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width="1.25rem" xmlns="http://www.w3.org/2000/svg"><polyline points="6 9 6 2 18 2 18 9"></polyline><path d="M6 18H4a2 2 0 0 1-2-2v-5a2 2 0 0 1 2-2h16a2 2 0 0 1 2 2v5a2 2 0 0 1-2 2h-2"></path><rect x="6" y="14" width="12" height="8"></rect></svg></a></button></div></div><div><div class="flex flex-wrap"><p class=" text-primary font-semibold">Commentary</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1"></div><p class=" text-primary font-semibold">Video</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1 "></div><time class="text-gray-500 " dateTime="2024-11-11T15:00:00.000">November 11, 2024</time></div><h1 class="text-[26px] font-medium leading-8">Future Breast Cancer Treatments: A Focus on SIRDs, Biomarkers</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/cameron-santoro">Cameron Santoro</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Future Breast Cancer Treatments: A Focus on SIRDs, Biomarkers" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" 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lg:items-center lg:justify-end"><div class="related-landing sm:w-auto md:max-w-fit lg:w-[auto] md:text-center my-2 md:my-0 p-0 sm:px-4"><a class="" href="/partners/us-oncology-network"><div class="relative max-w-[300px]"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%27262.3666666666667%27%20height=%2751%27/%3e"/></span><img src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" class="shrink-0" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4c487c84faffb9c415baa61497e29cc2d9b429d4-926x180.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=384&q=75 1x, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4c487c84faffb9c415baa61497e29cc2d9b429d4-926x180.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 2x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4c487c84faffb9c415baa61497e29cc2d9b429d4-926x180.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a></div></div><p class="py-2 mb-2 text-sm italic text-gray-600">Mabel Mardones, MD, Rocky Mountain Cancer Centers, discusses the future of HR+/HER2– breast cancer treatment, focusing on the importance of biomarkers and the potential of SIRDs to improve patient outcomes.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2">Mabel Mardones, MD, board-certified medical oncologist and hematologist with an advanced subspecialty in <a target="_blank" href="https://www.ajmc.com/compendium/breast-cancer">breast cancer</a> at Rocky Mountain Cancer Centers, led a discussion on new treatments for HR+/HER2– breast cancer at the <a target="_blank" href="https://www.ajmc.com/ivbmevents?display=home">Denver Regional Institute for Value-Based Medicine<sup class="text-inherit">®</sup></a>.<br/></p><p class="pb-2">Mardones highlighted in an interview with <em>The American Journal of Managed Care</em>® the growing issue of drug resistance in HR+/HER2– breast cancer. She emphasized the need for biomarkers to identify patients who could benefit from more aggressive therapies, such as triplet therapy. She also discussed the promising potential of selective estrogen receptor degraders (SIRDs), which may replace aromatase inhibitors as the standard of care due to their superior efficacy and reduced side effects.</p><p class="pb-2"></p><p class="pb-2"><em>This transcript was lightly edited for clarity.</em></p><p class="pb-2"><em></em></p><p class="pb-2"><strong><span style="text-decoration:underline">Transcript</span></strong></p><p class="pb-2"><strong><span style="text-decoration:underline"></span></strong></p><p class="pb-2"><strong>How are researchers addressing the challenges of drug resistance and recurrence in HR+/HER2- breast cancer?</strong><br/></p><p class="pb-2">With the <a target="_blank" href="https://www.ajmc.com/view/fda-approves-inavolisib-in-locally-advanced-metastatic-breast-cancer">inavolisib approval</a>, there's the concept that, obviously, many patients are, in fact, endocrine-resistant and will become endocrine-resistant. This is not likely early on in the course of their treatment, but likely somewhere around years 5 through 10 or beyond. These are patients who metastasize and are resistant to an aromatase inhibitor.</p><p class="pb-2"></p><p class="pb-2">I think that being forward thinkers and thinking ahead of the menu of choices we already have and using biomarkers like this trial did. The <a rel="nofollow noreferrer noopener" target="_blank" href="https://medlineplus.gov/genetics/gene/pik3ca/">PIK3CA</a> patients that progress on aromatase inhibitors within a year are the patients that are going to get a triplet therapy, so escalate therapy in those [patients] who are truly endocrine resistant.</p><p class="pb-2"></p><p class="pb-2">There are a lot of challenges in sequencing that still remain today that I think are not answered. I think we have a lot of choices out but then we're left with "How do we choose one agent over another?" I think that speaks to the testament of how quickly the FDA is approving these agents, the clinical trials, and how robust they have been, but that leaves us in the clinic with challenges. I think biomarkers probably would be my conclusion statement on how to do a better job with resistance.</p><p class="pb-2"></p><p class="pb-2"><strong>In your opinion, what are the most exciting areas of research that may lead to significant breakthroughs in the treatment of HR+/HER2- breast cancer in the next decade?</strong></p><p class="pb-2"></p><p class="pb-2">We have a variety of menus in our current treatment options with the oral SIRDs, selective estrogen receptor degraders. I tell my patients this; we've made it known that SIRDs are superior to our most potent injection, which is faslodex [fulvestrant] in the metastatic setting. There's no reason to believe that SIRDS are not going to be more effective than an aromatase inhibitor.</p><p class="pb-2"></p><p class="pb-2">If we look at just the trajectory of how tamoxifen beat aromatase inhibitors, now we have this new wave of options. I do think that SIRDs will replace aromatase inhibitors probably in the next 10 years, whether that's only in the high-risk population or not is to be determined.</p><p class="pb-2"></p><p class="pb-2">But these are the trials that are now being done in high-risk women and in high-risk women who are switching from an aromatase inhibitor to a SIRD after 2 to 5 years.</p><p class="pb-2"></p><p class="pb-2">Those trials are accruing; they're about to be enrolling in the community, patients who truly represent the patients that we're treating and will be treating ongoingly, and women are incredibly excited to have choices.</p><p class="pb-2"></p><p class="pb-2">I think probably the biggest thing or selling point of these SIRDs is the fact that arthralgias and joint pain, which seems to be probably the top-line concern and number one reason for discontinuation of aromatase inhibitors, is a whole lot less—that we've noted so far. 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PhD, clinical lecturer in respiratory medicine at The University of Manchester" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4aabbee95177fcd39517a945c70aed016dab6005-2814x1554.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=30 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4aabbee95177fcd39517a945c70aed016dab6005-2814x1554.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=30 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4aabbee95177fcd39517a945c70aed016dab6005-2814x1554.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=30 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4aabbee95177fcd39517a945c70aed016dab6005-2814x1554.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=30 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F4aabbee95177fcd39517a945c70aed016dab6005-2814x1554.png%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=30 1200w, 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loading="lazy"/></noscript></span></div><div class="w-full flex-wrap text-center text-sm mt-4 font-light no-underline text-white"></div></a></div></div><div class="relative block sm:hidden"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/6c4eacfe9c992d1f7ea48bbb7606ade7b9a0b9cf-1920x1080.jpg?fit=crop&auto=format" alt="Don M. Benson, MD, PhD, James Cancer Hospital" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent">Balancing Life and Myeloma: A Patient-Centered Approach</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In this second part of our discussion with Don M. Benson, MD, PhD, from our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains how his ultimate goal for his patients is for them to live as long and as well as possible.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/research-priorities-evolve-with-amivantamab-s-broader-nsclc-indications?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/b924e135f2e0564215c00b9b28af5867586299e6-1200x675.jpg?fit=crop&auto=format" alt="Martin Dietrich, MD, PhD" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/research-priorities-evolve-with-amivantamab-s-broader-nsclc-indications?utm_source=www.ajmc.com&utm_medium=relatedContent">Research Priorities Evolve With Amivantamab's Broader NSCLC Indications</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/research-priorities-evolve-with-amivantamab-s-broader-nsclc-indications?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In September, amivantamab (Rybrevant; Johnson & Johnson) received its fourth treatment indication from the FDA to treat non–small cell lung cancer (NSCLC).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/community-investment-engagement-are-essential-to-fully-address-cardiovascular-health-disparities?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e6a6b3083d61a8df9607a840c3e41ba56b38b0c4-2880x1618.png?fit=crop&auto=format" alt="Khadijah Breathett, MD" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 19th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/community-investment-engagement-are-essential-to-fully-address-cardiovascular-health-disparities?utm_source=www.ajmc.com&utm_medium=relatedContent">Community Investment, Engagement Are Essential to Fully Address Cardiovascular Health Disparities</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/community-investment-engagement-are-essential-to-fully-address-cardiovascular-health-disparities?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Community-based researchers can teach clinicians a lot about how to best approach underserved populations disproportionately impacted by cardiovascular health complications. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/kraken-oral-muvalaplin-safely-lowers-lp-a-in-early-stage-trial?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/ba7aefa89bdc1169ec3566ccea614e62d7ac7dff-8192x5461.jpg?fit=crop&auto=format" alt="Blood test | Image: Edward Jenner for Pexels" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 18th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/kraken-oral-muvalaplin-safely-lowers-lp-a-in-early-stage-trial?utm_source=www.ajmc.com&utm_medium=relatedContent">KRAKEN: Oral Muvalaplin Safely Lowers Lp(a) in Early-Stage Trial</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/mary-caffrey">Mary Caffrey</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/kraken-oral-muvalaplin-safely-lowers-lp-a-in-early-stage-trial?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Results bring more competition to treat this genetically driven target for cardiovascular risk.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="relative hidden sm:block"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/6c4eacfe9c992d1f7ea48bbb7606ade7b9a0b9cf-1920x1080.jpg?fit=crop&auto=format" alt="Don M. Benson, MD, PhD, James Cancer Hospital" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent">Balancing Life and Myeloma: A Patient-Centered Approach</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In this second part of our discussion with Don M. Benson, MD, PhD, from our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains how his ultimate goal for his patients is for them to live as long and as well as possible.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/research-priorities-evolve-with-amivantamab-s-broader-nsclc-indications?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/b924e135f2e0564215c00b9b28af5867586299e6-1200x675.jpg?fit=crop&auto=format" alt="Martin Dietrich, MD, PhD" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/research-priorities-evolve-with-amivantamab-s-broader-nsclc-indications?utm_source=www.ajmc.com&utm_medium=relatedContent">Research Priorities Evolve With Amivantamab's Broader NSCLC Indications</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/research-priorities-evolve-with-amivantamab-s-broader-nsclc-indications?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In September, amivantamab (Rybrevant; Johnson & Johnson) received its fourth treatment indication from the FDA to treat non–small cell lung cancer (NSCLC).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/community-investment-engagement-are-essential-to-fully-address-cardiovascular-health-disparities?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e6a6b3083d61a8df9607a840c3e41ba56b38b0c4-2880x1618.png?fit=crop&auto=format" alt="Khadijah Breathett, MD" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 19th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/community-investment-engagement-are-essential-to-fully-address-cardiovascular-health-disparities?utm_source=www.ajmc.com&utm_medium=relatedContent">Community Investment, Engagement Are Essential to Fully Address Cardiovascular Health Disparities</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/community-investment-engagement-are-essential-to-fully-address-cardiovascular-health-disparities?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Community-based researchers can teach clinicians a lot about how to best approach underserved populations disproportionately impacted by cardiovascular health complications. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/kraken-oral-muvalaplin-safely-lowers-lp-a-in-early-stage-trial?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/ba7aefa89bdc1169ec3566ccea614e62d7ac7dff-8192x5461.jpg?fit=crop&auto=format" alt="Blood test | Image: Edward Jenner for Pexels" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 18th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/kraken-oral-muvalaplin-safely-lowers-lp-a-in-early-stage-trial?utm_source=www.ajmc.com&utm_medium=relatedContent">KRAKEN: Oral Muvalaplin Safely Lowers Lp(a) in Early-Stage Trial</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/mary-caffrey">Mary Caffrey</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/kraken-oral-muvalaplin-safely-lowers-lp-a-in-early-stage-trial?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Results bring more competition to treat this genetically driven target for cardiovascular risk.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Future Breast Cancer Treatments: A Focus on SIRDs, Biomarkers","datePublished":"2024-11-11T15:00:00.000Z","dateModified":"2024-11-04T16:17:01Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/2538600dfa3947cc1d35f9d158a64c4e7ab3b624-2834x1614.png?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/future-breast-cancer-treatments-a-focus-on-sirds-biomarkers"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"inavolisib,HR+/HER2–,PIK3CA,FDA,fulvestrant,tamoxifen,aromatase inhibitors,SIRDs","articleBody":"\n\nMabel Mardones, MD, board-certified medical oncologist and hematologist with an advanced subspecialty in breast cancer at Rocky Mountain Cancer Centers, led a discussion on new treatments for HR+/HER2– breast cancer at the Denver Regional Institute for Value-Based Medicine®.\n\n\nMardones highlighted in an interview with The American Journal of Managed Care® the growing issue of drug resistance in HR+/HER2– breast cancer. She emphasized the need for biomarkers to identify patients who could benefit from more aggressive therapies, such as triplet therapy. She also discussed the promising potential of selective estrogen receptor degraders (SIRDs), which may replace aromatase inhibitors as the standard of care due to their superior efficacy and reduced side effects.\n\n\n\nThis transcript was lightly edited for clarity.\n\n\n\nTranscript\n\n\n\nHow are researchers addressing the challenges of drug resistance and recurrence in HR+/HER2- breast cancer?\n\n\nWith the inavolisib approval, there's the concept that, obviously, many patients are, in fact, endocrine-resistant and will become endocrine-resistant. This is not likely early on in the course of their treatment, but likely somewhere around years 5 through 10 or beyond. These are patients who metastasize and are resistant to an aromatase inhibitor.\n\n\n\nI think that being forward thinkers and thinking ahead of the menu of choices we already have and using biomarkers like this trial did. The PIK3CA patients that progress on aromatase inhibitors within a year are the patients that are going to get a triplet therapy, so escalate therapy in those [patients] who are truly endocrine resistant.\n\n\n\nThere are a lot of challenges in sequencing that still remain today that I think are not answered. I think we have a lot of choices out but then we're left with \"How do we choose one agent over another?\" I think that speaks to the testament of how quickly the FDA is approving these agents, the clinical trials, and how robust they have been, but that leaves us in the clinic with challenges. I think biomarkers probably would be my conclusion statement on how to do a better job with resistance.\n\n\n\nIn your opinion, what are the most exciting areas of research that may lead to significant breakthroughs in the treatment of HR+/HER2- breast cancer in the next decade?\n\n\n\nWe have a variety of menus in our current treatment options with the oral SIRDs, selective estrogen receptor degraders. I tell my patients this; we've made it known that SIRDs are superior to our most potent injection, which is faslodex [fulvestrant] in the metastatic setting. There's no reason to believe that SIRDS are not going to be more effective than an aromatase inhibitor.\n\n\n\nIf we look at just the trajectory of how tamoxifen beat aromatase inhibitors, now we have this new wave of options. I do think that SIRDs will replace aromatase inhibitors probably in the next 10 years, whether that's only in the high-risk population or not is to be determined.\n\n\n\nBut these are the trials that are now being done in high-risk women and in high-risk women who are switching from an aromatase inhibitor to a SIRD after 2 to 5 years.\n\n\n\nThose trials are accruing; they're about to be enrolling in the community, patients who truly represent the patients that we're treating and will be treating ongoingly, and women are incredibly excited to have choices.\n\n\n\nI think probably the biggest thing or selling point of these SIRDs is the fact that arthralgias and joint pain, which seems to be probably the top-line concern and number one reason for discontinuation of aromatase inhibitors, is a whole lot less—that we've noted so far. That's been encouraging, and we remain optimistic that, hopefully, the compliance level of adjuvant endocrine therapy will rise as we bring on better choices but less toxic choices as well.","description":"Mabel Mardones, MD, Rocky Mountain Cancer Centers, discusses the future of HR+/HER2– breast cancer treatment, focusing on the importance of biomarkers and the potential of SIRDs to improve patient outcomes.","author":[{"@type":"Person","name":"Cameron Santoro"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div 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She also discussed the promising potential of selective estrogen receptor degraders (SIRDs), which may replace aromatase inhibitors as the standard of care due to their superior efficacy and reduced side effects.","_key":"3df55b7eec162"}],"_type":"block","upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"8c14608d2a15","markDefs":[]},{"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"ca57627aedb6"}],"_type":"block","style":"normal","_key":"7ae221f77943","markDefs":[],"upload_doc":null,"uploadAudio":null},{"_key":"720a75177db5","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_key":"0680d733074a0","_type":"span","marks":["em"],"text":"This transcript was lightly edited for clarity."}],"_type":"block","style":"normal"},{"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"88b988e3a04b","markDefs":[],"children":[{"_key":"189dd60054cc","_type":"span","marks":["em"],"text":""}],"upload_doc":null},{"_key":"598ad4066b01","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"text":"Transcript","_key":"5842a52687740","_type":"span","marks":["strong","underline"]}],"_type":"block","style":"normal"},{"medias":null,"_type":"block","style":"normal","_key":"f5580236957b","markDefs":[],"children":[{"marks":["strong","underline"],"text":"","_key":"455a1820fbd7","_type":"span"}],"upload_doc":null,"uploadAudio":null},{"uploadAudio":null,"medias":null,"style":"normal","_key":"2d06ebbdcf1d","markDefs":[],"children":[{"marks":["strong"],"text":"How are researchers addressing the challenges of drug resistance and recurrence in HR+/HER2- breast cancer?","_key":"23f59ad9b77f0","_type":"span"},{"marks":[],"text":"\n","_key":"14fd722cf57f0","_type":"span"}],"_type":"block","upload_doc":null},{"upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[{"blank":true,"_type":"link","href":"https://www.ajmc.com/view/fda-approves-inavolisib-in-locally-advanced-metastatic-breast-cancer","_key":"4b1f5b12da88"}],"children":[{"_type":"span","marks":[],"text":"With the ","_key":"f4758d3ad69c0"},{"text":"inavolisib approval","_key":"f4758d3ad69c1","_type":"span","marks":["4b1f5b12da88"]},{"marks":[],"text":", there's the concept that, obviously, many patients are, in fact, endocrine-resistant and will become endocrine-resistant. This is not likely early on in the course of their treatment, but likely somewhere around years 5 through 10 or beyond. These are patients who metastasize and are resistant to an aromatase inhibitor.","_key":"f4758d3ad69c2","_type":"span"}],"_type":"block","style":"normal","_key":"71a5d08689ab"},{"markDefs":[],"children":[{"text":"","_key":"390e497e25170","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"7831442b55a7","upload_doc":null,"uploadAudio":null,"medias":null},{"markDefs":[{"_type":"link","href":"https://medlineplus.gov/genetics/gene/pik3ca/","_key":"8150e1d3cd47","nofollow":true,"blank":true}],"children":[{"text":"I think that being forward thinkers and thinking ahead of the menu of choices we already have and using biomarkers like this trial did. The ","_key":"44e3658316ff0","_type":"span","marks":[]},{"_type":"span","marks":["8150e1d3cd47"],"text":"PIK3CA","_key":"44e3658316ff1"},{"_type":"span","marks":[],"text":" patients that progress on aromatase inhibitors within a year are the patients that are going to get a triplet therapy, so escalate therapy in those [patients] who are truly endocrine resistant.","_key":"44e3658316ff2"}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"cebc231237fa"},{"upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_key":"0e3b1f2db2680","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"018f3a98424f"},{"style":"normal","_key":"877ba8185f11","markDefs":[],"children":[{"text":"There are a lot of challenges in sequencing that still remain today that I think are not answered. I think we have a lot of choices out but then we're left with \"How do we choose one agent over another?\" I think that speaks to the testament of how quickly the FDA is approving these agents, the clinical trials, and how robust they have been, but that leaves us in the clinic with challenges. I think biomarkers probably would be my conclusion statement on how to do a better job with resistance.","_key":"0a8ee1340b9d0","_type":"span","marks":[]}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block"},{"_type":"block","style":"normal","_key":"2ae16d96ecc7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e56c8f9b41370"}],"upload_doc":null,"uploadAudio":null,"medias":null},{"_type":"block","style":"normal","_key":"42f01ef033bf","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":["strong"],"text":"In your opinion, what are the most exciting areas of research that may lead to significant breakthroughs in the treatment of HR+/HER2- breast cancer in the next decade?","_key":"09ee36fe776a0"}]},{"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a90cb3d8d9cd0"}],"_type":"block","style":"normal","_key":"431b40871dbf","upload_doc":null},{"uploadAudio":null,"medias":null,"_key":"a408d60c044e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We have a variety of menus in our current treatment options with the oral SIRDs, selective estrogen receptor degraders. I tell my patients this; we've made it known that SIRDs are superior to our most potent injection, which is faslodex [fulvestrant] in the metastatic setting. There's no reason to believe that SIRDS are not going to be more effective than an aromatase inhibitor.","_key":"88acd30695a60"}],"_type":"block","style":"normal","upload_doc":null},{"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"904c0b035270","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4fa5a4d767fe0"}]},{"_type":"block","style":"normal","_key":"7199c7efdae9","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"If we look at just the trajectory of how tamoxifen beat aromatase inhibitors, now we have this new wave of options. I do think that SIRDs will replace aromatase inhibitors probably in the next 10 years, whether that's only in the high-risk population or not is to be determined.","_key":"c53e0fc688e10"}]},{"style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"318b19c145bd","markDefs":[],"children":[{"_key":"2689492cf0d70","_type":"span","marks":[],"text":""}],"_type":"block"},{"uploadAudio":null,"medias":null,"style":"normal","_key":"10f584b6ed67","markDefs":[],"children":[{"_type":"span","marks":[],"text":"But these are the trials that are now being done in high-risk women and in high-risk women who are switching from an aromatase inhibitor to a SIRD after 2 to 5 years.","_key":"8a3dfa12ecb80"}],"_type":"block","upload_doc":null},{"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"71dbed488baa0"}],"_type":"block","style":"normal","_key":"c571bd904800","markDefs":[],"upload_doc":null,"uploadAudio":null},{"medias":null,"children":[{"_type":"span","marks":[],"text":"Those trials are accruing; they're about to be enrolling in the community, patients who truly represent the patients that we're treating and will be treating ongoingly, and women are incredibly excited to have choices.","_key":"087607adf4820"}],"_type":"block","style":"normal","_key":"7fc74c120042","markDefs":[],"upload_doc":null,"uploadAudio":null},{"style":"normal","_key":"4567e1f70ebd","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6f5c926b6b000"}],"_type":"block"},{"_type":"block","style":"normal","_key":"de8752e3704d","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think probably the biggest thing or selling point of these SIRDs is the fact that arthralgias and joint pain, which seems to be probably the top-line concern and number one reason for discontinuation of aromatase inhibitors, is a whole lot less—that we've noted so far. That's been encouraging, and we remain optimistic that, hopefully, the compliance level of adjuvant endocrine therapy will rise as we bring on better choices but less toxic choices as well.","_key":"b796f00ee4bb0"}]}],"_rev":"IlIq0JCGGmrvSiDduj3Az3","articleType":"Commentary","contentGroup":null,"factCheckAuthorMapping":null,"authorMapping":[{"firstName":"Cameron","displayName":"Cameron Santoro","_createdAt":"2023-11-22T18:35:06Z","_rev":"sgy4yN0CjmArmRDnE2KiNm","_type":"author","_id":"232836b2-a7d6-4cdd-8d7e-65ab104eaf06","profileImage":{"_type":"mainImage","alt":"Cameron Santoro","asset":{"_ref":"image-6ae51a61642a5ecba7cf4085fe97e68814e3c917-430x430-png","_type":"reference"}},"lastName":"Santoro","biography":[{"style":"normal","_key":"3da8fced8696","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Cameron Santoro is an associate editor for ","_key":"93662c5c4cfd"},{"_key":"213c257c1eca","_type":"span","marks":["em"],"text":"The American Journal of Managed Care"},{"_key":"f546acb0aa91","_type":"span","marks":["superscript"],"text":"®"},{"_type":"span","marks":[],"text":" (","_key":"acd931edd707"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"843f7d4e787d"},{"marks":["superscript"],"text":"®","_key":"7c809e803edb","_type":"span"},{"_type":"span","marks":[],"text":"), AJMC.com, and The Center for Biosimilars","_key":"35b69a01dbbe"},{"_type":"span","marks":["superscript"],"text":"®","_key":"8ddca200bc46"},{"marks":[],"text":".","_key":"ba3cca6122e3","_type":"span"}],"_type":"block"}],"_updatedAt":"2024-05-20T19:28:22Z","url":{"current":"cameron-santoro","_type":"slug"}}],"_type":"article","_createdAt":"2024-11-01T19:21:20Z","_id":"8408d3e0-9804-4aa6-a21e-8724a6e34ff4","filter":null,"disableAds":false,"disableRelatedContent":false,"relatedArticles":[{"_createdAt":"2024-11-20T21:38:58Z","thumbnail":{"asset":{"_ref":"image-6c4eacfe9c992d1f7ea48bbb7606ade7b9a0b9cf-1920x1080-jpg","_type":"reference"},"_type":"mainImage","alt":"Don M. 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Benson, MD, PHD, The Ohio State University Comprehensive Cancer Center, who moderated the ","_key":"2592f014ca730"},{"_key":"0af77768d6e5","_type":"span","marks":["5a0178e4c1ba"],"text":"multiple myeloma"},{"text":" panel discussion at our recent Institute for Value-Based Medicine","_key":"cf217c02123f","_type":"span","marks":[]},{"text":"®","_key":"f4ec3272c8b3","_type":"span","marks":["superscript"]},{"_key":"81972df0b58e","_type":"span","marks":[],"text":" event in Cleveland, Ohio, he explains what are his top priorities for his patients throughout their treatment journey for multiple myeloma and how caring for them is a true partnership."}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"8c1ad11449210"}],"_type":"block","style":"normal","_key":"462a4228e945","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"As a hematologist-oncologist, Benson has cared for patients at James Cancer Hospital for 22 years, where he strives to enable his patients to live as long and as well as possible, he explains in this clip.","_key":"9449e83194530"}],"_type":"block","style":"normal","_key":"22febbd0ab00"},{"_key":"3de47787d4c5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"638191e129540"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"“We make it work,” he says, “and that's amazing because, again, we didn't do that 20 years ago.\"","_key":"cc994e6256690"}],"_type":"block","style":"normal","_key":"046ca8e6eaef","markDefs":[]},{"_type":"block","style":"normal","_key":"bc9deeee28b0","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"80c96e0d37ef0"}]},{"_key":"130d0899d593","markDefs":[],"children":[{"_type":"span","marks":["em"],"text":"The transcript has been lightly edited for clarity.","_key":"37ebafbb69890"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"6510ab3f88b00","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"38a76c774d84"},{"style":"normal","_key":"eff4cdd2ca8c","markDefs":[],"children":[{"text":"Transcript","_key":"c419739049240","_type":"span","marks":["strong","underline"]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b8634f56af260"}],"_type":"block","style":"normal","_key":"a6d1ef38925d"},{"_key":"2d601c3ed554","markDefs":[],"children":[{"text":"What factors should guide the choice between traditional transplant options and newer immunotherapy approaches for newly diagnosed or relapsed disease?","_key":"e7fe88b227810","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"055f18a117ef","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"141e674a7a2e0"}]},{"_type":"block","style":"normal","_key":"a1c302885f65","markDefs":[],"children":[{"marks":[],"text":"When I meet somebody with myeloma, my goal is for them to live as long as possible and as well as possible. Leaving the complexities aside for a second, the principal goal of induction treatment is to alleviate suffering, get symptoms under control, get the disease in remission. I tell my patients, we're going to play offense, we're going to take the ball. We're playing offense, and the goal is a complete remission. The goal is to get you back to life before you heard those words that you have myeloma.","_key":"98a12fa87f160","_type":"span"}]},{"_type":"block","style":"normal","_key":"b87ccab950ce","markDefs":[],"children":[{"text":"","_key":"e5122cc087dd0","_type":"span","marks":[]}]},{"_type":"block","style":"normal","_key":"4fa1f2e9a11a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We’re blessed. We can achieve that now for the vast majority of people within a few months.The challenge really isn't getting the disease under control nowadays, it's doing it in a way to minimize toxicities, minimize side effects, even down to things like time. How long are you in the clinic? How long are you away from your life? These are things that we never would have thought of 20 years ago. So I think starting with principles and then moving forward, once the disease is in remission.","_key":"903297a2544e0"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"d68b2f25f9270"}],"_type":"block","style":"normal","_key":"350f7d4b1a54","markDefs":[]},{"_key":"0e3a9819924f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We talk a little bit about this shared decision-making model of, we have a panoply of options available. What makes sense for you with your myeloma right now? Realizing that that answer might be different 2 years from now or 5 years from now. But what can we do right now to stay on our true north, that I want you to live as long as possible and as well as possible. And for some people, that's a transplant.For some people, that's maybe a CAR [chimeric antigen receptor] T cell. 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","_key":"e7f5faf8a2970","_type":"span","marks":[]},{"_type":"span","marks":["4d69bbd233df"],"text":"I mentioned","_key":"e7f5faf8a2971"},{"_type":"span","marks":[],"text":" the indication in first-line EGFR exon 19 and 21 in MARIPOSA, first-line EGFR exon 20 in PAPILLON, the post progression in MARIPOSA-2, as well as the CHRYSALIS [NCT02609776] data that had the single-agent indication for EGFR exon 20. So it really tells you that it captures all of the difficult intracellular kinase domain processes that are not as easily approachable by a tyrosine kinase small molecule.","_key":"e7f5faf8a2972"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"e0b26f99564f0"}],"_type":"block","style":"normal","_key":"5e5afe9e6d20","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We are seeing, obviously, still concerns about durability. We're still learning about overall survival.Those trials, while they've had very good initial results, are still maturing. We're still trying to see the optimal sequence and trying to refine which patient benefits the most from these therapies. Are there patients that are fine with monotherapy alone? Whenever we add additional therapy combinations, we always expect an increase in side effects.","_key":"f16e085683b70"}],"_type":"block","style":"normal","_key":"2b7e279d11d7"},{"style":"normal","_key":"765819e017d3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7ae22fd46fd40"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"So we're still learning a lot about the biomarker space, and there's still a lot of improvements and tailoring that can be made for patients to really optimize outcomes. Prospectively, I'm excited about these lessons. I think it has been a priority to take the lessons from MARIPOSA and MARIPOSA-2 back into new clinical trial designs that help us refine the way we give the medication—both in frequency and application route—expecting a subcutaneous injection over the intravenous route that we're currently using.I think we'll be seeing additional insight and protocols with regards to management of skin toxicities.","_key":"eb55346cf0df0"}],"_type":"block","style":"normal","_key":"6ffb276f5c11"},{"style":"normal","_key":"9c83a597786d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"19862b2906240"}],"_type":"block"},{"_key":"070cc569aa37","markDefs":[],"children":[{"_key":"ddca81f3a3e90","_type":"span","marks":[],"text":"So there is more to be learned, and I think that's always the beautiful part of a clinical trial. It is a lesson that answers as many questions as it poses, and so a continuous driver, if we take it on, as a continuous learning lesson."}],"_type":"block","style":"normal"},{"_key":"700c12972b3d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"69e774ada1430"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"And then prospectively, obviously, a side of amivantamab that we haven't really tackled in our discussion at all is, obviously, we know that CMET is an escape mechanism for post progression on an EGFR TKI in the first-line setting, but CMET plays a role individually in non–small cell lung cancer as well, both through amplification and through intercellular kinase domain alterations, including the MET exon 14 skipping mutation that essentially leads to a decreased turnover on the intracellular side and a decrease in protein reduction by ubiquitous retention.So I think there's still a lot more development to be seen with the amivantamab molecule.","_key":"ba5fb1a7a7140"}],"_type":"block","style":"normal","_key":"8dcf7b70af2c"},{"_type":"block","style":"normal","_key":"8f4e9f23fec9","markDefs":[],"children":[{"_key":"c8a6fc73965d0","_type":"span","marks":[],"text":""}]},{"_key":"037371594a7d","markDefs":[],"children":[{"marks":[],"text":"Unfortunately, even though patients are doing better, we're still in the process of now resorting our thoughts not only with regards to who do we select what first-line therapy for, but also what are we going to do when a patient progresses? What therapies do we use in the first line, and then how would this influence second- and third-line treatment for our patients? So always good to have new options, but the complexity is getting higher and higher. It used to be sort of a 1-drug space, and that has certainly been augmented broadly with these new approvals.","_key":"62b0b7304c4c0","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"e97476c23f25","markDefs":[],"children":[{"marks":[],"text":"","_key":"d010cca02ffd0","_type":"span"}]},{"style":"normal","_key":"f6f92fd5785a","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Can you discuss what should be research priorities moving forward in patients with ","_key":"91d795b73c180"},{"_type":"span","marks":["strong","em"],"text":"EGFR","_key":"920412dab374"},{"_type":"span","marks":["strong"],"text":"-mutated NSCLC?","_key":"0a6beb5e14a7"}],"_type":"block"},{"style":"normal","_key":"9e3518565d3c","markDefs":[],"children":[{"_key":"e04087742cc50","_type":"span","marks":[],"text":""}],"_type":"block"},{"style":"normal","_key":"6d938dccf93e","markDefs":[],"children":[{"marks":[],"text":"In this scenario, we're talking about really the complexity of the ","_key":"8af98d05f5550","_type":"span"},{"_type":"span","marks":["em"],"text":"EGFR","_key":"8af98d05f5551"},{"_key":"8af98d05f5552","_type":"span","marks":[],"text":" mutation family, and we are having mutations in exon 18, 19, 20, and 21. And while MARIPOSA addresses mutations in exon 19 and 21, the specifically referenced regimen, the PAPILLON regimen, references mutations in EGFR exon 20. It's a very difficult-to-treat subset where we had very limited success obtaining small molecule inhibitors that would mimic the response pattern that we've seen in exon 19 and 21."}],"_type":"block"},{"markDefs":[],"children":[{"_key":"c66b028fb1df0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"e48388703169"},{"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.takeda.com/newsroom/newsreleases/2023/takeda-provides-update-on-exkivity-mobocertinib/","_key":"11f99a973a94"}],"children":[{"marks":[],"text":"So, it's the same receptor, similar mutations, but clinically very, very difficult to treat. And we were having 2 options for treatment in the second-line setting for EGFR exon 20: amivantamab as a monotherapy based on the CHRYSALIS study, and we had for a brief period of time also mobocertinib as a targeted therapy—that has been ","_key":"ee4188dc6dad0","_type":"span"},{"marks":["11f99a973a94"],"text":"removed by the FDA","_key":"ee4188dc6dad1","_type":"span"},{"_key":"ee4188dc6dad2","_type":"span","marks":[],"text":". But now we've seen the results of the PAPILLON study, where we combine chemotherapy as the previous first-line standard of care in the EGFR exon 20 population, and adding amivantamab, and we're seeing a doubling in the progression-free survival."}],"_type":"block","style":"normal","_key":"f147d2cd254b"},{"children":[{"_type":"span","marks":[],"text":"","_key":"b0cfddf9ee6c0"}],"_type":"block","style":"normal","_key":"8c291b875db5","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"We're seeing very nice and deep responses, with about 60% response rates in this subgroup. This adds to the reach of amivantamab by basically overcoming any intracellular kinase domain alterations by tackling the EGFR receptor from the extracellular side. So, it shows the versatility of the agent, basically reaching any EGFR alteration in this subset of treatment.","_key":"e3146a5b22220"}],"_type":"block","style":"normal","_key":"3bb53c19e4da","markDefs":[]},{"style":"normal","_key":"e4333dee49b0","markDefs":[],"children":[{"text":"","_key":"8aa6eeb80fff0","_type":"span","marks":[]}],"_type":"block"},{"children":[{"marks":[],"text":"We've seen some data published also for the atypical mutations. And again, agnostically and biologically, there's absolutely no reason why amivantamab wouldn't be helpful in this subset, so we're using it. 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One: we definitely need to include the community. In my own work, I've focused on developing a patient and stakeholder community advisory board that's national that we use to develop ideas, to understand what the problems are, to develop the strategies, using actually implementation science frameworks, to then attempt to deploy in studies to fix some of these major disparities that are facing our nation, particularly in the way that we deliver cardiovascular care.","_key":"b45fa4389fd30"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"6ff65949ab96","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"93233c8ae9680"}]},{"children":[{"_type":"span","marks":[],"text":"I think there's a greater focus on that now, on community-based research, community-based participatory research as well. I think one of the major benefits that have happened over the past couple years is that some of the large funding organizations also recognize that this is important, and have made this a major requirement to compete for some of these large awards.","_key":"14aa778aa0150"}],"_type":"block","style":"normal","_key":"27278cc791c5","markDefs":[]},{"_key":"12129dcedb91","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"bf078adc498e0"}],"_type":"block","style":"normal"},{"children":[{"text":"We have to include the community as we're moving forward to address these problems of disparities in cardiovascular disease. It's devastating underrepresented populations, and it's only projected to worsen over the next several decades.","_key":"eb7ef1c359ac0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c0777f824464","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"2bf946af1018"}],"_type":"block","style":"normal","_key":"3ee20bb44013","markDefs":[]},{"style":"normal","_key":"d8cbf8228c96","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Can you speak to the value of community engagement? What strategies have you found are the most effective for building trust and optimizing engagement within communities impacted by cardiovascular health disparities?","_key":"b9b01b8739d60"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"9e6890c5d5840"}],"_type":"block","style":"normal","_key":"c131b477784f","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"We know you have to belong to the community and invest in the community to develop those appropriate relationships and identify \"what does the community need?\" so that we can again work collaboratively together to meet those needs. And so for me, personally, it's really important just in terms of who I am to belong to my faith community, to my church, and so that's a natural community I already belong to. And I use those different communities to also work on the some of the research that I do. As I've lived in many different places over the past couple decades, I've developed relationships with individuals that also care about these things, with community members and also those may have an academic position as well to figure out, how can we do things differently, how can we think outside of the box of what is considered the status quo, to do things differently. ","_key":"284c523b98fc0","_type":"span"}],"_type":"block","style":"normal","_key":"a4ef3961385e"},{"style":"normal","_key":"c23ed1a6a7fc","markDefs":[],"children":[{"_key":"ec6fbb4daa0b","_type":"span","marks":[],"text":""}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I had a study called the CEASe study that was actually funded through the HRSA [Health Resources and Services Administration] to identify how to improve cardiovascular care delivery in an inpatient setting. And we looked at population data nationwide, statewide, to understand what are the differences in care, particularly in regards to something called the segregation index, to understand the likelihood that a patient will receive care from a cardiologist, or whether they'll receive care from a group of people that vary based upon the race of the actual patient, and how does that impact their care. We've had a lot of complex findings. Some are still under review with respective journals, so I can't completely share all of what we found, but there were some interesting, significant findings that need to be addressed further. ","_key":"a9dacfd6ca57"}],"_type":"block","style":"normal","_key":"4c958ae61d98"},{"_type":"block","style":"normal","_key":"309709c995b2","markDefs":[{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/conference/acc","_key":"a12354dc2c68"}],"children":[{"_type":"span","marks":[],"text":"And so we presented this data to our national patient stakeholder advisory board, and then discussed what were the next steps. And some of the next steps included actually directly observing patients and health care team members over the course of the day, watching what the interactions were like, and then performing interviews with these individuals to understand what they think are potential issues and what their views are on social determinants of health. And that work is actually also in development in a manuscript form, but one of my mentees actually presented that at","_key":"be240f1f8bd8"},{"marks":["a12354dc2c68"],"text":" the American College of Cardiology","_key":"dbd3d0ad88a9","_type":"span"},{"marks":[],"text":" just earlier this year, and it's formed the basis for another large grant that we have under review to, again, work at addressing that focal cause of improving health care delivery, particularly to minoritized racial/ethnic groups and women.","_key":"d8ec96c85f2c","_type":"span"}]}],"title":"Community Investment, Engagement Are Essential to Fully Address Cardiovascular Health Disparities","authorMapping":[{"lastName":"Munz","displayName":"Kyle Munz","_createdAt":"2023-07-19T18:48:50Z","_type":"author","_id":"30e9dc45-7c46-468b-b88c-40fcb46b4537","profileImage":{"alt":"Kyle Munz","asset":{"_ref":"image-afb5da0a933e7f6f632d76cd52a5bc1c1243fb36-430x430-png","_type":"reference"},"_type":"mainImage"},"url":{"current":"kyle-munz","_type":"slug"},"firstName":"Kyle","_rev":"m9zO7fOEUWAduYt5irO25q","_updatedAt":"2024-05-20T19:25:58Z"}],"documentGroup":{"_id":"conference_aha","_updatedAt":"2024-01-17T16:50:18Z","pixelTrackingCode":null,"_rev":"Sik6IfwDKxX0JgkwgBkqto","_type":"documentGroup","_createdAt":"2020-05-04T23:47:20Z","name":"AHA: American Heart Association Scientific Sessions","identifier":{"_type":"slug","current":"aha"},"parent":{"_type":"documentGroup","parent":null,"_createdAt":"2020-04-03T18:14:34Z","_rev":"4o2kwjzNDJRdyxUiyQV0Zp","_updatedAt":"2022-07-31T01:49:46Z","identifier":{"current":"conference","_type":"slug"},"pixelTrackingCode":{"_ref":"c42e5374-778f-4c0d-9f48-73dc34bb9008","_type":"reference"},"name":"Conference","_id":"a0e8a8bf-62dd-45ed-a1e1-cd1e5e8de6f6"}},"factCheckAuthorMapping":null,"factCheckAuthors":null,"ExcludeFromPubMedXML":false,"taxonomyMapping":[{"_createdAt":"2020-03-30T19:06:53Z","_type":"taxonomy","parent":null,"pixelTrackingCode":null,"identifier":"conference","_rev":"Zzg2CQjl4x3UedGJkY3tyu","name":"Conference","_id":"1862ee25-8e65-4dbe-8fd3-d4c11642b211","_updatedAt":"2022-07-31T01:47:04Z"},{"_updatedAt":"2023-10-30T17:48:32Z","name":"Interviews","_rev":"xqhc4WIQcOa1P2rns6bqkh","_type":"taxonomy","_id":"2d909731-8acf-4e3d-8962-d59b0da85320","identifier":"interviews","_createdAt":"2020-03-30T19:16:54Z","parent":null,"pixelTrackingCode":null,"sortOrder":3},{"name":"News","_updatedAt":"2022-01-19T10:20:16Z","identifier":"news","_createdAt":"2020-03-30T18:05:45Z","_rev":"OU32WOWh4YetHW0RkWbkso","pixelTrackingCode":null,"_type":"taxonomy","_id":"39be7351-bd4c-4e98-82b3-0d675ae4671b","parent":null},{"thumbnail":{"_type":"mainImage","alt":"Logo for the Center on Health Equity \u0026 Access","asset":{"_ref":"image-5f5a1d7609b5e2167e8398bb48c8734b1ba7aca8-800x212-jpg","_type":"reference"}},"identifier":"center-on-health-equity-and-access","parent":{"_rev":"SpZIJtjiAn4ebHE4u6sWYc","_id":"15012229-f713-4f0a-8f82-7667530bb382","_updatedAt":"2021-10-21T10:15:35Z","identifier":"topic","_createdAt":"2020-03-31T14:24:50Z","_type":"taxonomy","name":"Topic","isMainTopic":true,"parent":null},"_createdAt":"2022-11-16T22:15:20Z","_id":"4ee49086-e720-4a65-883e-4efc24de53bb","_rev":"N7mKycgLbGtEq6btkPHYvR","_type":"taxonomy","name":"Center on Health Equity \u0026 Access","usedForRecommendations":false,"summary":[{"disableTextWrap":false,"disableLightBox":true,"_type":"figure","_key":"3b7c1e2bf551","alignment":"left","asset":{"_type":"reference","_ref":"image-5f5a1d7609b5e2167e8398bb48c8734b1ba7aca8-800x212-jpg"},"widthP":70},{"_type":"block","style":"normal","_key":"973bcb0dcce4","markDefs":[],"children":[{"marks":[],"text":"The mission of the Center on Health Equity \u0026 Access is to support improvement of health care delivery and health outcomes due to health disparities by maintaining a content platform focused on education, training, frontline perspectives, and practical application of evidence-based methodologies.","_key":"cdef2f34ef460","_type":"span"}]}],"_updatedAt":"2024-06-12T13:58:15Z","pixelTrackingCode":null}],"_updatedAt":"2024-11-20T16:26:21Z","is_visible":true,"seoTag":["cardiology","cardiovascular","health disparities","community engagement","structural racism"],"summary":"Community-based researchers can teach clinicians a lot about how to best approach underserved populations disproportionately impacted by cardiovascular health complications. 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As commenter Erin D. Michos, MD, MHS, of Johns Hopkins noted at a press briefing, Lp(a) affects about 1 in 5 people worldwide.","_key":"af84dbef009d0"}],"_type":"block","style":"normal","_key":"8e7497e9afef","markDefs":[]},{"widthP":25,"_type":"figure","disableLightBox":true,"disableTextWrap":false,"alignment":"left","_key":"ec6f5abc2305","asset":{"_ref":"image-49789b49f6b5f4766e09e6018b26dbed894a5aa5-293x293-webp","_type":"reference"},"alt":"Erin D. Michos, MD, MHS | Image credit: Johns Hopkins","imgcaption":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Erin D. 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To enroll, patients had to have serum level Lp(a) of at least 175 mmol/L.","_key":"1dbc88ca4ec70"}],"_type":"block","style":"normal","_key":"9b0a95e9f616"},{"_type":"block","style":"normal","_key":"7698f278b894","markDefs":[],"children":[{"text":"In addition, the study team measured how well muvalaplin reduced oxidized phospholipids; Nicholls explained that Lp(a) acts as a “reservoir” for oxidized phospholipids, and “there is a school of thought that this is plays a particular mechanistic role in driving the relationship between Lp(a) and atherosclerotic disease.”","_key":"343cab19bd160","_type":"span","marks":[]}]},{"children":[{"_type":"span","marks":[],"text":"Results showed the study drug significantly reduced oxidized phospholipids as well, he demonstrated. Detailed results showed:","_key":"4298d2c924080"}],"_type":"block","style":"normal","_key":"fb770dd48d6d","markDefs":[]},{"listItem":"bullet","markDefs":[],"children":[{"_key":"50ae2dc60cb40","_type":"span","marks":[],"text":"In the traditional blood test, muvalaplin reduced Lp(a) by 70% compared with placebo, and it reduced Lp(a) by 85.5% in a new test that evaluates “intact” Lp(a) particles, accounting for those particles that might attach to the drug, Nicholls explained."}],"level":1,"_type":"block","style":"normal","_key":"0421f1347029"},{"_type":"block","style":"normal","_key":"df48811cc380","listItem":"bullet","markDefs":[],"children":[{"text":"Treatment with muvalaplin helped 97% of participants to bring Lp(a) levels below 125 nmol/L, as measured by the intact Lp(a) particle test, or about 82% of what they measured with the traditional blood test.","_key":"34603225c0a80","_type":"span","marks":[]}],"level":1},{"_type":"block","style":"normal","_key":"0caafb18f003","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Compared with placebo, muvalaplin lowered ApoB by as much as 16% with no change in high-sensitivity C-reactive protein, which would have indicated heart attack or stroke risk.","_key":"3b1bbf53199b0"}],"level":1},{"listItem":"bullet","markDefs":[],"children":[{"marks":[],"text":"The percentage of serious adverse events was about the same in the placebo arm (6%) as the 10 mg arm (5.9%) , and the percentages were lower in the other arms, with 60 mg at 3.2% and 240 mg at 2.9%.","_key":"d45f4958a39b0","_type":"span"}],"level":1,"_type":"block","style":"normal","_key":"018a55208c87"},{"_key":"58784e3a3041","markDefs":[{"_type":"link","href":"https://jamanetwork.com/journals/jama/fullarticle/2808864","_key":"b75e071adc25"}],"children":[{"_type":"span","marks":[],"text":"Muvalaplin, being developed by Eli Lilly, is the latest of the therapies targeting Lp(a) to generate interest at recent cardiology conferences, but the first that would not require injection. Nicholls said these data follow up on previously reported phase 1 results, which showed a reduction of 65% for muvalaplin compared with placebo using the traditional blood test and ","_key":"9be85e134c930"},{"_type":"span","marks":["b75e071adc25"],"text":"were reported in ","_key":"9be85e134c931"},{"_key":"9be85e134c932","_type":"span","marks":["b75e071adc25","em"],"text":"JAMA"},{"_type":"span","marks":[],"text":" in 2023.","_key":"9be85e134c933"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"ec7a85b03341","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Nicholls emphasized that Lp(a) is a distinct, independent risk factor from others that might be treated by primary care physicians and cardiologists; current recommendations call for adults to be tested at least once in their lifetime to learn whether they have elevated levels. But Michos said right now, even when clinicians know a patient has high Lp(a) there is only so much they can do.","_key":"c95e39f71d1c0"}]},{"_key":"22859e776cc1","markDefs":[],"children":[{"text":"“Our current approach is to take an account to both the patient's global cardiovascular risk—so their other risk—as well as their absolute lipoprotein(a) level.”","_key":"11829c68cea30","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"By contrast, when treating LDL cholesterol, although there are certain thresholds between intermediate and high risk, she said, “it’s really a continuous threshold,” and “we try to treat all their risk factors the best we can, get their LDL as low as possible. But the reason why this is so important is that even in patients who are treated very intensively and get their LDL less than 70 on a statin, having high Lp(a) still carries some independent risks that can't be fully eliminated by our other risk modifying strategies.”","_key":"c392121bd3830"}],"_type":"block","style":"normal","_key":"62e72c6c9b40"},{"style":"normal","_key":"f7b68f6dc9be","markDefs":[{"_type":"link","href":"https://www.ahajournals.org/doi/full/10.1161/ATV.0000000000000147","_key":"2f77f604cf46"}],"children":[{"_type":"span","marks":[],"text":"Black individuals of African descent and South Asian populations frequently have the highest Lp(a) levels, according to the AHA’s 2021 ","_key":"2ef9018d9ebf0"},{"_type":"span","marks":["2f77f604cf46"],"text":"scientific statement","_key":"2ef9018d9ebf1"},{"_type":"span","marks":[],"text":" “Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease.”","_key":"2ef9018d9ebf2"}],"_type":"block"},{"markDefs":[{"_type":"link","href":"https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/familial-hypercholesterolemia-fh","_key":"19491898eadb"}],"children":[{"_key":"f753dd6358a40","_type":"span","marks":[],"text":"Lp(a) levels of 50 mg/dL (125 nmol/L) or higher contribute to clotting and inflammation, and significantly elevate the the risk of heart attack, stroke, peripheral artery disease; the presence of Lp(a) is especially dangerous for those who have existing CVD or a history of "},{"_type":"span","marks":["19491898eadb"],"text":"familial hypercholesterolemia","_key":"f753dd6358a41"},{"_key":"f753dd6358a42","_type":"span","marks":[],"text":"."}],"_type":"block","style":"normal","_key":"1de5a02c7780"},{"_type":"block","style":"normal","_key":"ffa9388f794a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Multiple Lp(a) therapies are under development; those in the later stages include:","_key":"8394187600a20"}]},{"style":"normal","_key":"9e84f6a13e9e","listItem":"bullet","markDefs":[],"children":[{"marks":[],"text":"Pelacarsen, an antisense oligonucleotide given once a month. Developed by Ionis/Novartis, its phase 3 HORIZON outcomes trial is expected to be complete in 2025.","_key":"82ad68c811fd0","_type":"span"}],"level":1,"_type":"block"},{"_type":"block","style":"normal","_key":"b505f2f7a1c1","listItem":"bullet","markDefs":[],"children":[{"marks":[],"text":"Olpasiran, an siRNA therapy given every 3 months. Developed by Amgen, its phase 3 OCEAN(a) outcomes trial is scheduled to be complete in 2027.","_key":"9ce2f6b585570","_type":"span"}],"level":1},{"_key":"e37562c10841","markDefs":[],"children":[{"text":"Nicholls said the next steps for muvalaplin are phase 3 trials and cardiovascular outcomes trials before the therapy could reach the market. But while studies continue, he said, the first step is knowing who are the patients with high levels of Lp(a). “In most countries around the world, Lp(a) testing is not covered by payers. It's largely an out-of-pocket expense to patients, and that presents an enormous barrier. Many of us in the field are advocating strongly to payers around the world to have Lp(a) testing included in prevention—to be covered—because it is an important tool, as Dr. Michos has already suggested, in terms of the way that we assess risk today, in terms of the way that we try to manage established cardiovascular risk factors.","_key":"2a0390b59e69","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_key":"da8deb342bbe","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“These therapies will come to the clinic, and we need to be able to target the right patient to the right therapy.”","_key":"ca4ebd6e1f450"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Reference","_key":"cbff4a386fcb"}],"_type":"block","style":"normal","_key":"b29a3a968d57","markDefs":[]},{"_key":"e18b5bef6c57","markDefs":[],"children":[{"marks":[],"text":"Nicholls SJ, Wei N, Rhodes GM, et al. 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