CSCO 2014：Massimo Cristofanilli：抗癌，我们在一起

ASCO-CSCO Joint Symposium

Subject: New Targeted Therapy Breast Cance(r 08:30~12:00, September 18,1D Meeting Room)

Dr. Massimo Cristofanilli (Co-Chair, Thomas Jefferson University, USA)

ASCO is interested in promoting quali⁃ ty and affordable cancer care globally. Moreover, prevention and early detection strategies would be of extreme value in the design of future strategies. This topic is par⁃ ticularly relevant in emerging economies such as China and India. Moreover, early indicators forecast a dramatic increase in the incidence of the most common malig⁃ nancies in these countries with significant challenges for the health systems. ASCO and CSCO need to collaborate in promoting healthy lifestyle, evaluating and implement⁃ ing novel, cost-effective screening strate⁃gies and measure quality of multidisci⁃ plinary treatments.

Breast cancer research contributed dramatically to the improvements in pre⁃ vention, adjuvant and management of meta⁃ static breast cancer. Recent studies showed that adjuvant aromatase inhibitors in com⁃ bination with LH-RH agonists for ovarian suppression represent an additional option in the adjuvant setting of premenopausal women with ER + primary breast cancer (Pagani et al, N Engl J Med 2014, 371: 107). HER-2 targeted therapies have im⁃ proved outcome in patients with metastatic disease and novel agents such as pertuzum⁃ ab (Baselga J et al, N Engl J Med 2012, 366:109) and TDM-1 (Verma S et al, N Engl J Med 2012, 367:1783) have been ap⁃ proved by the FDA providing additional op⁃ tions for patients with this aggressive dis⁃ ease. Combining HER-2 targeted therapiesappears to increase pathological response in neoadjuvant setting (Gianni L Lancet On⁃ cology 2012, 13:25) but such combinations lack impact on survival in adjuvant setting (Piccard-Gebhart et al, ASCO 2014). These data have raised issues with regard to the value of the neoadjuvant model in predicting survival. We are looking forward to more mature data of the I-SPY2 trial testing multiple targeted therapies in com⁃ bination with chemotherapy in primary breast cancer. The study also incorporates molecular diagnostic tests such as mamma⁃ print and protein array testing. This area of molecular diagnostics is likely going to change the way we evaluate and select treatments for patients in primary and meta⁃ static setting.

Over the years it has been shown that multicenter, international studies are possi⁃ ble and contribute significantly to the vali⁃dation of efficacy across race and ethnicity. Such studies require significant organiza⁃ tional structure and monitoring. There is no question that clinical research is tightly reg⁃ ulated in the US and we need to make sure similar standards are maintained in all par⁃ ticipating institutions. The process of pa⁃ tient selection, education, consent, treat⁃ ment, evaluation and monitoring needs careful coordination and reporting. Toxicity for a specific agent can vary and cultural in⁃ fluence that could play a role in adherence to the protocol should be considered for each patient. We look forward to increase the opportunities for working on the design and implementation of prospective studies addressing not only standard endpoints of efficacy and toxicity but also evaluating a therapeutic agent in a different cultural re⁃ ality. For example what is the preference in terms of oral vs. intravenous treatment?

Today, oncology is a global problem and we should approach it from an interna⁃ tional perspective. We need to provide edu⁃ cational opportunities for physicians abroad and develop tools for patients that not only speak a different language but have a unique and different perspective on their disease.