Breast Cancer

The National Cancer Institute (NCI) recently announced that the breast cancer death rate in American women continued to decline through 1993.

DALLAS--Estradiol scans, currently being used in research for the diagnosis of early breast cancer (see illustration on page 1), have in some cases identified breast cancer 2 years prior to diagnosis by conventional means, such as mam-mography, physical examination, and ultrasound, David F. Preston, MD, said in an interview with Oncology News International.

The incidence of breast cancer has risen steadily over the past several decades. Breast cancer is second only to lung cancer as a cause of cancer deaths among women; 46,000 women died of breast cancer in the United States alone in 1995. Despite efforts to improve the survival of women with metastatic breast cancer with currently available chemotherapeutic agents, results remain disappointing. The primary use of such agents continues to be for palliation, not cure.

Several new agents undergoing clinical development appear to be effective and tolerable in the management of metastatic breast cancer. In recent years, a number of new and exciting combinations have been described, with an efficacy similar or, in some cases, apparently superior to that of standard chemotherapeutic regimens, such as FAC and CMF. The next several years will witness a large number of comparative clinical trials, the major purpose of which will be to establish the role of these new drugs and combinations in the management of metastatic breast cancer. Almost simultaneously, similar strategies will be pursued for adjuvant therapy for primary breast cancer, with the goal of improving the curative efficacy of current regimens. These prospects are exciting; however, enthusiasm must be tempered with the knowledge that long-term toxicity is always a distinct possibility. Therefore, the development of new combinations, especially in the setting of adjuvant chemotherapy, should follow a systematic, conservative strategy. [ONCOLOGY 10(Suppl):30-36, 1996]

Over the past 5 years, many new cytotoxic agents with activity against metastatic cancer have been discovered, and several are currently undergoing clinical trials. Whether their marked degree of activity represents a real

The definition of refractory advanced breast cancer remains elusive. Because of different definitions of objective response, frequent lack of precision in defining the number of prior chemotherapies, and differing interpretations

The treatment of refractory metastatic breast cancer is complex and challenging. Practicing oncologists must choose from an array of therapuetic options. Palliation remains the primary goal of treatment, and the risks and

NEW YORK--Cell-adhesion molecules (proteins on the cell surface that interlock with those of other cells) appear to play an important role in checking tumor metastasis, says Dr. Rachel Hazan, a biochemist at Memorial Sloan-Kettering Cancer Center.

Areview of major clinical trials strongly supports the value of mammography screening for women in their 40s. The review showed a 24% decrease in deaths from breast cancer among women who underwent screening mammograms compared to

ImClone Systems has initiated an additional phase Ib/IIa clinical trial of C225, the company's epidermal growth factor (EGF)-receptor antagonist. The dose-escalation study will evaluate C225 in conjunction with the chemotherapeutic agent paclitaxel

PARIS--Paclitaxel (Taxol), the flagship of the new taxanes, has been hailed as a pharmacologic breakthrough, but its ideal use in the treatment of breast cancer is still a matter of debate. Speaking at the Sixth International Congress on Anti-Cancer Treatment (ICACT), National Cancer Institute oncologist Joyce O'Shaughnessy attempted to answer the most compelling unanswered questions about paclitaxel use.

TORONTO--TRUQUANT BR RIA, Biomira Diagnostics Inc.'s radio-immunassay, has been cleared for marketing for the early detection of recurrent breast cancer in patients previously treated for stage II or III cancer. According to the company, it is the first breast tumor marker test to receive expedited review by the FDA and is the first such test to be approved. The test is expected to cost approximately $50, the company said.

Aspecifically designed monoclonal antibody has been shown to reduce tumors in patients with late-stage breast cancer, according to a new study by scientists at Memorial Sloan-Kettering Cancer Center.

This report was prepared by a special committee of the Royal College of Radiologists. It provides a British perspective on how to manage this potential complication of breast irradiation.

An expert panel of seven cancer researchers and a representative of the National Alliance of Breast Cancer Organizations (NABCO) came together at the San Antonio Breast Cancer Symposium for a roundtable discussion of

PARIS--New analyses from the mega-databank of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) have confirmed that both ovarian ablation and polychemotherapy make a small but real difference in survival, Professor Richard Peto, of the University of Oxford's ICRF Clinical Trial Service Unit, said at the Sixth International Congress on Anti-Cancer Treatment (ICACT).

WASHINGTON--The US Postal Service will release its Breast Cancer Awareness stamp on June 15, in conjunction with the 1996 National Race for the Cure, the 5K race that raises money to fund breast cancer research, education, treatment, and screening.

Sequential dosing may improve the effectiveness of adjuvant chemotherapy regimens in node-positive breast cancer, by limiting overlapping toxicity while maximizing dose-intensity, Clifford A. Hudis, MD, said at the Chemotherapy Foundation's 13th annual symposium. At Memorial Sloan-Kettering Cancer Center, where Dr. Hudis is assistant attending physician in the Breast Cancer Medicine Service, researchers are testing a sequential dosing regimen that combines doxorubicin, paclitaxel (Taxol), and cyclophosphamide, supported by granulocyte-colony stimulating factor (G-CSF, Neupogen).

The anticancer benefits of nonsteroidal anti-inflammatory drugs (NSAIDs), seen in studies of colon cancer risk, may extend to human breast cancer as well.

PARIS--Although properly applied high-dose chemotherapy can produce massive cytoreduction in breast cancer, it may not be adequate to cure the disease. "The problem has never been the achievement of remissions with high-dose therapy; the problem is making them stick," Larry Norton, MD, of Memorial Sloan-Kettering Cancer Center, said at the Sixth International Congress on Anti-Cancer Treatment.

VILLEJUIF, France--Salvage therapy with docetaxel (Taxotere) produced responses in more than a quarter of heavily pretreated, anthracycline-resistant breast cancer patients, said Jean-Louis Misset, MD, an oncologist at Paul Brousse Hospital, Villejuif.

A new DNA-based sequencing technique-Sequence Based Diagnosis (SBD)-that determines p53 gene status in primary breast cancers, yields better prognostic information than standard immunohistochemistry, according to a study in the February 20, 1996, issue of the Journal of the National Cancer Institute. The findings may have important implications for some of the over 180,000 US women diagnosed annually with breast cancer.

Breast-conserving surgery without radiation therapy is not an effective treatment for early-stage breast cancer, a Harvard Medical School study concludes.

SAN FRANCISCO--Use of estrogen supplements may lower breast cancer mortality, an American Cancer Society study has shown. The study, which was discussed at the ACS's science writers meeting, followed 400,000 women who provided data about their cancer risk factors. After 9 years, breast cancer mortality was 16% lower in those women who used estrogen, suggesting that their tumors were less aggressive.

Although most studies of the relationship between oral contraceptives (OCs) and breast cancer have focused on a possible causative role for OCs, new data suggest that breast cancer patients with a history of OC use may actually fare better than women who have never taken the pill.

African-American breast cancer patients survive as long as their Caucasian counterparts, a new study with up to a 40-year follow-up shows. The study, conducted at the University of Chicago, also found that African-American women do not have more aggressive cancer.

It is widely accepted that the causation of cancer is the result of environmental exposures (including endogenous hormone exposure) and genetic susceptibility. Ultimately, to prevent breast cancer, we must understand both the environmental and genetic components.

It is perhaps not surprising that the increased incidence of a disease that has a major impact on mortality in young women (even though the absolute risk of death from breast cancer in this age group is low) should create so much interest. Yet, despite decades of research, it is by no means clear that everyone would agree with King and Schottenfeld that the appropriate approach to breast cancer prevention is one that "focuses on the physiologic effects of the sex steroid hormones and their potential interactions with family history." However, this tantalizing statement appearing at the end of the abstract of their article fortunately is elaborated upon at the end of the article itself. This elaboration refers specifically to physical activity, energy consumption, obesity, pregnancy history and exogenous estrogens and their potential interactions with family history, with which many will agree.

Drs. King and Schottenfeld have provided an interesting review of the literature in their attempts to relate changes in breast cancer incidence over time to secular changes in postulated risk factors.

Breast cancer incidence rates in the United States rose by 24% between 1973 and 1991. Mortality during this period, however, remained stable. Both the 5-year relative survival rate and the rates of in situ and stage I