Breast Cancer

HAMBURG-Preliminary findings from a small German study presented at the San Antonio Symposium have provided what investigators describe as the first evidence that dose-intensive adjuvant chemotherapy improves disease-free survival in high-risk breast cancer patients.

NEW YORK-The field of adjuvant therapy for breast cancer has entered an era marked by great opportunities and challenges.

TAMPERE, Finland-Adjuvant treatment with the nonsteroidal estrogen inhibitor toremifene (Fareston) proved equivalent to tamoxifen (Nolvadex) for prevention of breast cancer recurrence but was associated with fewer embolic events, investigators in an ongoing Finnish trial reported at the San Antonio Breast Cancer Symposium.

BARCELONA-Clinical and scientific rationale increasingly supports the use of cytotoxic and bio-logic agents in combination to treat breast cancer, a Spanish oncologist asserted during a satellite meeting at the San Antonio Breast Cancer Symposium, sponsored by Bristol-Myers Squibb Oncology.

MANHASSET, NY-An open-label study of vinorelbine (Navelbine) followed by paclitaxel (Taxol) in patients with metastatic breast cancer has yielded an active dosing schedule for this regimen for use in phase II testing, Daniel R. Budman, MD, said at a poster session of the San Antonio Breast Cancer Symposium.

LOS ANGELES-Twice-weekly paclitaxel (Taxol) combined with radiation therapy constitutes a “promising primary management” strategy for locally advanced breast cancer, California oncologists reported at the San Antonio Breast Cancer Symposium.

NEW YORK-An overview of clinical trials of trastuzumab (Herceptin) has provided additional evidence that the agent has cardiotoxic effects, especially when used with anthracycline chemotherapy, according to data presented at the San Antonio Breast Cancer Symposium.

NEW YORK-Combination chemotherapy with doxorubicin and docetaxel (Taxotere) resulted in objective major responses in 32 of 51 patients with previously untreated metastatic breast cancer, setting the stage for a large-scale comparison of the combination against doxorubicin and cyclophosphamide.

CHICAGO-The first US multicenter cost analyses comparing autologous peripheral blood stem cell transplant (PBSCT) and autologous bone marrow transplant (BMT) in breast cancer and non-Hodgkin’s lymphoma (NHL) showed a cost advantage for stem cells in breast cancer, but not NHL. Tammy Stinson, project manager and analyst for Health Services Research, Northwestern University and VA Chicago Healthcare System, presented the results at the ASH meeting.

SAN ANTONIO-In a trial of first-line, single-agent therapy for metastatic breast cancers that overexpress the HER-2 breast cancer gene, Herceptin (trastuzu-mab) resulted in major objective responses in 20% to 25% of patients. The monoclonal antibody is approved for use as first-line therapy in combination with paclitaxel (Taxol) and as a single agent in second- and third-line therapy.

The addition of the sleep hormone melatonin can boost the effectiveness of tamoxifen and help reverse tamoxifen (Nolvadex) resistance in the treatment of breast cancer, reported David E. Blask, MD, PhD, at a meeting on Comprehensive

NEW YORK-The observation in the early 1970s that an estrogen-receptor modulator called tamoxifen (Nolvadex) could decrease breast tumor recurrences and secondary primaries launched trials that continue to yield remarkable results, D. Lawrence Wickerham, MD, said at a teleconference for patients, sponsored by Cancer Care, Inc. Tamoxifen became the most commonly prescribed breast cancer drug, and now it has become the first to be approved for reducing the incidence of breast cancer in high-risk women.

CHICAGO-Researchers at the Hamilton Regional Cancer Centre (HRCC), Hamilton, Ontario, have developed a decision aid that improves treatment decision-making for women with breast cancer and is widely accepted by the surgeons who have used it in patient counseling, Dr. Tim Whelan said at a quality of life and outcomes symposium, sponsored by Northwestern University and Evanston Northwestern Healthcare. Dr. Whelan is a radiation oncologist at the HRCC and associate professor of medicine, McMaster University.

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed with breast cancer in 1997, and approximately 97,000 of these women have an extremely low chance of suffering a recurrence of their cancer. With an average age at diagnosis of 60 years and a 25-year expected duration of survival, the current number of breast cancer survivors in the United States may approach 2.5 million women. Since breast cancer is now being detected at an earlier stage than previously and since adjuvant chemotherapy may cause ovarian failure, an increasing number of women are becoming postmenopausal at a younger age after breast cancer treatment. This conference was convened in September 1997 to consider how menopausal breast cancer survivors should be treated at the present time and what future studies are needed to develop improved therapeutic strategies. A total of 59 breast cancer experts and patient advocates participated. The proceedings of the conference will be published in six installments in successive issues of oncology. The first part, published last month, defined the problem and explored its magnitude and ramifications for patient management. This second part focuses on the benefits and risks of hormone replacement therapy (HRT) in patients with breast cancer. [ONCOLOGY 13(2):245-267, 1999]

WASHINGTON-Postal patrons bought 45 million Breast Cancer stamps in the first 3.5 months after its release, raising about $3.6 million for research. Each stamp costs 8 cents more than a regular first-class stamp, with the additional money designated for funding breast cancer research at the National Institutes of Health and Department of Defense.

FLORENCE-Long-term tamoxifen (Nolvadex) treatment and polychemother-apy prevent some 20,000 to 30,000 breast cancer deaths each year and, if more widely applied, could avert as many as 50,000 such deaths, according to the latest update from the 1995-1999 data cycle of the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).

PHOENIX-Breast cancer patients age 40 and younger treated with breast conservation and irradiation have a significantly increased risk of breast recurrence and distant metastases, compared with older patients, a large retrospective French study has shown.

Sentinel lymph node biopsy, a minimally invasive procedure for staging patients with breast cancer, is a rapidly evolving technique in breast surgery. In response, a task force convened by the American Society of Breast Surgeons has issued a

As Dr. Cody points out, sentinel lymph node mapping of axillary nodes in patients with invasive breast cancer will probably become the standard of care for patients with early breast cancer, and will replace standard axillary dissection for many of these patients. With mammography increasing the detection of small, nonpalpable breast cancers, which pose a very low risk of axillary metastases, it is difficult to justify the continued use of standard axillary dissection. To my mind, it is also difficult to justify omitting axillary dissection of any type in these settings.

PHOENIX-A matched case-control study from Yale University suggests that early-stage breast cancer patients with deleterious BRCA1 or 2 mutations are at greater risk of late recurrences after breast-conserving surgery and radiation therapy than those without a mutation. Further, many of these late recurrences appear to be new primary breast cancers.

The Susan G. Komen Breast Cancer Foundation, a pioneer in the funding of research for breast cancer, announced at its 1998 National Grant Conference that the Joseph Drown Foundation has awarded the Komen Foundation a matching grant

A pharmaceutical now being considered for approval by the FDA for the diagnosis of certain lung tumors may also aid in the detection of primary and metastatic breast cancer tumors, according to a preliminary clinical study presented at the annual

FLORENCE, Italy-Although as many as 2.8% to 4.5% of all breast cancers occur during pregnancy or lactation, there are scant controlled trial data to help clinicians steer the difficult course between optimizing the outcome for the mother and protecting the child.

PHOENIX-Five-year results of a pilot study at the Ochsner Clinic, New Orleans, suggests that a 4-day course of brachytherapy may be just as effective as a 6-week course of external beam radiation therapy in breast cancer patients who have undergone breast-conserving surgery.

MIAMI BEACH-Use of aggressive induction therapy followed by high-dose chemotherapy with autologous bone marrow transplantation (ABMT) yielded a 40% complete remission rate among 425 women with metastatic breast cancer treated at Duke University Medical Center. Of these women, 11% remained in complete remission 5 years after therapy, David A. Rizzieri, MD, reported at the 40th Annual Meeting of the American Society of Hematology (ASH).

Dr. Cody presents a very thorough review of the use of sentinel lymphadenectomy in breast cancer. The article raises key issues related to a procedure that is becoming more widespread and may indeed replace axillary dissection for the staging of breast cancer.

Sentinel node surgery for breast cancer has generated considerable interest, and the timely article by Dr. Cody provides a concise, well-written review of the topic. This commentary will add a few relatively minor points and will offer some alternative viewpoints to the author’s conclusions.

Sentinel lymph node (SLN) biopsy is a rapidly emerging treatment option for patients with early-stage invasive breast cancer and a clinically negative axilla. In the era of mammographic detection, SLN biopsy has the potential to eliminate axillary dissection for the enlarging cohort of breast cancer patients who are node-negative. Using radioisotope, blue dye, or both methods, experienced surgeons can successfully localize SLNs in more than 90% of cases. The effects of isotope and blue dye may be additive. Sentinel lymph node biopsy reliably predicts axillary node status in 98% of all patients and 95% of those who are node-positive. The operation is best learned under a formalized protocol in which a backup axillary dissection is performed to validate the technique during the surgeon’s early experience. Enhanced pathologic analysis, including serial sections and immunohistochemical (IHC) staining, is an essential element of the procedure. In experienced hands, SLN biopsy has less morbidity and greater accuracy than conventional axillary dissection. [ONCOLOGY 1(13):25-34, 1999]

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed with breast cancer in 1997, and approximately 97,000 of these women have an extremely low chance of suffering a recurrence of their cancer. With an average age at diagnosis of 60 years and a 25-year expected duration of survival, the current number of breast cancer survivors in the United States may approach 2.5 million women. Since breast cancer is now being detected at an earlier stage than previously and since adjuvant chemotherapy may cause ovarian failure, an increasing number of women are becoming postmenopausal at a younger age after breast cancer treatment. This conference was convened in September 1997 to consider how menopausal breast cancer survivors should be treated at the present time and what future studies are needed to develop improved therapeutic strategies. A total of 47 breast cancer experts and 13 patient advocates participated. The proceedings of the conference will be published in six installments in successive issues of oncology. This first part defines the problem and explores its magnitude and ramifications for patient management. [ONCOLOGY 1(13):109-136, 1999]

FLORENCE, Italy-Long-term follow-up of node-negative postmenopausal breast cancer patients has shown that using tamoxifen (Nolvadex) as an adjunct to breast-conserving surgery and postoperative radiotherapy markedly improves event-free survival in these low-risk women.