So what have been the highlights here for advanced breast cancer?
I really believe that we have to speak about the CLEOPATRA trial. Yesterday we had astonishing data in metastatic breast cancer HER2 demonstrating that dual targeting with pertuzumab and trastuzumab may increase by one year overall survival of patients with metastatic breast cancer HER2 . So finally my conclusion is that dual targeting plus chemotherapy is no more an option but is the option for the treatment of these patients.
Is it given time-wise or together?
The problem is that we have to face the cost of this type of combination. So, on one hand, we have a really important increase in overall survival and disease free survival for our patients; on the other hand we have to face the economic burden of the dual targeting in real life. Many countries in Europe, as ESMO also stated, do not have access either to trastuzumab that was the standard of care before the CLEOPATRA data. So it will be important for the future to understand how to phase the access to innovative treatment for breast cancer patients but also for other settings of disease.
So they don’t have access to trastuzumab and also they don’t have access to…?
To other agents, yes, you are completely right. Many countries in Europe do not have the money to buy high cost drugs and it will be important for the future to create the political conditions to give access to these patients. How to manage this? Maybe we will have the bio-similar in a few years, at least for trastuzumab; this will reduce the cost of some specific biological agents and this maybe will permit the access to innovative treatment to many patients. But when we speak about new treatments like pertuzumab plus trastuzumab this will be really a huge problem to face for the next years.
I imagine pertuzumab is even more expensive than trastuzumab?
It will be at least expensive like actually trastuzumab but if you have to face the cost of two drugs it’s much more than one.
So what is the option for a woman that would be eligible for this type of therapy? Would it be a clinical trial?
If we had a clinical trial this would be the right option but finally we demonstrated that dual targeting is better than single targeting, either in the neoadjuvant setting with the NeoSphere trial, either in the metastatic. So we don’t have any more clinical trials to demonstrate this so we have to find a political solution to give access to new agents to all women in Europe.
And other highlights for advanced breast cancer?
I would like to remind the IMELDA trial, bevacizumab plus capecitabine versus bevacizumab as maintenance treatment following chemotherapy plus bevacizumab in metastatic breast cancer. This is an interesting trial, I believe, because there is the concept of maintenance treatment following chemotherapy. This trial demonstrated a benefit in terms of disease free survival and overall survival. Some highlights on the IMELDA trial: first of all patients did not receive endocrine therapy in the arm of bevacizumab. Secondly, the control arm did not include a chemotherapy but just a biological agent. But I believe it’s a very important trial because maintenance treatment is a matter of debate and we need strongly a trial in ER disease where we usually give endocrine therapy as maintenance despite there is no trial demonstrating that this will give a benefit to our patients.
Just briefly, you were in a session this morning on immunotherapy and breast cancer. Can you give us a little bit of…?
Oh yes, we did a great session, very well attended. The final message is the following: there are some patients that have tumours that are much more immunogenic than others. Features of the disease that can predict immunogenicity are infiltrating tumour lymphocytes that are prognostic factors, usually tumours with TAS positive usually go better. They are also predictive of response to neoadjuvant chemotherapy and anti-HER2 treatment. I believe immunology will be the future in the treatment of cancer and we need much more trials in the field of breast cancer.
Are there many centres in Europe which are looking at infiltrating T-cells?
Also at our centre in the European Institute of Oncology we performed a very interesting trial in the post-neoadjuvant setting in patients with resectable disease following chemotherapy as neoadjuvant therapy. We discovered that patients with TAS positive have a very good prognosis so this is an important observation because we can stratify patients into TAS positive and TAS negative and we have to concentrate in the TAS negative in which the prognosis is not so good.
So all in all a very exciting meeting?
It was a great meeting, more than 20,000 people attended and the most surprising thing is that all the rooms and the conference rooms are full of people. Here in Madrid it’s beautiful weather, you can go for shopping and for everything but people are here to listen to these very interesting presentations.