Expert Commentary – Evandro de Azambuja: early breast cancer, highlights in 2018.

  • Daniela Ovadia — Agenzia Zoe
  • Oncology news
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Evandro de Azambuja, is the Head of the Medical Support Team (Academic Promoting Team) at the Jules Bordet Institute in Brussels, Belgium. His research is mainly focused on breast cancer and toxicity of new drugs in oncology. He is an active member of the European Society of Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO) and the American Association of Cancer Research (AACR).


  • In my opinion, the most striking news for patients with early breast cancer is the result of the KATHERINE study presented at San Antonio Breast Cancer Symposium and published on the same day (December, 5th) on the News England Journal of Medicine (doi: 10.1056/NEJMoa1814017).
  • Patients (n=1486) with HER2-positive early breast cancer with residual invasive disease at surgery after a neoadjuvant therapy containing a taxane and trastuzumab were involved in this phase 3, open-label study. They were randomly assigned to receive 14 cycles of trastuzumab or trastuzumab emtasine (T-DM1), an antibody-drug conjugate of trastuzumab and a cytotoxic agent.  
  • Treatment with T-DM1 reduced the risk of recurrence of invasive breast cancer or death, showing a 50% decrease in this endpoint with respect to treatment with trastuzumab alone.
  • I believe these results will be practice-changing, even if some data are still missing (i.e. data on overall survival): we know that patients not achieving pathological complete response after neoadjuvant therapy have a worse prognosis, but now we have a new strategy to follow, depending on the pathological findings at surgery.
  • Personalized breast cancer medicine, also focusing on the possibility to conduct whole genome sequencing analysis on all breast cancer patients, is another interesting topic in the field, even if not related only to early disease. At the moment, I think we are not ready to have all these genomic assessments, but it’s noteworthy that genomic information and risk scores (based on the Oncotype DX test) have been proven to be really important for a chemotherapy sparing approach in some patients, as presented at ASCO earlier this year.
  • Research on diagnosis and therapy is moving fast but, as clinicians, we should always keep in mind that patient is central in every decision about disease management.