Assisting Community-Based Oncologists and Surgeons in Making Neoadjuvant Treatment Decisions for Patients with Early Breast CancerALTERNATE trial of neoadjuvant endocrine treatment
1:38 minutes.
TRANSCRIPTION:
DR MAMOUNAS: That has been a marker that actually has been validated in several settings, decreasing Ki-67, either 2 weeks or 4 weeks, predicts for response to endocrine therapy. And Matt now has the ALTERNATE trial that actually uses this model to differentiate who will continue neoadjuvant endocrine therapy versus who will get chemotherapy in the neoadjuvant setting. And then also he has developed the so-called PEPI score that uses information from response and at the time of surgery to derive who is at low risk for subsequent recurrence and will continue with endocrine therapy or who needs, potentially, adjuvant chemotherapy at that point. So I think that’s a very, very interesting approach. DR BLACKWELL: Yes. And I think that trial is really important. It’s a very difficult trial to kind of talk to patients about. It’s not difficult to talk to patients, but it’s a trial that people come with a preconceived notion, “I either want it all. Give me all the chemo you can give me,” or, “I’m not going to touch your chemo, no matter how much it benefits me.” And I think the reality is, patient advocates were involved in the development of that trial. But for the patient facing breast cancer, if their tumor’s melting away, that’s great and everyone’s happy. But it’s for these patients who have these not-so-great responses where there’s a randomization and not great responses in terms of Ki-67. It’s kind of hard to say, “Okay. Let’s keep doing what we’re doing” and as the trials become more complex, the knowledge base of both the physicians and the research nurses who are presenting them has to become much higher. |