Genomic Profiling Can Improve Outcomes in Metastatic Breast Cancer

Use of genomic profiling supported by validated criteria, such as the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT), can help improve outcomes in patients with metastatic breast cancer, according to a pooled analysis presented at the virtual San Antonio Breast Cancer Symposium.

In this exclusive MedPage Today video, Halle Moore, MD, of the Cleveland Clinic, outlines the results and what they mean moving forward.

Following is a transcript of her remarks:

In a combined analysis of the SAFIR02 and SAFIR-PI3K trials presented by Fabrice André, MD, PhD, investigators sought to look at the clinical utility of molecular tumor profiling. Patients with HER2-negative metastatic breast cancer who were eligible for either first- or second-line chemotherapy underwent biopsy of a metastatic site with genomic analysis of that tissue. And participants also underwent BRCA testing.

Those who had control of their metastatic disease after six to eight cycles of chemotherapy, and who had an actionable genomic alteration were then eligible for randomization to either continuation of chemotherapy or changing to a targeted treatment based on the genomic alteration.

The investigators compared progression-free survival in the two groups overall, and also looked at progression-free survival among those with ESCAT I/II alterations, which essentially means a molecular target for which a particular treatment has previously demonstrated efficacy in clinical trials.

Two-hundred thirty-eight of 1,462 patients, or about 16% of the initial cohort, were eligible for the randomization between maintenance chemotherapy and a targeted treatment. About half of those had the ESCAT I/II genomic alterations, such as a PIK3CA-mutation or a BRCA-mutation. Among that subset, progression-free survival was 9.1 months with targeted therapy compared to 2.8 months with maintenance chemotherapy. And this was statistically significant. For the larger randomized group, progression-free survival was 5.5 months with targeted treatment versus 2.9 months with maintenance chemotherapy. And that difference was not statistically significant. The investigators also identified certain genomic alterations associated with poorer outcomes or with resistance to CDK4/6 inhibitors or with response to a particular treatment.

The takeaway from this presentation is that molecular tumor profiling can identify important genomic alterations, which are associated with targeted treatment options, which can improve outcomes. However, currently, a relatively small minority of our patients with metastatic breast cancer will be candidates for these genomically targeted treatments that have clear improvements in outcome.

Last Updated December 21, 2021