment, were revealed by descriptive analyses on SNL positive patients.
Of 28,070 cT1-4 breast cancer patients undergoing amputation with SLNB from 2009 up until 2018, 10,706 were diagnosed as SLN positive. In the latter, the frequency of subsequent cALND went down significantly from 78% in 2009 to 10% in 2018 (P < 0.001), while adjunctive radiotherapy increased from 4% to 49% (P < 0.001). Omission of any additional local treatment increased from 18% to 41% (P < 0.001). In N1 patients cALND decreased from 57% to 13% (P < 0.001) and was mostly replaced by radiotherapy, increasing from 2% to 70% (P < 0.001). In N1mi and N0i+ patients, cALND decreased to less than 1% of cases in 2018, while radiotherapy increased from 4% to 40% and 8% to 13% (P < 0.001), respectively.
In SLN positive breast cancer patients undergoing breast amputation, cALND had become rare 10 years following the AMAROS and Z0011 trial results. While radiotherapy mostly replaced cALND in the vast majority of N1 patients, less than half of N1mi and only a tenth of N0i+ patients received radiotherapy as the only adjunctive axillary treatment by the end of 2018.
Concurrent treatment with endocrine- and chemotherapy
Chaja Jacobs, medical oncologist in training, Amsterdam UMC
Hormoontherapie is de meest gebruikte modaliteit bij de behandeling van vroege borstkanker. In theorie zou deze behandeling al op de dag van diagnose kunnen worden geïnitieerd, maar in de praktijk wordt deze vaak uitgesteld tot na het voltooien van operatie, chemotherapie en/of radiotherapie. Wij hebben een literatuuronderzoek verricht om de beschikbare gegevens hieromtrent samen te vatten. Hieruit blijkt dat gelijktijdige toediening van hormonale en chemotherapie minstens gelijkwaardig is ten opzichte van sequentiële toediening en er mogelijk zelfs voordeel van gelijktijdige behandeling kan zijn. In het bijzonder bij het gelijktijdig toedienen van aromataseremmers en chemotherapie worden veelbelovende resultaten ten aanzien van klinische respons bereikt. Wij vinden daarom dat gelijktijdige chemo-hormonale therapi kan worden overwogen als standaard behandelstrategie bij hormoongevoelige borstkanker.
Inflammatory breast cancer
Moderator: Maud Bessems, surgical oncologist, Jeroen Bosch Hospital
Ritse Mann, radiation oncologist, Radboudumc
Jelle Wesseling, pathologist, NKI-AvL
Treatment of inflammatory breast cancer
Caroline Schröder, medical oncologist, UMC Groningen
Developments in neoadjuvant treatment
Moderator: Koop Bosscha, surgical oncologist, Jeroen Bosch Hospital
The role of imaging
Marc Lobbes, radiation oncologist, MUMC+
Bij de beoordeling van therapieresponse tijdens neoadjuvant systemische behandeling is beeldvorming essentieel. Om de response op therapie te beoordelen, werd initieel voornamelijk gebruik gemaakt van mammografie en echografie. Uit studies is naar voren gekomen dat MRI op dit moment de meest robuuste methode is om deze response te beoordelen. In deze presentatie zal kort uitgelegd worden hoe deze beoordeling plaatsvindt, maar wordt er ook gekeken naar de mogelijkheden in de toekomst, o.a. met meer geavanceerde MRI-technieken en de toepassing van kunstmatige intelligentie, maar ook met contrast-versterkte mammografie.
NET: the future
Anna Weiss, assistant professor of surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
She will be presenting “The role of neo-adjuvant endocrine therapy in breast cancer”. She has a special interest in surgical management of the axilla after neoadjuvant endocrine therapy, so this presentation will briefly touch on the well-established data supporting endocrine therapy to downsize breast tumors but will then focus on the axillary management controversies.
What after the MICRA?
Marie-Jeanne Vrancken Peeters, surgical oncologist, NKI-AvL
Moderatoren: Sabine Siesling, clinical epidemiologist, IKNL and University Twente and Koop Bosscha, surgical oncologist, Jeroen Bosch Hospital
The Corona-pandemic: lessons from the USA
Jill Dietz, president of the American Society of Breast Surgeons, director of Breast Center Operations, University Hospitals Case Medical Center , University Hospital, Cleveland Medical Center, Cleveland, OH USA
Immunotherapy in breast cancer treatment
Moderator: Jolien Tol, medical oncologist, Jeroen Bosch Hospital
Immunotherapy in metastatic triple negative breast cancer
Birgit Vriens, medical oncologist,, Catherina Hospital
The future of immunotherapy in breast cancer
Sherene Loi, professor of medical oncology, University of Melbourne, Melbourne, Australia
During the last decades, breast cancer survival increased impressively as a consequence of extensive adjuvant treatment. Consequently attention shifted from only survival to a combined endpoint including both survival as well as quality of life. This attention shift resulted in the question: “How can we limit overtreatment?”. All research I perform(ed) in Maastricht suits this qualification.
gnantConcerning axillary treatment, the ultimate goal is treatment equally safe though with less lifelong morbidity. Therefore I am interested in noninvasive nodal staging study with (PET) MRI, which has the potential to offer the same knowledge as the sentinel node/axillary lymph node dissection without operating.
My goal is also supported by the BOOG-studies, RISAS- en MINIMAX-study. These (RCT/cohort) studies investigate the value of axillary treatment in clinical node negative and positive patients in standard and neoadjuvant setting. European PIs (incl me) on similar studies concerning axillary de-escalation collaborate in EUBreast. The aim is to connect PIs and collaborate on axillary de-escalation studies aiming to empower outcome and improve implementation.
The study om the role of microbiome composition in systemic cancer treatment suits the same theme: “How to improve response and decrease side effects by manipulation of the gut microbiome in breast and colorectal patients?”.
How to treat the axilla?
Moderators: Luc Scheijmans, radiation-oncologist, Tolbrug, Tilburg/’s-Hertogenbosch and Marjolein Smidt, surgical oncologist, MUMC+
What can we expect?
Janine Simons, radiation oncology resident, Erasmus MC
The changing role of RT
Duncan Wheatley, Director of Research and Innovation Cornwall, Royal Hospitals Cornwall, UK
Marjolein Smidt, surgical oncologist, MUMC+
Highlights in systemic/endocrine therapy
Moderator: Jolien Tol, medical oncologist, Jeroen Bosch Hospital
Biphosphonates: the past and the future
Michael Gnant, professor of Surgery, Medical University of Vienna, Austria
Traditionally, bone-targeted agents (BTAs), such as bisphosphonates and Receptor activator of nuclear factor kappa-Β (RANK) ligand inhibitors, were used in patients with bone metastases from breast (and other) cancer, because they reduce morbidity, pain, quality of life (QoL) and skeletal-related events (SREs). More recently, bisphosphonates and denosumab have been used in early breast cancer – for the prevention and treatment of detrimental bone health side effects of adjuvant endocrine therapy, but also outcome improvements have been show. Large clinical trials (e.g. ABCSG-12, AZURE, ZO/Z-FAST, HOBOE, ABCSG-18, D-CARE) have been performed, however results were controversial in some aspects. What appears to be clear (from an Oxford meta-analysis) is that adjuvant bisphosphonates improve outcomes in postmenopausal women with luminal breast cancer, and that denosumab very effectively prevents fractures in patients on AI therapy (ABCSG-18).
Role of PIK3CA-inhibitors
Agnes Jager, medical oncologist Erasmus MC
Neo-adjuvant treatment of HER2+ breast cancer: where will the TRAIN bring us?
Gabe Sonke, medical oncologist, NKI-AvL
Response rates to neo-adjuvant treatment and long-term outcome in patients with HER2+ breast cancer have dramatically improved since the introduction of anti-HER2 targeting agents. The Dutch TRAIN studies have contributed to optimizing efficacy and toxicity in this patient group. Benefiting from a strong collaboration with the Dutch breast cancer research group (BOOG) and participation of many Dutch hospitals, the TRAIN studies will continue to improve individualized treatment regimens.