Highlights

“It [Abraxane] is so easy to give. Women tolerate it so well. It works pretty good, it doesn’t work all the time, it works pretty well, and the patients don’t get so fatigued, they don’t have side effects, they don’t need premeds, and they rarely need to be boosted for white cells decrease. Whereas in the Eribulin, you know they’re gonna be coming back. It’s a pretty easy drug to give. Patients tolerate it fairly well… I use it [Abraxane] as first line and I go back to it. Even if I have somebody that progresses, if they’ve been off of it for a while, I will often even go back to it.”

“It’s [Eribulin] a pretty easy drug to give. The data looked good in that you can use it in patients that already had Taxanes. It’s pretty tolerable. The only disadvantage I see is that it does cause a lot of neutropenia. Every patient I’ve ever treated has to get boosted with Neupogen. Since it’s a drug that’s given on a weekly basis, they’ve got to be coming back every day for Neupogen for some time. It causes an awful lot of fatigue.”

“That [Eribulin] tends to be my next go-to drug after Abraxane if they have progressed through Abraxane. I usually put people on Eribulin. Ixempra is a drug that’s trying to distinguish itself saying that they do better in a triple-negative population. I haven’t really used that drug for a while because it has a lot of side effects associated with it.”

“If I have a triple-negative that’s metastatic, I’ll send their samples out [for next –gen sequencing]. The markers have been interesting that I’ve been getting back, but they’re not actionable such as increased EGFR. I have nothing that I can treat the patient with. I think maybe with next-gen sequencing, we’re going to be able to get more markers and different drugs…ASCO has their program that’s supposed to be starting this year. NCI, I think, has their match program that’s supposed to be starting this year. Hopefully, patients such as this patient of mine who expired unfortunately, maybe I would be able to get her Cytoxan at off-label.”

“When I send my patients for next-gen sequencing, they test for androgen receptors. I’ve never gotten one of my triple-negatives to express one. Again, your big centers are probably going to see it. I had almost done a study. It never really took off. Looking at the ER positive patients, thinking that you always have positive androgen receptors, but you don’t. Now they’re finding them in triple-negative breast cancers which is kind of interesting. Now you have another hormonal treatment for these women, albeit prostate cancer drugs. They did present some data in San Antonio with Enzalutamide.”

“I think that it’s [PD-1 inhibitors] a different mechanism that we’re going to be able to, hopefully, get some better responses out of these patients. Just have a more novel way of being able to treat the patients. I think that immunotherapy is going to be something that’s going to be really big.”

“I do [see a role for PARP inhibitors in triple-negative cancer]. Particularly in those BRCA mutations, because then you can get your double hit. The biology between the DNA makes sense if you can tag on a platinum and a PARP inhibitor or a PARP inhibitor in those mutation carriers makes most sense. Yes, I do, because what else do we have?”

“I don’t know if it’s going to happen in the next five years, but I think it would be really great if we could sequence these people before we even start treating them, and if we’re able to find any of these markers. If you have someone who is expressing androgen receptor, that you’re able to put them on the appropriate care. Or say if the PD-1 marker comes out to be positive then they just go right on to their immunotherapy. I think that kind of personalized medicine is the future. Look as this company NantKwest started by Dr. Patrick Soon-Shiong. I think this whole immunotherapy is probably what’s going to be taking over the whole market, and particularly in triple-negative because we have no other targets.”