Treatment Advances in Breast Cancer with Dr. Richard Lee

So the first thing that I wanted to talk to you about, and this is something that we've been doing for a few years now, but, but really is becoming more solidified, and that's ovarian function suppression.

And, uh, for the listeners, essentially what that is, is for a woman who is premenopausal, we are using medications to render them essentially postmenopausal, pharmacologically postmenopausal, as a strategy, uh, to improve the efficacy of their anti-endocrine therapy.

Uh, data, soft trial, text trials, um, now have, uh, more mature data coming out showing that there is an advantage to the strategy.

So, you know, Rich, if you could sort of describe to me which patients you're considering for OFS and how you're utilizing it in your practice and what, what your thoughts are on, on sort of that landscape.

Yeah, sure.

So, you know, ovarian suppression, a-as you mentioned, Tom, I'm usually using that and considering that for patients.

So these are all patients with early-stage breast cancer that are, um, hormone receptor-positive, which we, you know, we've defined as being estrogen or progesterone, uh, receptor-positive.

So, you know, the decision really in those premenopausal patients is whether to add suppression of the ovaries, because if you think about it, in premenopausal patients, uh, the main source of your estrogen, and hence, um, really the thing that would feed a growing estrogen-dependent breast cancer, the estrogen is coming from the ovaries.

So the idea of basically shutting down the ovaries and putting a premenopausal patient into a premature menopause, um, really is a, a strategy which we use now in many patients.

Um, you know, I'm generally considering for premenopausal patients, um, uh, an ovarian function suppression strategy in those who are generally higher risk.

So when we look at patients, um, and, you know, how do we define high risk, um, in, in ER-positive breast cancer patients who are premenopausal? You know, it's, it's usually patients who are younger.

So we know from clinical studies, um, you know, it's particularly young patients diagnosed with ER-positive breast cancer, so younger than age thirty-five.

Um, patients who have sort of more, uh, high risk, uh, features such as high-grade cancers, you know, grade three, um, other prognostic factors such as lymph node positive, uh, positive, uh, breast cancer, so breast cancer where it's spread to the lymph nodes.

Those are patients who are considered high risk.

Now, we know from some clinical studies, you know, a surrogate measure for high risk for patients, let's say, who will have been deemed to require chemotherapy after their surgery to lower the risk of recurrence.

Um, so all of those factors are sort of the things that we take into consideration when, you know, we're thinking about should we shut down somebody's ovaries in addition to giving them anti-estrogen treatment.

So make either medications that, uh, generally block the estrogen receptor or-

Yeah.

-additionally reduce the circulating estrogen even in a postmenopausal state.

Yeah.

So these are patients that you would, uh, traditionally consider for chemotherapy, then therefore, they also fall into the category of somebody that should have more aggressive endocrine therapy-

Yeah.

-if I'm, if I'm hearing you correctly.

Yes.

That, that is correct.

So the first thing that I wanted to talk to you about, and this is something that we've been doing for a few years now, but, but really is becoming more solidified, and that's ovarian function suppression.

And, uh, for the listeners, essentially what that is, is for a woman who is premenopausal, we are using medications to render them essentially postmenopausal, pharmacologically postmenopausal, as a strategy, uh, to improve the efficacy of their anti-endocrine therapy.

Uh, data, soft trial, text trials, um, now have, uh, more mature data coming out showing that there is an advantage to the strategy.

So, you know, Rich, if you could sort of describe to me which patients you're considering for OFS and how you're utilizing it in your practice and what, what your thoughts are on, on sort of that landscape.

Yeah, sure.

So, you know, ovarian suppression, a-as you mentioned, Tom, I'm usually using that and considering that for patients.

So these are all patients with early-stage breast cancer that are, um, hormone receptor-positive, which we, you know, we've defined as being estrogen or progesterone, uh, receptor-positive.

So, you know, the decision really in those premenopausal patients is whether to add suppression of the ovaries, because if you think about it, in premenopausal patients, uh, the main source of your estrogen, and hence, um, really the thing that would feed a growing estrogen-dependent breast cancer, the estrogen is coming from the ovaries.

So the idea of basically shutting down the ovaries and putting a premenopausal patient into a premature menopause, um, really is a, a strategy which we use now in many patients.

Um, you know, I'm generally considering for premenopausal patients, um, uh, an ovarian function suppression strategy in those who are generally higher risk.

So when we look at patients, um, and, you know, how do we define high risk, um, in, in ER-positive breast cancer patients who are premenopausal? You know, it's, it's usually patients who are younger.

So we know from clinical studies, um, you know, it's particularly young patients diagnosed with ER-positive breast cancer, so younger than age thirty-five.

Um, patients who have sort of more, uh, high risk, uh, features such as high-grade cancers, you know, grade three, um, other prognostic factors such as lymph node positive, uh, positive, uh, breast cancer, so breast cancer where it's spread to the lymph nodes.

Those are patients who are considered high risk.

Now, we know from some clinical studies, you know, a surrogate measure for high risk for patients, let's say, who will have been deemed to require chemotherapy after their surgery to lower the risk of recurrence.

Um, so all of those factors are sort of the things that we take into consideration when, you know, we're thinking about should we shut down somebody's ovaries in addition to giving them anti-estrogen treatment.

So make either medications that, uh, generally block the estrogen receptor or-

Yeah.

-additionally reduce the circulating estrogen even in a postmenopausal state.

Yeah.

So these are patients that you would, uh, traditionally consider for chemotherapy, then therefore, they also fall into the category of somebody that should have more aggressive endocrine therapy-

Yeah.

-if I'm, if I'm hearing you correctly.

Yes.

That, that is correct.