Day 3 in San Antonio, 2022

After the marathon day yesterday, we got a slower start to the day today. A calm port in the storm of the conference activity is the Patient Advocacy Lounge sponsored by Eli Lilly, which gives those of us who need a break some down time and a place to connect with other patient advocates. Starting our day in a place just for us has made it easier the last few years. Following breakfast and assisting (just a little) with the set up at the SurvivingBreastCancer.org booth, I attended more sessions on Her2 low and a rather intense review session on immunotherapy and the role of the T-cells in treating tumors.

Amazingly enough, this is my fifth (5th) year attending the San Antonio Breast Cancer Symposium (SABCS) with one virtual attendance and four in person. I’ve learned to space out the learning opportunities with time connecting with other advocates and to prioritize attending the sessions that are focused on those of us living with MBC. One such educational opportunity is the Hot Topic Mentor sessions organized by the Alamo Breast Cancer Foundation (ABCF), which is typically held each evening and features trusted medical professionals sharing what they see as the significant developments presented that day.

This first hot topic mentor session today was presented by Dr. Bisi Ademuyiwa, Dr. Jenny Chang, Dr. Mariana Chavez, and Dr. Alastair Thompson. I took a LOT of notes and will summarize the developments below that they highlighted. I anticipate writing about each evening until the end of the conference and below is a graphic with some of the pre-recorded discussions accessible through registering at their website.

The discussion this evening first focused on the prevention of the data from the Destiny 02 and Destiny 03 clinical trials. These are the trials that have brought us trastuzumab deruxtecan a/k/a Enhertu, which has been getting a whole lot of attention lately. With each subsequent trial iteration, more and more information is understood about this Adjuvant Drug Conjugate (ADC) and applicability to treat various MBC subtypes. Subsequent work will be looking at use in the early stage setting as well as getting closer to understanding more specifics of when Enhertu should be utilized.

What we seem to know so far is that Enhertu is most effective in the treatment of Her2+ cancer and can also be helpful for people with some Her2 expression, now known as Her2 low; at the same time, figuring out which patients would benefit is still somewhat murky. During one of the sessions I attended during the day, a pathologist presented information on how his profession will have to innovate to be able to meet the need to know who has low or even ultra low Her2 expression.

The discussion this evening then moved from medical oncology into surgical oncology and addressed some concepts presented today about limiting surgical intervention, especially with regard to lymph nodes. Since lymph node dissection has become prevalent, with many associated long term debilitating affects, this is great news for patients. There was also a session on DCIS, also known as stage 0, about rebranding in order to right-size treatment versus over treatment. An interesting concept that will alleviate the experiences of many patients.

The third mentor suggested that we pay close attention to the studies looking at racial disparities from every angle because we desperately need to know why our black and brown brothers and sisters often have far worse outcomes. Many different researchers are attempting to get to the bottom of this serious issue without clear answers. Could perhaps part of the explanation be within the tumor microenvironment (or as Dr. Love calls it, the tumor’s neighborhood)? A question we really do need to answer and sooner rather than later.

The final mentor reviewed much of what I’ve included about Her2 low and how the ADCs above are in the process of changing perspectives, treatment choices, and improving outcomes for patients with breast cancer. The results relevant to Her2 low are in the Destiny 04 trial, the results of which are definitely a hot topic at this conference and likely for quite a while.

Stay tuned for more information tomorrow …