- Monday 24 June 2019

2019 BIG-NABCG meeting: de-escalating therapies in breast cancer

Intro text: 

Last May, BIG and the North American Breast Cancer Group (NABCG) – a network of major US and Canadian-based research groups supported by the US National Cancer Institute (NCI) – held their annual meeting in Chicago, USA, prior to ASCO 2019.

About 60 world-class cancer researchers – oncologists, radiotherapists, surgeons, statisticians, psychologists, etc. – gathered to brainstorm on the topic of ‘de-escalating systemic adjuvant therapy for breast cancer’, tackling two main challenges: how to develop clinical trials that will, in the future, help doctors better identify which patients will really benefit from adjuvant treatment and which can safely be spared, and how to better involve patients in the design of these de-escalation trials.


<  Dr Piccart and the patient representatives at BIG’s Patient Workshop, Brussels (Belgium), 30 April 2019

In preparation for this important meeting, two patient workshops were organised in April, one in New York and one at BIG Headquarters in Brussels, Belgium. About 20 patient advocates, men and women, were invited to discuss their own experiences as cancer patients and express their thoughts about de-escalation clinical trials. Among the questions asked were what is the level of cancer recurrence risk that patients would be willing to accept in a de-escalation trial, how is the balance between risks and benefits communicated to them and which factors influence their decision to participate in a clinical trial.

At the end of each workshop, patients responded to a survey that probed what factors are taken into account in the decision to participate in clinical trials with de-escalation strategy. Four patients were invited to attend the annual meeting in Chicago to share the workshop conclusions.

Several topics were discussed at the annual BIG-NABCG meeting, including the psychological aspects of treatment de-escalation, the statistical design of such trials, the rationale behind reduction of loco-regional and other adjuvant chemo or endocrine therapies, and what type of biomarkers can be used as tools to facilitate de-escalation trials.

At the end of the meeting, experts agreed that the patient perspective is essential in the development and design of new de-escalation trials. Both BIG and NABCG will work together to increasingly involve patients in future projects.

De-escalating therapies in breast cancer

There is growing concern about the overtreatment of patients with early breast cancer who, according to the current practice, receive additional (adjuvant) treatment after surgery to avoid the risk of cancer recurrence. Indeed, in some cases, this post-surgery treatment might do more harm than good, when we compare the real benefits with the side effects and impact on quality of life.

Several de-escalation trials have emerged on both sides of the Atlantic in recent years, including those aiming to evaluate the utility of genetic tests to characterize the biological profile of tumours and shed more light on their potential aggressiveness. This is the case of the two BIG trials MINDACT and EXPERT, for example.

BIG-NABCG: a long-term international collaboration

BIG and NABCG have been meeting annually since 2005 with the aim of identifying difficult aspects of breast cancer research, focusing on research areas not supported by the pharmaceutical industry, and collaborating to resolve common problems.

This collaboration is made possible by the generosity of the Breast Cancer Research Foundation.