Dr. Gatti-Mays Provides Important Breast Cancer Insights at Oncology Brothers Advancements in Oncology Event

The Oncology Brothers Advancements in Oncology event, held on Saturday, June 1, took place on the second day of the 2024 American Society of Clinical Oncology Annual Meeting, the most significant gathering of oncology professionals worldwide.

Advancements in Oncology featured a panel of some of the brightest minds in cancer research. Co-hosts Rohit Gosain, MD, and Rahul Gosain, MD, MBA, known collectively as The Oncology Brothers, and the panelists explored the latest data on breast, gastrointestinal, genitourinary, and lung cancers. They also covered breakthroughs in cancer care, with the aim of enhancing the practice of all attendees.

The first panelist of the night, Margaret Gatti-Mays, MD, MPH, of the Ohio State University Comprehensive Cancer Center, provided invaluable insights on breast cancer, beginning with hormone receptor-positive disease.

“With hormone receptor-positive disease in the early-stage setting, we proceed with surgery, and then the treatment depends on the Oncotype DX score, which is further divided into whether we need to give chemotherapy or not give chemotherapy,” said Dr. Rohit Gosain. “The tricky part is the perimenopausal era.” He proceeded to ask Dr. Gatti-Mays if chemotherapy should be administered based on hormonal status.

“I think this is a great topic to start off on because it’s about as clear as mud, as they say,” Dr. Gatti-Mays noted. “Obviously, one of our goals, especially in the early breast cancer setting, is to make sure that we are treating our patients but not over-treating them. The use of Oncotype DX has really helped identify those patients who benefit from chemo and those who do not benefit from chemo. But there’s a large group in between where it’s not quite clear what the benefit is.”

Expounding on the topic of hormonal status, Dr. Gatti-Mays noted that patients who are postmenopausal can have Oncotype DX scores of up to 25 or up to 3 lymph nodes, and they would not need chemotherapy. “However, in the premenopausal patients, based on the RxPONDER data, those who have positive lymph nodes would benefit from chemotherapy at this point,” Dr. Gatti-Mays said.

She went on to discuss newer data that are coming out, focused specifically on patients who might not fit into the trial criteria of being under 50 years of age and premenopausal. “As we all know, sometimes self-report of menopausal status is not quite clear,” Dr. Gatti-Mays said. “We also know that sometimes age may not necessarily determine menopausal status. The average age of menopause in the United States is about 51. But in many of the TAILORx and RxPONDER patients, we use 50 as a cutoff. Historically, we’ve been using estradiol, LH, FSH. And again, there’s not quite clear guidance in terms of what to do.”

Specifically, in discussing the RxPONDER subgroup analysis, Dr. Gatti-Mays expressed excitement around the findings. “I eagerly await the data that are going to be coming out, using a cutoff of 10 for [that patient population]. In patients who have an AMH level greater than 10, it seems that they do benefit from chemotherapy. Hopefully, in those patients where the AMH level is actually less than 10, we may be able to spare them chemotherapy.”

Dr. Rahul Gosain noted that it’s “very important for us in the community to appreciate who we are over-treating. And let’s make sure we’re not under-treating. Moving that population from over-treating to the right segment is what we’re looking for.”

Dr. Gatti-Mays echoed those sentiments, saying, “Exactly. I think that this has come up in many discussions of RxPONDER in the past, where it seems that those premenopausal patients in the age range of 40 to 50, it’s not quite clear whether or not the benefit has truly been from chemotherapy or if it’s been from the ovarian suppression that’s induced by the chemotherapy. Hopefully this will provide a little bit more data to help guide that treatment decision.”