Highlights

Identifying patients who need additional therapies, particularly in HR+/HER2- where there is a lot of therapy use without clear benefit, certainly in early breast cancer. Identifying resistance pathways more clearly is still an area that needs considerable work. How best to sequence therapies is an area that needs an enormous amount of work. And, obviously, particularly in HR+/HER2-, tumor dormancy and drivers for that, and identifying what may be the optimal time for treatment is important. In HER2+ breast cancer, treatments have become very effective, particularly in early breast cancer, one of the challenges is trying to optimize treatment for individual patients, so personalized medicine, to reduce unnecessary exposure to treatment and allow patients to continue to get on with their lives without therapy. So, something that’s often called de-escalation, there are some trials in that area.

The majority of patients who should be getting systemic therapy upfront are not getting systemic therapy upfront, and patients are going to surgery when they should be having drug therapy first. A lot of hospitals are not able to cope with doing clinical trials, they don’t offer patients new therapies, they just follow pathways that are established without thinking about the needs of the patients.