Breast Cancer

ROCKVILLE, Maryland-The US Preventive Services Task Force (USPSTF) has recommended against the use of tamoxifen (Nolvadex) and raloxifene (Evista) for the primary prevention of breast cancer in women at low or moderate risk

Women with early-stage breast cancer treated with a docetaxel (Taxotere)-based regimen after surgery had a 32% less chance of developing disease recurrence than did women receiving one of the most effective adjuvant treatments currently available. Results from the Breast Cancer International Research Group (BCIRG) trial 001, the first phase III trial to evaluate docetaxel after breast surgery, were presented at the recent annual meeting of the American Society of Clinical Oncology (ASCO) by the BCIRG.

ORLANDO-The concept of sentinel lymph node biopsy as an alternative to axillary node dissection appears to be applicable and useful in breast cancer patients after neoadjuvant chemotherapy, according to an analysis from protocol B-27

BETHESDA, Maryland-Researchers abruptly halted a prevention trial of estrogen/ progestin in healthy menopausal women after an independent monitoring committee found a 26% increase in invasive breast cancer among women taking the hormone replacement therapy (HRT). The committee also found that the HRT group had a greater risk of coronary heart disease, stroke, and pulmonary embolism than the placebo group.

Rubinstein and colleagues provide an excellent review of mathematical models for estimating breast cancer risk, including the risk of carrying inherited mutations of BRCA1 and BRCA2. Since we and others reviewed early models to predict the likelihood of inherited susceptibility to breast cancer,[1] newer quantitative tools, most notably by Parmigiani and colleagues,[2] have been developed. These models have been made available on CD-ROM, over the Internet, and in other electronic versions that are accessible to most clinicians and researchers. These quantitative resources constitute useful and important aids in genetic counseling.

Breast and ovarian carcinomas pose major public health problems in most Western countries. Countless attempts have been made to better understand a patient’s lifetime risk of breast cancer. The most significant etiologic risk is increasing age, followed by family history. In addition, hormonal and reproductive factors-ie, early menarche and later age at menopause, nulliparity (and, therefore, a greater number of ovulations over the patient’s lifetime), and late age at first pregnancy (greater than age 30 years)-also increase a patient’s breast cancer risk.

Women at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]

LOS ANGELES-A large German multicenter study has shown that sentinel lymph node (SLN) biopsy for breast cancer accurately predicts the status of the axillary lymph node. In addition, the study found that physician experience and the choice of lymphography technique-blue dye or scintigraphy-influence the detection rate significantly.

MANHASSET, New York-Early clinical results suggest that capecitabine (Xeloda) may work well in several new combinations for metastatic breast cancer, according to Daniel R. Budman, MD, professor of medicine at New York University and associate director of medical oncology at North Shore University Hospital, Manhasset, New York

NANTES, France-Results of a large phase II European trial validate the antitumor activity of capecitabine (Xeloda) in metastatic breast cancer and present a strong rationale for its use earlier in the disease course, said Pierre Fumoleau, MD,

ORLANDO-With an ever-expanding list of active agents for metastatic breast cancer and even more potential combinations, choosing the best therapy for each patient can be a challenge, according to Clifford Hudis, MD, chief of the

LONDON-Intermittent dosing with R115777 (tipifarnib, also known as Zarnestra) is equally effective as continuous dosing in advanced breast cancer patients, but has significantly less hematologic toxicity, according to a study presented at the American Society of Clinical Oncology 38th annual meeting (ASCO abstract 138).

ALBUQUERQUE, New Mexico-Carboplatin (Paraplatin), vinorelbine (Navelbine), and capecitabine (Xeloda) given in combination to patients with anthracycline- and taxane-pretreated metastatic breast cancer appears active and well tolerated, according to an interim analysis reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 1960).

SEOUL, Korea-Use of capecitabine (Xeloda) plus vinorelbine (Navelbine) is effective in metastatic breast cancer patients previously treated with anthracycline and taxane drugs, according to preliminary data from a phase II study. The study

PALO ALTO, California-Treatment with oral chemotherapy for metastatic breast cancer showed promising efficacy with minimal toxicity and warrants further investigation, according to results of a phase I trial conducted at Stanford University.

ORLANDO-Adding capecitabine (Xeloda) to docetaxel (Taxotere) (XT) significantly improves response rates, time to progression, and overall survival, compared with docetaxel alone in patients with metastatic breast cancer, according to results of a phase III study of the combination.

BARCELONA, Spain-In patients with metastatic breast cancer, weekly dosing with docetaxel (Taxotere) appears to provide benefits equal to those of every-3-week dosing, according to results of a multicenter, randomized, European phase II

JACKSONVILLE, Florida-An encouraging study reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 206) suggests that irinotecan (CPT-11, Camptosar) may prove valuable in advanced breast cancer.

MAYWOOD, Illinois-A novel fixed-dose schedule of uracil/tegafur (UFT) plus leucovorin (UFT/LV, also known as Orzel, investigational) achieved significant disease stabilization in advanced breast cancer, according to a phase II multicenter study reported at ASCO (abstract 240).

The addition of paclitaxel before surgery to primary systemic therapy with doxorubicin, followed by CMF

ORLANDO-Data from a massive pathologic reanalysis of breast cancer patients with apparently negative lymph nodes show that women with occult micrometastases have shorter disease-free survival and are more likely to die from breast cancer than are women whose nodes are negative on immunohistochemistry.

LOS ANGELES-Early data from a Breast Cancer International Research Group (BCIRG) study showed that docetaxel (Taxotere)-based combination therapy was significantly more effective than standard FAC (fluorouracil/doxorubicin

SAN FRANCISCO-Insulin resistance, as determined by C-peptide levels, appears to be linked to increased breast cancer risk, Celia Byrne, PhD, said at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 1179). In a study of 1,226 women, those who developed breast cancer were more likely than controls to have elevated concentrations of C-peptide, considered an indication of insulin secretion.

HOUSTON-Weekly paclitaxel (Taxol) as part of a primary systemic chemotherapy regimen for operable breast cancer improves pathologic complete remission rates when compared with every 3-week paclitaxel therapy, according to results of a prospective phase III trial (ASCO abstract 135).

WASHINGTON-Uninsured Americans confront a greater likelihood of poorer health and premature death than those with private medical and hospital coverage, a committee of the National Academy of Sciences’ Institute of Medicine (IOM) has concluded.