Nadia Harbeck
LMU Breast Center, Munich, Germany
Professor Nadia Harbeck, MD, is Breast Center Director at LMU University Hospital, Munich, Germany. She obtained her specialist degree (OB&GYN) at the Technical University of Munich (TUM) and her medical degree from the Ludwig-Maximilians University (LMU) of Munich.
She is ESMO Director of Education and Subject Editor of the ESMO Breast Cancer Guidelines. Prof. Harbeck is member of the German AGO breast cancer guideline committee (www.ago-online.de) and co-director of the West German Study Group (www.wsg-online.com). From 2009-2015, she served on the EORTC Executive Board. She is PI or SC member of numerous breast cancer trials with novel targeted compounds or individualized treatment strategies and co-developer of CANKADO, an international digital patient diary (www.cankado.com).
Professor Harbeck is one of the most frequently cited clinical researchers worldwide (Highly Cited Researcher 2021,2022). She has authored more than 650 papers in peer-reviewed journals (h-index 95) and is editor-in-chief of Breast Care (Karger). She is co-director of the annual Methods in Clinical Cancer Research Workshop (MCCR) and panel member of several international breast cancer consensus conferences.
Professor Harbeck is recipient of the 2023 German Cancer Award and the 2020 ESMO Lifetime Achievement Award. She also received several additional recognitions of her clinical and translational research such as the 2021 UPO Award for Women in Academy and Research, the 2015 Bavarian Cancer Patient Award, the 2012 Claudia von Schilling Award, the 2008 EBCC Award, the 2002 AGO Schmidt-Matthiesen Award, a 2001 AACR Award, and the 2001 ASCO Fellowship Merit Award for the highest ranking abstract.
Use of Ki67 and Oncotype prior to surgery to avoid chemotherapy (ADAPT programme)
In HR+ HER2- early breast cancer, the question whether chemotherapy is needed in addition to endocrine therapy (ET) is key. In patients with < 3 involved lymph nodes (LN), gene expression assays (GEA) help to estimate risk of recurrence more accurately than clinic-pathological factors. In postmenopausal patients < 3LN, prospective clinical trials (e.g. TAILOR X, RxPONDER, MINDACT) have shown that chemotherapy can safely be omitted in low-risk tumors by GEA. However, in premenopausal patients < 3LN, uncertainty remains whether different GEA cut-offs are needed or whether N+ patients derive small benefit from chemotherapy even if low-risk by GEA.
The ADAPT program builds on the pioneering work from the POETIC trialists and their prior translational research and combines GEA and short preoperative ET. Endocrine response is defined as Ki67 of < 10% (surgical specimen) after 3-4 weeks of preoperative ET. In ADAPT (n=2290), patients with < 3 LN, endocrine responsive tumors and an Oncotype DX recurrence score < 25 were able to forgo chemotherapy and had excellent 5y dDFS of about 97%, independent of menopausal status. Thus, combining endocrine response assessment and GEA results leads to more patients being safely spared chemotherapy than using GEA alone. Optimal preoperative ET with an endocrine response probability of 70-80% consists of 2-4 weeks of AI in postmenopausal and 4 weeks of GnRH +AI in premenopausal patients. ADAPTcycle (n=1670 randomized) is evaluating whether chemotherapy can be replaced by CDK 4/6i + ET in intermediate risk patients according to GEA and endocrine response assessment.
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