Dr Shen on Histology-Specific Trials in Lobular Breast Cancer

Sherry Shen, MD, explains why lobular breast cancer, despite long-recognized differences in its biology and genomic makeup, is still largely treated the same way as invasive carcinoma of no special type, and why histology-specific clinical trials may be the key to changing that.

Shen, a breast medical oncologist and co-director of the Lobular Breast Cancer Program at Memorial Sloan Kettering Cancer Center (MSK), points to a central challenge in lobular carcinoma research. The differences between this histology and the more common invasive carcinoma of no special type have been understood for years, yet those differences have not translated into a distinct treatment approach. Some nuances exist, including how clinicians approach imaging of the breast and imaging of the whole body. But when it comes to the drugs selected for treatment, histology is rarely a deciding factor.

According to Shen, the most exciting development on the horizon is the creation of histology-specific clinical trials. This work centers on identifying the unique vulnerabilities of lobular breast cancer, understanding how those vulnerabilities can inform treatment selection and the drugs used, and designing trials built specifically for patients with this subtype.

Shen also describes the MSK Lobular Breast Cancer Program, launched approximately 2 years ago. The program screens patients for clinical trials, including those with metastatic disease who have already received standard-of-care treatment options and are seeking a clinical trial. Shen emphasizes that the program aims to help identify new treatment options that may make sense for these patients and to partner with outside oncologists on their care.

While lobular histology does not yet change treatment much in practice, Shen notes that it still shapes many individual decisions. These include how to select imaging, when to order an estrogen-based PET scan, the implications of insulin signaling pathway alterations and other genomic mutations, how those findings may even affect a patient's diet, and how to choose the most appropriate hormone therapy.

Looking ahead, Shen highlights artificial intelligence as an area of active interest within the MSK program, with the goal of achieving more accurate diagnoses and ultimately improving care for patients with this challenging histologic subtype. She sees considerable promise, excitement, and hope in where the field is headed.