C Lisanti

Controversies in monitoring metastatic breast cancer during systemic treatment. Results of a GIM (Gruppo Italiano Mammella) survey

BACKGROUNDnThe optimal strategy for monitoring metastatic breast cancer (M-MBC) is unclear. Nevertheless, M-MBC influences patients quality of life and it affects the use of resources in terms of both drugs and diagnostic exam prescription. We aim to disclose oncologists approach on M-MBC, identifying controversial areas.nnnMETHODSnAn anonymous online survey was conducted among GIM members who, based on their on-field experience, shared their own method for M-MBC planning. Chi-square tests and Fisher exact tests were used as appropriate.nnnRESULTSnThe survey was completed by 256 recipients (51%). The majority of them were medical oncologists. Approximately 50% of respondents reported that M-MBC was primarily based on the monitoring strategies used in clinical trials, and for 70% of them M-MBC should be evidence-based. Areas of controversies included the primary goal of M-MBC, the use of tumour markers, the optimal timing for baseline assessment and frequency of repeating testing. Respondents agreed on planning M-MBC before treatments start and on discussing with the patient about the M-MBC strategy and on choosing CT-scan as the preferred reassessment imaging method. The most relevant factors influencing the M-MBC strategy were performance status, triple negative histology, exams contraindication, the presence of clinically measurable disease, and treatment safety profile; on the contrary, patients socio-economic status, exams cost, and hospitals logistic limits were less relevant. Experienced oncologists seemed less prone to intensive follow-up.nnnCONCLUSIONnM-MBC strategy still has controversial issues and its potential clinical effects for breast cancer patients need ad hoc studies.

Atezolizumab for the treatment of breast cancer

ABSTRACT Introduction: Breast cancer (BC) is the most common cancer diagnosed among women. The development of new personalized therapeutic strategies has reshaped the landscape in this field. However, BC is still the first cause of death among women. Interestingly, several preclinical studies and some clinical evidences are focused their attention on the role of immune system and immunotherapy on cancer control, also in BC. Areas covered: Usually, BC has been considered a not immunogenic tumor for its low mutational load. However, recent studies have evidenced that some subtypes, triple negative and HER-2 positive BC, are ‘hot’ tumors, thus more immunogenic. Moreover, the presence of immune infiltrate is positively associated with favorable prognosis. Therefore, the use of immune-checkpoint inhibitors seems to be an encouraging treatment option also in BC. Among these drugs, atezolizumab is an anti-PD-L1 monoclonal antibody with a particular structure that reduce antibody-dependent cellular cytotoxicity against T cells, increasing quantitatively and qualitatively the effective response. Expert opinion: The use of immunotherapy is a promising option for BC. However, at the same time it still raises many doubts. Surely, the research and the validation of immune biomarkers can permit to identify patients who more benefit from these drugs.