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Medicine Matters oncology

So the very first one that I was very curious to see that's going to be presented in the ASCO is that, as you know, there have been large scale of CDK4/6 inhibitor studies, including the kind of three musketeers of three CDK4/6 inhibitor, including ribociclib, palbociclib, and the other milciclib. And one of the good news that I heard is that in many of the MONALEESA studies or the palbociclib-based study that we have been learning more and more about, what are the key secreted biomarkers, either for predicting the responders or the emerging resistance? For example, that we had some data that the PIK3CA was one of the commonly mutated discovered in plasma using the ctDNA platform. And yet, depends on which subtype or which type of the PIK3CA may or may not correlate with the response to the CDK4/6 inhibitor.



And then, there was a lot of discussion about the ESR1 mutations and causing either resistance or sensitivity to the CDK4/6 inhibitor. And yet, that connection has not been yet fully discovered. So I think Dr. Fabrice André and his group are going to analyze and report out the pooled circulating tumor DNA analysis from the MONLEESA study that was done from the phase 3 in ABC trials.



So of course, I have not had a chance to look into the details of the data, or I'm sure he has the data that he's going to actually show us in more details. To me, I've been interested in liquid biopsy. Because this is very critical in less invasive monitoring, truly intervene when we have an opportunity before cancer actually continue to mutate and progress. So this is one of the exciting study that I've been looking forward to hear about.



That's one. And then, actually, there's a couple more that I also was interested. So the other one that I've been interested is sort of in the same line of study. So a lot of things that we've been learning is that, as you know, the estrogen receptor positive metastatic or advanced cancer is still the major.



When I talk to my patients, they would always tell you-- because there's a lot of us exist and we live longer than some of the other cancer patients. We tend to kind of be pushed away and saying you're not the major areas of focus for our research. You're already doing well. What's the point?



However, one of the things, almost like a paradigm shifting for our breast cancer patients and the learning that we obtain from this type of longevity of prolonged response in one therapeutic such as CDK4/6 inhibitor is that, despite all the success as a whole, there are still patients that they have a lot of different heterogeneity within their tumor. And yet, we don't really understand about the heterogeneity. So for example, over the years, we have developed the idea that triple negative breast cancer is what's not instead of what is. And therefore, it is a group of heterogeneous subtype of tumor.



And by understanding their biomarkers and secrets at how they survive, maybe we can target them better. So there's a lot of movement that's going on, which is another part of a study that ASCO is going to have a lot of posters on. And yet, this luminal cancer, or the hormone receptor positive cancers, even though there are sub-populations of patients who do poorly, you know, as poor as triple negative breast cancer patients, and yet that aspect of how this resistance and emerging mutations and the cooperative pathway that's going to confer the resistance have yet to be understood.



So if you look at the list of the abstracts and poster that's going to be discussed within the ASCO this year, there is a study review, the alpelisib plus fulvestrant with the PIK3CA mutation carrier of the hormone receptor positive breast cancer - in HER2 negative, of course. And then, these are the patients who have been exposed to the CDK4/6 inhibitor. And I don't know how much of the study-- it's called BYLieve because of the BYL is the original name of the alpelisib-- I don't know how much the data we're going to learn from it.



But my perspective of having so much interest in this study is that, even though we know so much about the PIK3CA mutations and the ER-positive and [INAUDIBLE] population that consists of 40% or so patients, and yet we still don't really have a true understanding who's going to be the one that was going to respond, what's the relationship after patient had progressed in the CDK4/6 inhibitor. So that's another study in the same line that I have an interest in and I would love to see what the actual outcome is.



Because I'm from MD Anderson and I represent my MD Anderson investigator. There's a lot of study that we're going to have a short presentation to kind of expose what we have learned about that heterogeneous group of triple negative breast cancer. So there is a platform that we created called ARTEMIS. I can never remember what's the acronym of those.



But basically what we're trying to do is we profile their tumor at the beginning, with anybody with a triple negative breast cancer. Then we give them standard adriamycin and cyclophosphamide. We profile them again at the end of the AC.



If you don't have optimal response, we determine as 70% or more by ultrasound, then based on the profile that we did at the beginning or after the treatment, we allocate them into the different targeted therapies. So there will be a lot of posters and discussions that's going to come around around the ARTEMIS. And so if you have some time and interest about the triple negative breast cancer, please come and visit.



And then, actually, as a kind of small addition, I think the AZURE study, the NSAPB-34, that's who's going to benefit from the adjuvant bisphosphonate. You remember a couple of years ago, or even longer, for a long time, the adjuvant bisphosphonate has been a point of discussion. Do we need to give it to everybody? Do we need to give it to older patients with the osteoporosis risk?



And what are going to be the benefits? Who's going to benefit? So I think there is a poster about that, who might be the patient who's going to benefit from the adjuvant bisphosphonate. So something I personally was interested and would love to see, who may actually benefit.