Future Therapies in Breast Cancer and Final Thoughts

Jacob Kettle, PharmD, BCOP, and Allison Butts, PharmD, BCOP, share some future therapies for the management of breast cancer.

Jacob Kettle, PharmD, BCOP: Some last questions for you: What are upcoming data out there that you’re most looking forward to seeing? What trajectory in the world of early breast cancer are you most excited about following in the next 2 to 3 years or so?

Allison Butts, PharmD, BCOP: There are a lot coming out. One of the studies that’s going on right now is looking at the role of immunotherapy in breast cancer. We now have an approval of atezolizumab for our triple-negative patients: our metastatic triple negatives. Something that’s going to be interesting coming up is what the role of immunotherapy is with HER2 [human epidermal growth factor receptor 2]—positive breast cancer.

There are trials ongoing with a number of immunotherapy agents, so we’ll see who comes out first with that. We [at the University of Kentucky] have 1 patient for whom we’re using atezolizumab off-study. It’s the best response she’s had compared with any of the prior therapies she’s had, both in the curative intent as well as in the metastatic setting that she’s found herself in. That’s 1 huge area for us that we’re looking forward to seeing for sure in the next couple of years.

Jacob Kettle, PharmD, BCOP: I’ll absolutely be following that closely. We saw early publications last year with atezolizumab approved. There were some early trials in which atezolizumab was approved in the metastatic space, triple negative. There are some early results in an adequate space, and it’s going to be an interesting discussion to see that play out. I’ll be curious to see if there are any more emerging actionable biomarkers that rear their heads in the breast cancer space.

I see a tremendous trend throughout the whole oncology landscape where we’re having many potentially actionable biomarkers. I’ll be curious to see how that continues to transform breast cancer, particularly HER2. Is anything else that is going to emerge beyond that HER2 manipulation? Is there something else that shows? It will be fascinating to follow.

Allison Butts, PharmD, BCOP: That’s a great point. There are so many downstream players that we can target in the HER2 cascade. Some of these PI3K inhibitors that are being studied in the metastatic space right now. What does that do for our patients in the curative intent setting? What do we in the metastatic setting since we don’t know the answer to that yet? How does that play into adjuvant cases? That seems to be the way of things with this cancer: everything gets studied in the metastatic setting and trickles on down. We’ll see.

Jacob Kettle, PharmD, BCOP: There will be no shortage of innovation, development, and advancement over the next several years, which is wonderful news for patients as we keep moving forward.

Before we conclude, I have some final thoughts. We’re in a fascinating time in oncology practice regardless of your discipline. In medical oncology, surgical oncology, nurses, and pharmacy in particular, there has been a major shift in the way pharmacy practices.

You see all these challenges occur, and we’ve certainly moved far beyond dose calculations and those kinds of things, deeper into therapeutics, safety, operations, and financial impact. They’re so big and broad with these drugs. It’s an exciting time for pharmacists, and I’m excited to see where we can continue to grow as a profession to keep delivering better and better outcomes for our patients.

Allison, any final thoughts for you?

Allison Butts, PharmD, BCOP: I’m with you. It’s an exciting time. There are good problems that we have. We have to figure out how we’re going to juggle this plentiful group of therapies we have. I’d certainly rather be on the side that we’re trying to figure out how to operationalize therapies rather than trying to figure out what to do with the few options we have. It’s a great time to be in the breast cancer world, and there’s a lot of excitement out there for all of us across the treatment spectrum.

Jacob Kettle, PharmD, BCOP: All right. To our viewing audience, thank you for listening. I hope you found this to be a richly rewarding experience. I certainly enjoyed being here. Thank you to Pharmacy Times® for putting this together.