Breast Cancer

The spectrum of CD30+ lymphoproliferative diseases of the skin includes CD30+ cutaneous anaplastic large cell lymphoma, lymphomatoid papulosis, as well as borderline cases. These entities constitute the second most common group of cutaneous lymphomas according to the newly revised World Health Organization and European Organisation for Research and Treatment of Cancer consensus classification. Recent progress in immune and molecular biology, and identification of therapeutic targets have increased our understanding of these diseases and have led to novel treatment approaches. This review will provide an update on recent findings of immunologic, molecular, cytogenetic features and treatment strategies for patients with CD30+ lympho-proliferative diseases.

Inflammatory breast cancer (IBC) is a rare and aggressive form of the disease. It is diagnosed based on clinical signs of a rapidly enlarging, tender, erythematous, edematous breast that often presents without an underlying breast mass. IBC historically was considered a uniformly fatal disease. With the advent of multimodality treatments including primary systemic chemotherapy, surgery, and radiation therapy, approximately one-third of women diagnosed with IBC will become long-term survivors. This review examines the limitations of the current definition of IBC, explores our current understanding of the biology of IBC, and reviews the many exciting advances in locoregional and systemic treatment of IBC.

In 1995, it is projected that there will be 183,400 new cases of breast cancer and 46,240 deaths from the disease, despite an emphasis on early detection [1]. Fewer than 10% of patients will present with metastatic disease, but nearly 50% of newly diagnosed patients may eventually develop it. Unfortunately, advanced breast cancer is incurable. In a classic study of untreated patients, the median survival was 2.7 years from the onset of symptoms [2].

Ms. B is a 44-year-old married African-American female who was diagnosed with locally advanced right breast cancer in 2002. Immunohistochemistry in the original tumor was estrogen- and progesterone-receptor-negative, HER2-positive. Her past medical history is significant for hypertension and miscarriage in 1995.

BH is a 54-year-old white, married female with a health history significant for depression at the time of breast cancer diagnosis. She was scheduled for a routine bilateral mammogram in the summer of 2001. Following an abnormal mammogram of the right breast, BH was referred for an excisional biopsy, which was performed in July 2001.

Tykerb (lapatinib, GlaxoSmithKline) has received US Food and Drug Administration approval in combination with Xeloda (capecitabine, Roche) for the treatment of locally advanced or metastatic breast cancer in patients whose tumors over-express the HER2 receptor and who have previously received other cancer drugs, including an anthracycline, a taxane, and trastuzumab (Herceptin).

A computerized mail and phone reminder program managed by appointment secretaries significantly increased the percentage of patients undergoing annual mammography at the Mayo Clinic

Baylor College of Medicine investigators believe they have identified a key reason for breast cancer relapses after chemotherapy.

A new study shows that recent declines in breast cancer mortality rates have been most significant among women with estrogen-receptor (ER)-positive tumors and women younger than age 70

A home-grown molecular breast imaging system using a dual-headed cadmium-zinc-telluride (CZT) gamma camera was highly sensitive in detecting breast tumors less than 10 mm in size in a preliminary study of 100 patients with confirmed breast cancer.

Magnetic resonance imaging (MRI) of the contralateral breast in 969 women newly diagnosed with cancer in one breast detected 30 (3.1%) contralateral breast cancers that were missed by mammography and clinical breast exam at the time of diagnosis.

A chemotherapy regimen that is both dose dense and dose intense significantly improved relapse-free and overall survival

The combination of trastuzumab (Herceptin) and bevacizumab (Avastin) as first-line treatment of metastatic breast cancer showed promising results in the first phase II study to evaluate this regimen.

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Several issues raised in the article by Cianfrocca and Wolff and the accompanying reviews in the January issue of ONCOLOGY (21:63-80, 2007) deserve further comment. First, all authors address American resource-rich patient populations only. According to data from Parkin et al, nearly two-thirds of all new cases of breast cancer globally (a total of 1 million cases) occur among poor women. Half of these (500,000 cases) are in premenopausal women with hormone-receptor-positive tumors.[1] We need to broaden our horizons to consider these much larger populations whenever we discuss breast cancer therapies.

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Investigational vaccines to prevent breast cancer recurrence are showing promise in small clinical trials

A large proportion of human breast cancers may be associated with the human mammary tumor virus (HMTV), which is nearly identical to the murine mammary tumor virus (MMTV) that is implicated in breast cancer in mice.

A mobile mammography unit that links a digital mammography system with a commercial satellite service provides near real-time interpretation of breast imaging scans to Native American women on remote rural reservations

Two groups of researchers have separately concluded that use of Herceptin (trastuzumab) in combination with standard anthracycline-based chemotherapy is cost effective as adjuvant therapy for early-stage HER2-positive breast cancer

Proliferating macrophages (promacs) in invasive breast tumors predict worse outcomes and are particularly frequent in breast cancers from women in West Africa

Ultrasound-guided placement of a balloon catheter for partial breast brachytherapy can be safely delayed until after the final pathology report has confirmed that the patient is a candidate for the procedure, according to a new study.

Long-term (median, 51 months) follow-up data from the Breast International Group (BIG) I-98 trial support earlier findings that the aromatase inhibitor letrozole (Femara) is more effective than tamoxifen as initial postsurgery therapy for early breast cancer

A planned interimanalysis of a phase II internationalstudy of first-line nab-paclitaxel(Abraxane) vs docetaxel (Taxotere) inchemonaive patients with stage IV breastcancer shows nab-paclitaxel yielded longerprogression-free survival (PFS) at alldose levels tested.