Breast Cancer

In their review of multi-gene assays of breast cancer, Drs. Gökmen-Polar and Badve highlight the overall similarity of “first-generation” molecular assays that have been developed, using different strategies, to understand the relationship between gene expression within tumor samples and the outcomes of patients with breast cancer.

Future randomized studies should focus on determining which patients benefit most from the inclusion of molecular diagnostics in treatment decision making and on the development of treatment algorithms that incorporate patient factors, histologic and biologic findings, and molecular markers.

In this review, we will present the current data on commercially available molecular profiling assays in breast cancer and discuss the challenges surrounding their incorporation into routine clinical practice as prognostic and predictive tools.

A large-scale study of US women between the ages of 20 and 44 shows that using the injectable contraceptive, depot medroxyprogesterone acetate (DMPA), is associated with a two-fold increase in the risk of invasive breast cancer when the contraceptive is used for at least one year.

Researchers at the University of British Columbia in Vancouver, Canada have sequenced and analyzed over 100 triple-negative breast tumors at the time of diagnosis, the first in-depth genomic analysis of this heterogeneous breast cancer subtype.

Development of a novel method for drug discovery using active compounds as pharmacodynamic biomarkers in triple-negative breast cancer cell lines.

Researchers have identified a marker of DNA damage that may be able to predict a patient’s response to platinum-based chemotherapy agents such as cisplatin and carboplatin.

A wide negative margin during breast-conserving surgery should be attempted for women with ductal carcinoma in situ–this is the conclusion from an analysis published today in the Journal of the National Cancer Institute.

Typically women who are likely to be treated with systemic therapy before surgery have bulky disease. But should all breast cancer patients receive systemic neoadjuvant therapy?

Reasons for recurrence after treatment for early breast cancer are still not well understood. Lifestyle and other longer-term factors are likely at play, but the subject is difficult to study. The best advice for cancer patients is exercise and a healthy diet.

Endocrine-therapy resistant HER2-negative breast cancer is the most common cause of breast cancer death. The basis for this resistance is heavily studied to identify new ways to treat these patients.

What are the latest advances in the treatment of triple-negative breast cancer? Are there new ways to molecularly characterize breast cancer tumors to identify specific mutation targets and increase the chance of response in this disease?

Breast cancer tumors that have a loss of function in DNA-repair genes like BRCA1 and BRCA2 may be particularly sensitive to PARP inhibitors such as olaparib.

Over the past several months, the results of four randomized bisphosphonate adjuvant trials in a range of different patients have been released, two of these trials showed a survival benefit for the addition of a bisphosphonate to standard systemic therapy. ER-positive patients who are postmenopausal and have had no chemotherapy seemed to benefit the most.

Women who received estrogen while part of the Women's Health Initiative (WHI) trial had lower rates of invasive breast cancer compared to those who received placebo, and they were less likely to die of the disease compared to women who never took the hormone replacement therapy.

Given the abundance of breast cancer data, this review will focus on breast cancer–related lymphedema. However, the principles and controversies discussed are relevant regardless of the type of malignancy to which the lymphedema is attributed.

The etiology and risk factors of breast cancer–related lymphedema (BCRL) are multifactorial and not fully understood.

Triple-negative breast cancer is aggressive, has a high rate of metastases, and carries a poor prognosis. Dr. Joyce O’Shaughnessy, who will be presenting at the Miami Breast Cancer Conference, discusses an overview of new therapies for triple-negative breast cancer.

Two studies published today help clarify how to interpret CYP2D6 genetic testing and the results will likely affect the current trend of CYP2D6 genotyping prior to tamoxifen usage in early-stage ER-positive breast cancer patients.

Four publications on cancer treatment during pregnancy were published last week in the journal Lancet, serving as new treatment guidelines for chemotherapy and surgery in pregnant patients with solid tumors and hematologic malignancies.

Dr. Gunter von Minckwitz discusses the recent paper he authored that showed that bevacizumab in addition to neoadjuvant chemotherapy significantly increased the rate of pathological complete response in patients with early stage HER2-negative breast cancer.

Breast cancer survivorship continues to rise, but the long-lasting psychosocial and quality-of-life changes that occur after treatment need to be studied, as treatment outcomes can lead to negative side effects that outlast the treatment.

It may not be appropriate, nor always considered standard, to recommend neoadjuvant chemotherapy for all patients for whom adjuvant therapy was recommended before surgery. Indeed, tumor size and nodal status play a role, as do hormone receptors, in determining the appropriate extent of adjuvant therapy.

Treatment of HER2-positive cancers has improved rapidly over the past decade, and the pace of progress continues to accelerate. The advances have been fueled in part by the conduct of neoadjuvant studies, which have aided in the development of novel therapies and more effective combination regimens.

This article provides a comprehensive summary of the knowledge gained from recent neoadjuvant trials conducted with agents targeting HER2, and will put them into perspective with current treatment recommendations from American and European guidelines.

A study published in the journal Cancer shows that breast cancer survivors can experience problems with specific mental abilities up to several years after treatment.

Epidemiologist Jack Cuzick, PhD, and colleagues, writing in the Journal of the National Cancer Institute in April, concluded that “tamoxifen-induced reductions in breast density can be used to identify women who will benefit the most from prophylactic treatment with this drug.”

The results of a study presented at the San Antonio Breast Cancer Symposium (SABCS) prompted enough controversy to warrant a statement from 3 major medical societies and an expert panel teleconference on December 14, 2011 to discuss the analysis of data presented by the MD Anderson Cancer Center physicians.

Bevacizumab (Avastin) improved progression-free survival (PFS) in women with HER2-positive locally recurrent or metastatic breast cancer by an average of 3 months when added to standard treatment as first-line therapy in the multinational, randomized, phase III AVEREL study.

Results of 4 trials involving bisphosphonates in a range of protocols and patient cohorts suggest that the role of these agents in preventing recurrence of breast cancer remains to be defined. In 2 of the 4 studies reported, favorable outcomes were obtained following intravenous administration of zoledronic acid. Neither of two trials in which a bisphosphonate was administered orally, however, achieved its primary endpoint.