4th Asia-Pacific Breast Cancer Summit
Dr Chris Pyke is a Associate Professor of Surgery at the University of Queensland and a member of the APBC Summit Organising Committee.
Hilton Hotel, Brisbane, Australia – 27 to 29 March 2015
The Asia-Pacific Breast Summit is an attempt to bring together all disciplines relating to breast cancer management in the Asia-Pacific corridor for a scientific meeting.
The group, http://www.breastsummit.org, is a conglomerate of academics and discipline leaders across the region with the stated aim “to bring together international & regional faculty experts in breast cancer to cover surgical, radiation and medical oncology related topics on early and advanced breast cancer management.”
The venue has been a rotating one. The last 3 years it has been held in Kuala Lumpur, Singapore and now in Brisbane. The 15 separate countries were recognised among the registrants and faculty – down from the 27 countries represented last year.
Key note addresses were given by Professor Nardia Harbeck from Munich, Professor Peter Schmid from London, Professor Sarah-Jane Dawson from Melbourne, Professor Edith Perez from the USA, Professor Shireneen Loi from Melbourne, Professor Sung Bae Kim from Korea.
Debates and panels were formed to discuss triple negative breast cancer, central nervous system metastases, controversies in locally advanced and metastatic cancer and mentoring junior faculty. Each panel highlighted the differing approaches in each country, based on guideline interpretation and reimbursement patterns.
Almost every area of breast cancer oncology was covered from “recent highlights from 2014”, the use of platinums in early stage breast cancer, updates on circulating tumour DNA and genomic profiling, the use of neo-adjuvant treatment in HER2 positive breast cancer, current and future directions of immunotherapy, a summary of the advanced breast cancer guidelines, surgery following neo-adjuvant treatment and the treatment of oligometastatic disease.
The scope of the meeting is ambitious and the program was packed with excellent “update” type presentations. There was no “free paper” session, but there was original research presented via the poster display.
Professor Nadia Harbeck gave the 2014 update, including a report from the recent St Gallen Conference. The case for treatment de-escalation was made (fewer re operations, less chemotherapy), especially in the light of increasing use of gene expression profiling and the notion of personalised medicine. Professor Peter Schmid addressed the conundrum of Luminal B cancers – and how they almost always came up as “high risk” in the GEP tests, but that endocrine manipulation is still worth considering.
A debate between Prof Nadia Harbeck and A/Prof Rick DeBoer on “Should Platinums be standard of care in early stage TNBC” made the points that the higher pCR rate with platinums in this group has not converted to an increased survival in unselected TNBC – but is recommended for the BRCA 1 and 2 patients. A/Prof Rebecca Dent updated the conference on the state of the art treatment for metastatic TNBC – a combination of platinums and taxanes.
A number of presentations on translational medicine came fresh from the lab: Evolving targets in TNBC from A/Prof Warwick Locke from the Garvan Institute, and on Genomic Profiling by A/Professor Darren Corbie from UQ – both addressed the importance of measuring and interpreting epigenetic silencing of expressed genes – and techniques already in the pipeline to quantify this. The use of circulating tumour DNA (ctNDA), although thought not ready for prime time according A/Professor Sarah-Jane Dawson from The Peter MacCallum, seems to provide site specific information on the clonal evolution of metastases. It is a more accurate cancer biomarker than current Circulating Tumour Cell (CTC) technology and in its own way provides genomic profiling of the metastases which are growing, and possibly resistant tot treatment.
Another theme of the meeting was the emerging use of immunotherapy and the study of the immune system in breast cancer.
Professor Sherene Loi from Peter MacCallum and Professor Edith Perez from the USA both spoke to the increasing complexity and opportunity of the immune system and its role in breast cancer. More than just TILS, there is an explosion in the studies of ligands which activate the immune system in immune surveillance and tumour cell death. For example, TILS rich tumours provide independent prognostic information to pCR in TNBC’s. Radiotherapy can enhance the production of TILS in metastatic deposits. TILs may be useful biomarkers.
Professor Sung Bae KIM from Korea updated the conference on the structure and function of a dedicated Centre for Personalized Cancer Medicine, including a “molecular tumour board”.
Surgical aspects following therapy for locally advanced breast cancer following chemotherapy were addressed by Professor Bruce Mann from the RMH, with an emphasis on the effect of chemotherapy both on surgical margins and the axilla.
A Geographic Tumour Board discussed cases with respect to local guidelines, changing treatments, local reliability of investigations and timing of Surgery. In this theme, Professor Ning Liao from Guandong present her experience in Her2 testing and treatment in China. A/Prof Shaheenah Dawood addressed the conference on the curability of oligometastases, and localised treatments of metastases.
An update of the role of GnRH analogue treatment from Prof Peter Schmid also built on the important prognostic value of the ER receptor in premenopausal women – also re stating the findings of the TEXT and SOFT trials presented last year at San Antonio.
The meeting finished with a summary of the changing landscape of breast cancer management and where we will be in 2020, by Prof Edith Perez.
Overall this meeting showed the complex interplay of tumour biology, gene expression profiling, both in prediction and prognosis and the emerging role for studies of the immune system in interpreting cancer prognosis, as well as the rich variety in breast cancer management philosophies. The focus on the Asia-Pacific corridor seems logical and all countries represented seem to have unique viewpoints.
This is a yearly meeting and the next will again be in Singapore – the promise is for more of the same, and more surgery![hr]
Dr Chris Pyke is Associate Professor at University of Queensland and Breast Cancer Surgeon, Department of Surgery, Mater Hospital, South Brisbane. He is the current Chairman of the Foundation for Breast Cancer Care. For more information on the 2016 Summit please click here.