Joseph A. Sparano, MD

Joseph A. Sparano, MD, professor of Medicine, Hematology, and Medical Oncology at the Icahn School of Medicine at Mount Sinai, discusses a key point raised during a presentation for the 19th Annual School of Breast Oncology® around the treatment of locally advanced breast cancer.

With both local and systemic therapies in mind, Sparano explains that analyses of pathologic complete response are surrogate end points when it comes to locally advanced breast cancer. However, it can provide insight into how patients will response long-term.

Sparano further notes that for the subgroup of patients with residual disease, there is therapeutic potential to achieve an even better response.

 the key principles that I touched upon, included the fact that pathologic complete response is a short term surrogate indicative of long term outcomes for patients with locally advanced breast cancer receiving systemic neoadjuvant chemotherapy. So that's point number one. 

 Point number two is that achieving a pathologic complete response is associated with a favorable long term outcome. But in those who have residual disease, there are therapeutic options that can further improve outcomes. That would include, say the use of capecitabine  being for patients with triple-negative disease or trust use of our T-DM1 for patients who have residual hurt to positive disease. 

 The third major point to take away is the recent approval of pembrolizumab in addition to chemotherapy for patients who have triple negative breast cancer, which has been shown to improve the likelihood of achieving a pathologic complete response, and also improving event free survival.

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Joseph A. Sparano, MD, who recently gave a talk during the 19th Annual School of Breast Oncology, discusses prolonging responses to therapy in patients with advanced breast cancer. 


Prolonging Responses in Locally Advanced Breast Cancer

Joseph A. Sparano, MD, professor in the Department of Medicine and Department of Obstetrics & Gynecology and Women's Health at the Albert Einstein College of Medicine, discusses how identifying the risk of recurrence in patients with breast cancer can help inform treatment decisions.

The decision for what therapy to use in a patient who is not benefiting from chemotherapy would depend on the underlying risk of recurrence as assessed by a new tool, which Sparano highlighted during a presentation during the 2020 San Antonio Breast Cancer Symposium (SABCS). For postmenopausal women who have substantial risk of recurrence, the only option is to ensure they receive the most optimal endocrine therapy, and the only option available in this setting is an aromatase inhibitor.

The standard treatment for most premenopausal women is tamoxifen (Soltamox), but premenopausal women at higher risk of recurrence could have lower risk when treated with ovarian function suppression and an aromatase inhibitor, says Sparano. If tools such as this are expanded to other higher risk clinical scenarios, physicians could identify patients who may be more likely to benefit from experimental therapies in clinical trials or novel therapies that have proven to be effective in high risk scenarios, such as CDK4/6 inhibitors.

Joseph A. Sparano, MD, discusses how identifying the risk of recurrence in patients with breast cancer can help inform treatment decisions.

Joseph A. Sparano, MD | Authors

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Prolonging Responses in Locally Advanced Breast Cancer

Determining Risk of Recurrence in Patients With Breast Cancer Could Inform Treatment Decisions

The Evolution of Endocrine Therapy in Breast Cancer