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News Forum: Breast Cancer Management
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Each meeting of experts in breast cancer brings fresh, exciting information on the risks, epidemiology, diagnosis, and treatment of the disease. Among many important subjects covered during these pivotal meetings over the past 12 months were the role of genetics in the development and growth of breast cancer, new findings on the best chemotherapeutic combinations to target particular tumor receptors and types of lesions, and innovations in the multimodality treatment of all stages of breast cancer.
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Surgery is the cornerstone of early breast cancer treatment. However, the best technique to resect malignant tissue remains a topic of controversy. Mastectomy still is widely used, yet breast-conserving surgery continues to be refined. Continued research into less invasive surgical methods to remove breast lesions will impart better cure rates and cosmetic results.
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Beginning with the development of paclitaxel years ago, taxanes have shown tremendous promise in the adjuvant treatment of early breast cancer. Use of these drugs with pharmaceuticals of other classes, including monoclonal antibodies, is improving outcomes in women with node-positive disease and those who overexpress HER2. Combined-modality treatment also is increasing success against early breast cancer; radiotherapy has lowered recurrence rates and improved mortality in various studies. Further research on genetic predisposition to various types of breast cancer will help clinicians to individualize chemotherapeutic regimens.
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The Study of Tamoxifen and Raloxifene (STAR) trial provided important information about the ability of adjuvant hormonal therapy to prevent different types of breast cancer in high-risk postmenopausal women. In other research, substituting an aromatase inhibitor for tamoxifen after several years of therapy reduced the risk of relapse and death in women diagnosed with early breast cancer; further, starting prophylactic therapy with an aromatase inhibitor reduced the early spread and relapse of the disease when compared with tamoxifen. Adverse effects related to hormonal therapy are important considerations when prescribing these drugs.
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The choice of first-line therapy for advanced breast cancer more frequently involves taxanes used in different formulations, dosing regimens, and combinations with drugs of other classes. Effective drug combinations for advanced breast cancer include paclitaxel or docetaxel given with such drugs as capecitabine, epirubicin, and gemcitabine. More recently, monoclonal antibodies have been added to taxane therapy to treat HER2-positive breast cancer. Interestingly, different nab-paclitaxel dosing regimens have yielded markedly different response rates.
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Tyrosine kinase inhibitors, monoclonal antibodies, and other targeted drugs are revolutionizing the treatment of breast cancer. When used with drugs of other classes, targeted therapies improve results in patients with inflammatory breast cancer and certain types of metastatic disease. As they learn more about the genetics of breast cancer and markers of breast tumors, clinical investigators may devise more individualized treatment for patients diagnosed with malignancies of all stages.
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Breast cancer cannot be treated unless it is found—and cutting-edge information on imaging techniques to detect breast cancer can save lives. The guidelines for using magnetic resonance imaging to diagnose breast cancer have changed—and various groups have reported on the utility of elasticity imaging software for ultrasound, digital mammography, dual-headed cadmium-zinc-telluride gamma camera imaging, computer-aided methods to interpret routine mammograms, and other technological advances in detecting and assessing breast lesions.
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Breast cancer may develop in anyone—but vast amounts of information on factors that predispose people to the disease continue to be uncovered. Recent reports discussed links between preventing the disease and vitamin intake, working habits, consumption of certain foods, performance of gynecologic surgery, and use of preventive vaccines. In addition, laboratory studies of investigational drug combinations showed promise in preventing certain tumors in mice and suggested that breast cancer may have roots in viral infection.
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Breast cancer is a disease of the body, but this condition also has profound effects on the psyche of affected patients. Cognitive therapy, relaxation techniques used alone and with structured attention/empathy approaches, and videotapes of patients discussing their lives and cancer experiences all have helped breast cancer patients to cope with their disease.
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Thankfully, all the research into breast cancer is paying off. Recently presented data showed a lower incidence of invasive breast cancer among certain patient groups in recent years; these findings may be the result of a dramatic drop in hormone replacement therapy use. Further, fewer women apparently are dying from breast cancer; in particular, a smaller number of patients having estrogen-receptor-negative tumors have succumbed to the disease.
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Supported by educational grants from
Genentech, Inc.
Supported by an unrestricted educational grant from
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