Breast Cancer

CHICAGO-Giving tamoxifen concurrently with adjuvant chemotherapy halves the benefit of the chemohormonal combination compared to giving tamoxifen after completion of chemotherapy in postmenopausal patients with node-positive, hormone-receptor positive breast cancer (ASCO abstract 143). These initial results from North American Breast Intergroup Trial 0100 (INT 0100, SWOG 8814), presented by Kathy S. Albain, MD, are expected to establish a new standard of care for treating breast cancer in postmenopausal women.

Two studies published recently in the Journal of Clinical Oncology showed promising response rates for docetaxel (Taxotere)-based therapy over existing therapies for several types of cancer

Over the past 2 decades, two major trends in the treatment of breast cancer-breast-conserving therapy and neoadjuvant (or preoperative) chemotherapy-have converged to stimulate interest in the use of neoadjuvant chemotherapy to facilitate breast conservation in women presenting with large tumors. After being established as the treatment of choice for locally advanced or inoperable breast cancer, theoretical considerations and the desire to extend breast-conserving therapy to more patients with large tumors have resulted in an increase in the use of neoadjuvant chemotherapy in operable patients. Drs. Green and Hortobagyi have provided us with a comprehensive review of the background and the current state of neoadjuvant chemotherapy for breast cancer.

It is nearly 30 years since the start of clinical trials of adjuvant chemotherapy in patients with operable breast cancer.[1] The rationale for using adjuvant chemotherapy at that time was that surgery and radiotherapy could only control local disease and cure patients who did not already have metastases. Chemotherapy could be used in patients with a poor prognosis to treat undetected micrometastatic disease and thereby reduce the risk of metastatic relapse and death from breast cancer.

Preoperative therapy delivers treatment at the earliest time in a tumor’s natural history. Is it beneficial or harmful? Should it be undertaken? The article by Drs. Green and Hortobagyi brings most aspects of neoadjuvant therapy under one umbrella and poses several key questions.

Adjuvant systemic chemotherapy has been shown to prolong survival in all subsets of patients with breast cancer. In addition, among patients with locally advanced breast cancer, neoadjuvant or preoperative chemotherapy has

In a recent issue of the Journal of the American College of Surgeons (194:648-656, 2002), a collective review led by Monica Morrow, MD, director of the Lynn Sage Comprehensive Breast Center at Northwestern Memorial Hospital in Chicago, presented recommendations on the use of ductal lavage in women at high risk for breast cancer. The article offers guidance on which women are most appropriate for ductal lavage and on how abnormal ductal lavage results should be managed.

Bedford Laboratories announced that it has received approval from the Food and Drug Administration to market pamidronate disodium for injection. The product will be the only liquid version available on the market, and is equivalent to the Novartis pamidronate disodium product (Aredia), a bone resorption inhibitor indicated for the treatment of hypercalcemia associated with malignancy, for Paget’s disease, and for osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma.

SAN FRANCISCO-Increased circulating levels of the protein leptin, which regulates body fat and fat mass, may be a risk factor for postmenopausal breast cancer, according to a presentation at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 2503).

WASHINGTON-A survey of 110 Hispanic women at elevated risk for breast and/or ovarian cancer revealed a high degree of interest in genetic testing but a low level of knowledge about their own objective risk of getting these cancers, Martha P. Martinez, PsyD, said at the American Psychological Association Conference on Enhancing Outcomes in Women’s Health. Dr. Martinez is a voluntary instructor of medicine at the University of Miami School of Medicine.

TAMPA, Florida-Giving suboptimal care, in terms of chemotherapy regimens and dose intensities, is "compromising survival" of elderly patients, according to a report by Julie Meyer, MPH, of a study involving close to 24,000 patients with early stage breast cancer and non-Hodgkin’s lymphoma. Ms. Meyer is a nurse practitioner in the Senior Adult Oncology Program at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida.

ASCO-Although aromatase inhibitors show promise for preventing recurrence following surgery in women with hormone-receptor-positive breast cancer, tamoxifen (Nolvadex) remains the standard of care, according to an evidence-based technology assessment of the aromatase inhibitors, sponsored by the American Society of Clinical Oncology. The ASCO expert panel found that the available data on aromatase inhibitors for this indication do not support routine use outside of clinical trials.

OMAHA-New research shows that some postchemotherapy fatigue in breast cancer patients is the result of disordered sleep and can be relieved by sleep intervention programs. At the 27th Annual Congress of the Oncology Nursing Society, Ann M. Berger, PhD, RN, AOCN, reported promising data from one such program that found that daily activity levels, fatigue, and quality of sleep all improved in cancer patients who went through a sleep intervention program. Dr. Berger is associate professor and advanced practice nurse at the University of Nebraska College of Nursing in Omaha.

BALTIMORE-New research indicates that exercise can play a significant role in combating fatigue related to cancer treatment and the accompanying loss of function fatigue brings, according to Victoria Mock, DNSc, RN. Dr. Mock is the American Cancer Society Professor of Oncology Nursing at Johns Hopkins School of Nursing and Director of Nursing Research Center at the Sidney Kimmel Comprehensive Center at Johns Hopkins in Baltimore.

The US Food and Drug Administration (FDA) has granted approval to AstraZeneca’s new breast cancer drug fulvestrant (Faslodex) for treatment of hormone-receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy, with, for example, tamoxifen. Fulvestrant is an estrogen-receptor antagonist without known agonist effects. It is the only estrogen-receptor antagonist to be proven effective after tamoxifen failure.

WILMINGTON, Delaware-The US Food and Drug Administration has granted approval to AstraZeneca’s breast cancer drug Faslodex (fulvestrant) Injection for treatment of hormone-receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy, such as tamoxifen (Nolvadex). Faslodex is a selective estrogen-receptor antagonist without known agonist effects.

Adjuvant chemotherapy is an integral component of the multidisciplinary curative treatment of primary breast cancers. The experience of the last 3 decades indicates that anthracycline-containing regimens provide the most effective cytotoxic treatment for this purpose.

Several clinical trials have explored the efficacy of docetaxel (Taxotere) as primary chemotherapy for breast cancer. Docetaxel has been evaluated as single-agent therapy, sequentially as a single agent following anthracycline-containing regimens, and in combination with anthracyclines, cisplatin, and trastuzumab (Herceptin) in patients with high-risk early breast cancer.

Docetaxel (Taxotere) has been intensively investigated for the treatment of metastatic breast cancer, where it has proved to be one of the most active agents. Initial phase II studies in anthracycline-resistant metastatic breast cancer demonstrated impressive response rates that have been confirmed in phase III randomized trials.

WASHINGTON-Medicare will soon cover image guidance techniques, such as stereotactic systems and ultrasound, used to biopsy palpable breast lesions that are difficult to biopsy with palpitation alone. However, contractors who administer Medicare benefits "have the discretion to decide what types of palpable lesions are difficult to biopsy using palpitation," the Centers for Medicare and Medicaid Services said. The new coverage will begin later this year and will not be retroactive. Medicare has covered image guidance to assist the biopsy of nonpalpable lesions since 1999.

The US Food and Drug Administration (FDA) has granted a 6-month priority review status to the supplemental new drug application filed by the AstraZeneca corporation for the use of anastrozole (Arimidex) in the adjuvant treatment of early breast cancer in postmenopausal women.

SAN ANTONIO-In the treatment of breast cancer, cardiomyopathy has represented a possible barrier to the use of trastuzumab (Herceptin) in the adjuvant setting. But a study by the Eastern Cooperative Oncology Group (ECOG) now suggests the risk is small when trastuzumab is combined with paclitaxel (Taxol), and, for the most part, cardiac changes are reversible.

A substantial minority of the women who see themselves as being at high risk for breast cancer because of family history suffer noticeable depressive symptoms and anxiety, and the anxiety can interfere with compliance with recommendations on breast self-examination (BSE), according to studies at the UCLA Revlon Breast Center.

HOLLYWOOD, Florida-The 2002 National Comprehensive Cancer Network (NCCN) breast cancer treatment guidelines include a number of important updates regarding the use of aromatase inhibitors, leuteinizing hormone-releasing hormone (LHRH) agonists, and sentinel lymph node biopsy. Robert W. Carlson, MD, chair of the NCCN Breast Cancer Panel, presented the guidelines at the Seventh Annual NCCN Conference.

Investigators recently reported the results of a study suggesting the benefits of identifying subgroups of breast cancer patients at high risk for hospitalization due to febrile neutropenia. Once identified, granulocyte colony-stimulating factor (G-CSF, Neupogen) might be administered prophylactically to these patients to help decrease the incidence of the side effect. The data were presented at the 24th annual San Antonio Breast Cancer Symposium.