Today, we had the chance to sit down with Dr. José Perez, Breast Cancer Specialist and our MedSIR Oncologist of the Month. Here’s an excerpt from our conversation:
MedSIR (MS): Thanks so much, Dr. Perez, for being with us today. It really is a pleasure for us to interview someone of your talent and passion for the field of Medical Oncology in general and, specifically, Breast Cancer.
José Perez (JP): The pleasure is mine.
MS: Before we jump into the amazing advances currently happening in cancer research, let’s get to know you a little bit better. What brought you to Oncology? When did you realize that you wanted to help in this fight against cancer?
JP: My father was an excellent surgeon. However, I was very uncoordinated (laughs). In addition, I really like internal medicine and at the same time, oncological diseases. For this reason, I decided to do my training in Oncology because it is a specialization that perfectly combines both areas. Moreover, Oncology is growing every day with huge knowledge in molecular cancer biology and the introduction of new therapies that are allowing to improve the outcome of our patients. It is an area of hope and I am a very optimistic person. It is really amazing.
MS: Very interesting! So, today you are currently working in the position of Director of Clinical Research at the Baselga Insitute of Oncology. How did you get there? What were your career steps? Who were the people who most influenced you along the way?
JP: I worked during 11 years at the Vall d´Hebron University Hospital with top oncologists such as Josep Baselga, Josep Tabernero, and Javier Cortes. During my residency, I felt an attraction to breast cancer that led me to finally focus on breast cancer, and more specifically, on HER2-positive breast cancer with a special interest in the development of new therapeutic agents. Later on, I received my PhD with research work regarding the prognostic and therapeutic implications of FGFR in metastatic breast cancer. At this moment, the Baselga Institute of Oncology gave me the opportunity to become the Director of Clinical Research and continuing with a special dedication to breast cancer.
MS: Your specialty is Breast Cancer. What are the most recent advances that have you thinking that we are close to making big steps towards even better outcomes?
JP: We have achieved impressive improvements in all the molecular subtypes, mainly in HER2-positive breast cancer with the introduction of Trastuzumab, Pertuzumab, and T-DM1. We are curing more than 90% of these patients with stage I-II disease in the adjuvant setting, 50% more than prior to the discovery of the HER2 protein. In addition, substantial improvements have been made in the luminal subtype with the use of CDK4/6 inhibitors. Moreover, results with new Pi3K inhibitors are awaiting with great interest. Finally, the triple-negative subtype, which is probably the ugly duckling. I really believe that there are several interesting drugs such as immunotherapy combinations, PARP inhibitors, antiandrogen agents, etc. However, we need to design clinical trials not directed to all triple-negative breast cancers, but to specific subtypes of triple-negative breast cancer. The future is great, because along with this, omics are improving, are cheaper, and are less invasive. Liquid biopsy, for example, will become common procedure in our clinical practice over the next years. The years of truly personalized medicine are not too far away.
MS: Let’s focus more on triple negative breast cancer. What do you think the best strategy is to help these patients in the future? Should we look for more treatable target genes in this population, for example, the androgen receptors? Are there any other potential targets or strategies out there? Why don’t CDK inhibitors work in TNBC; their mechanism of action seems universal, you would think they’d have a role outside of luminal disease.
JP: As I mentioned before, triple-negative disease is very heterogeneous. In my opinion, our big mistake is not to consider this heterogeneity. The main problem is that this subtype comprises around 10-15% of all breast cancers, and if we select specific populations among these patients, the target population is very small and Pharma companies lose interest in looking for new strategies in very tiny populations. Regarding CDK in triple-negative, I really think that they may have a role in the luminal-androgen subtype, probably in combination with anti-androgen agents. We have very interesting preclinical data in this subtype that it is obvious considering the molecular similarities between the luminal subtype and luminal-androgen triple-negative subtype.
MS: You previously mentioned Immunotherapy. Is there a place for it in Breast Cancer? Will it expand and make even bigger steps? What’s next after single-agent PD1/PDL1 inhibitors?
JP: Yes, in fact, our challenge is to discover which patients are more likely to respond to immunotherapy, the best setting, alone or in combination… In my opinion, current data with immunotherapy monotherapy in heavily-pretreated triple-negative breast cancer is disappointing. For this reason, maybe there is an option for immunotherapy alone in first-line in patients with high PD-L1 expression (just like in non-small cell lung cancer) or in combination with chemotherapy irrespective of the PD-L1 status. Another opportunity will be combinatorial strategies and to improve immunological response of cold tumors.
MS: Now, let’s leave the metastatic disease field and touch on early disease. As you mentioned before, it seems like we’ve made great strides and more and more patients are being cured. What’s left for us to improve in terms of neoadjuvant and adjuvant treatment?
JP: The neoadjuvant setting is an ideal setting to improve, because we want to cure our patients, but we also want to maintain their Quality of Life. The neoadjuvant setting is an ideal scenario to descale systemic therapy, to reduce the aggressiveness of loco-regional therapy, and to give a second opportunity to patients with poor initial outcomes.
MS: Lastly, what message of hope would you give to the many breast cancer patients and their families? Will we one day convert Breast Cancer into a chronic disease?
JP: Sure, breast cancer is a very treatable disease. We diagnose more and more in early stages, we know a lot about molecular subtypes, we have better drugs and new therapies, surgery and radiotherapy are also improving… I would personally prefer if we could prevent the disease from ever appearing (maybe one day we will), but it is clear that, considering all types of cancer, being a breast cancer oncologist is a blessing within Oncology, because we really truly have hope to cure our patients. That said, many exciting things are also going on in other other tumor types. Amazing advances have been observed almost everywhere.
MS: Thank you so much, Dr. Perez, for your time. It was really an honor to spend this moment with you.
JP: Thanks to you!