The Whole Enchilada: What's Hot at SABCS 2013

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Hi. This is Dr. Kathy Miller, from Indiana University in Indianapolis. There is a definite chill in the air, and despite the late-season tornados, many people's thoughts have turned to roasting turkeys and roasting chestnuts.

If you are a follower of breast cancer research, your thoughts have turned more to roasting jalapeños, because we are all preparing for the annual San Antonio Breast Cancer Symposium. This is perhaps our best time of year to be able to bring together all the breast cancer investigators, clinicians, and basic scientists from around the world to talk about what is new and where the field is headed.

I will be talking with some of my colleagues at that meeting and bringing you onsite updates, but I want to give you a heads-up about some of the research I am looking forward to seeing.

First, 2 important studies^[1,2] will clarify the potential role of platinums in patients with triple-negative disease. We saw the GeparSixto study^[3] at ASCO® (American Society of Clinical Oncology), and I think many of us have struggled with what to do with those results.

In that study, you will recall that adding a platinum in the neoadjuvant setting improved pathologic complete response rate, but investigators used a very nonstandard anthracycline taxane-based backbone, there was no long-term follow-up, and the toxicity was quite substantial. I think we have struggled with how to incorporate those results, and even with whether we should incorporate those results. The 2 studies^[1,2] that will be presented in San Antonio should make that much clearer for us.

Several studies^[4,5,6] have examined the impact of the immune system on breast cancer outcomes: immune-based signatures; the major prognostic impact of tumor-infiltrating lymphocytes in the primary tumor; and with some therapies becoming available, probably a therapeutic impact as well.

Now, admittedly, I know very little about immunology, and it has become clear that my time to remain ignorant of the immune system has come and gone. So I am looking forward to those sessions.

In the past, we have seen studies looking at circulating tumor cells (CTCs). They are certainly prognostic, but should we act on them? If you follow CTCs in patients with metastatic disease and change therapy because CTC levels have gone up or have not gone down, does that actually help patients? After all, that should be the goal of following disease -- those changes should be meaningful.

We will see the results from a very important SWOG study looking at that particular strategy.^[7] Does an early change driven by CTCs actually improve outcome?

And finally, over the past several years, we have seen major shifts in local therapy, particularly local therapy to the axilla: less surgery, more radiation. We will hear more updates^[8] of those studies this year and perhaps begin to unravel some of the biology and discern why there might be differences between those 2 local therapy modalities.

I know there will be a lot more, and I look forward to speaking with you from San Antonio. Get back to roasting your turkey while I find some jalapeños and guacamole. I will see you again soon.

Cite this: The Whole Enchilada: What's Hot at SABCS 2013 - Medscape - Nov 27, 2013.

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