ADAPTCycle: Adjuvant personalised therapy comparing endocrine therapy plus ribociclib versus chemotherapy in early breast cancer

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Published: 11 Jun 2019
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Prof Nadia Harbeck - Klinikum der Universität München, Munich, Germany

Prof Nadia Harbeck speaks to ecancer at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting about the use of endocrine therapy plus ribociclib compared to chemotherapy in patients with intermediate-risk HR /EER2- early breast cancer.

She describes the aims and methodology of the study, along with the current challenges in the treatment of this type of breast cancer.

Prof Harbeck also discusses the role and importance of personalising this approach, with the use of biomarkers to ensure patients receive optimal therapy.

 

We’re presenting here at ASCO 2019 an abstract called ADAPTCycle. It’s a study design of a study that’s going to start right after ASCO with the first patient in Germany. It’s actually a very forward-looking study where we’re trying to assess risk in early luminal breast cancer by combining Oncotype DX as well as a dynamic Ki67 measurement between the core biopsy and then three weeks of endocrine therapy and then seeing the result of the proliferation at surgery. Patients with an intermediate risk according to that combined risk assessment will be randomised for adjuvant or neoadjuvant chemotherapy versus endocrine based therapy with NAI plus or minus goserelin if it’s a pre-menopausal patient and ribociclib. So we’re randomised basically an endocrine based approach versus chemotherapy in intermediate risk early luminal breast cancer.

What do you hope to achieve or find from that trial?

The problem we’re having in luminal breast cancer is that in patients that conventionally get chemotherapy chemotherapy doesn’t help most of them. We know that patients with not so good Ki67 responsive data they get chemo, they have a pCR rate of 5%. So we’re trying to improve their outcome by giving them an endocrine based therapy instead of conventional chemotherapy. This study resonates very nicely with the theme of the metastatic breast cancer session here at ASCO where we’re going to see overall survival data from the MONALEESA-7 study as well as the [?? 1:41] study where they randomised in first line metastatic endocrine based with a CDK4/6 inhibitor versus chemotherapy and were able to show that the endocrine based approach is actually better with regard to progression free survival. So we’re quite hopeful for the ADAPTCycle study that it’s actually the thing to do in early luminal breast cancer.

Is there a role for personalised medicine in this type of approach?

I think it’s very personalised. We were neglecting the dynamic biomarker of early response in our early breast cancer treatment algorithm and there is so much to tell us from the way a tumour in a patient responds after only 2-3 weeks, not just in luminal but also in HER2 positive or triple negative, that we should in the future incorporate that information into giving each patient her optimal individual therapy.