Future breast cancer care: ESMO Breast Cancer 2024
Transcript: Latest updates from the TEXT and SOFT clinical trials
Professor Michael Gnant
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Yeah, I think that's also a very interesting result that I have also mentioned in my brief summary. Number one, SOFT and TEXT are great studies of the optimization of endocrine treatment in premenopausal women. And we always face the balance there of should we escalate the treatment, giving more intense, but even better endocrine treatment, which is the combination of rare infraction suppression plus an aromatase inhibitor, because that combination treatment usually has more side effects and more tolerability issues as compared, for example, to plain tamoxifen. So, personalising these approaches, basing it on individual patient risk profiles is something that we try to do that is difficult to do. And I think that a huge cohort of these two phase-three studies, I mean, that's a total of over 4,000 patients of which 345 were identified to have a lobular subtype. And the short message of this is that lobular cancers obviously benefit particularly from the combination of ovarian function suppression and the aromatase inhibitor, exemestane, that was used in these trials for that combination. So I believe that's helpful in terms of selecting patients who really need to have escalated combination endocrine treatment. I am a little bit cautious because of the TEXT have always seen lobular cancer different. There is other endocrine trials where that difference is not as striking, speaking of lobular versus ductal subtype. And the reason for this is that it's not so easy to fully differentiate between these two pure subtypes of breast cancer. So to really get to it, a more sophisticated molecular or even RNA sequencing approach is necessary, which is underway in many of the large trials. But as of now, I think that is interesting and clinically relevant information. So if after hearing those results, I see a patient with lobular breast cancer, I would be more inclined to recommend the more intense endocrine treatment regimen or, let's say, the threshold for trying to manage side effects to help our patients through some difficult phases if they faced durability issues would be higher, and I would be inclined to fight harder for a more intense treatment as compared to . So I think that's, in a very significant proportion of patients and on a global scale, premenopausal patients are, as a matter of fact, the majority of all breast cancer patients, which we sometimes tend to overlook in the western world. But in Asian countries, South America, premenopausal breast cancer is the mainstay of breast cancer. So for many patients around the world, this can be important information.
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