Breast Cancer

This article reviews clinical data informing the effective management of HER2-positive metastatic breast cancer, including the optimal sequence of HER2-targeted agents.

Additional insight into the biology of ER-positive breast cancers, particularly the higher risk luminal B cancers, could aid in identifying potential targets and new, effective therapies. And though the majority of triple-negative breast cancers are the “basal-like” subtype, significant proportions are in other subtypes.

If MGTs could predict which patients were most prone to late recurrence and thus might benefit from extended adjuvant endocrine therapy, it would be a huge advancement in the care and survivorship of our patients. More studies of MGTs are required to clarify their role in evaluating prognosis and predicting response to therapy in breast cancer.

Clinicians and bioinformatics experts must learn to speak the same language, starting with basic principles regarding analytical validity, clinical validity, and clinical utility. More than ever, a true partnership between clinical, laboratory, and bioinformatics scientists as part of a multidisciplinary team is needed to benefit our patients.

As more drugs become available in the HER2 arena, clinicians will be faced with increasing challenges regarding which sequences and combinations of drugs will be the best for their patients. In the era in which we practice, a great deal of this is likely to be dictated by the payers.

Third, how much do we really know about de novo and acquired resistance to trastuzumab and lapatinib? There are several possible clinical relevant mechanisms of trastuzumab resistance, including crosstalk with other receptors, amplification of the PI3K/AKT pathway, alteration of the trastuzumab binding domain, and loss of HER2 expression.

Last month brought the accelerated approval by the US Food and Drug Administration (FDA) of a fourth agent targeting the human epidermal growth factor receptor 2 (HER2) oncogene product: TDM-1 (Kadcyla), a conjugate of trastuzumab and a cytotoxic, emtansine.

Researchers have demonstrated that mammary tumor development can be directly inhibited by lifelong exposure to n-3 polyunsaturated fatty acid in mice. The new study directly shows the anticancer activity of omega-3s.

A new study from cancer stem cell experts at the University of Michigan is challenging the notion that trastuzumab (Herceptin) only works for HER2-positive breast cancer.

Ado-trastuzumab emtansine, formerly known as T-DM1, improved progression-free survival as first-line treatment for patients with HER2-positive metastatic breast cancer, when compared with the standard treatment of trastuzumab plus docetaxel in a randomized phase II multicenter study.

At the 30th Annual Miami Breast Cancer Conference, Lisa Carey, MD, presented the major questions in managing triple-negative breast cancer. This type of breast cancer makes up approximately 15% of all breast cancer cases, is typically more aggressive, and has a higher risk of early relapse.

Most breast cancer patients are treated with some form of chemotherapy, and because women with breast cancer are now surviving longer, the long-term effects of chemotherapy have become a major issue.

Risk factors for breast cancer can be parsed into genetic and biological factors, and environmental and lifestyle factors; and the general consensus is that screening and prevention strategies should be tailored based on an individual’s risk assessment.

How best to manage patients who present with ductal carcinoma in situ (DCIS), a noninvasive and early form of breast cancer, remains unclear. Treatment options range from minimal, breast-conserving surgical intervention and no follow-up treatment, to surgical intervention followed by additional treatment.

It used to be so easy. Patients with ER-positive breast cancer got 5 years of tamoxifen. You could anticipate most of the side effects. No one showed up with an armload of internet downloads ready to debate the utility of hormone therapy, the risks, and metabolism or drug interactions. No more.

As part of our coverage for the 30th Annual Miami Breast Cancer Conference, we bring you an interview with Dr. Mark Pegram, director of the breast cancer program at the Stanford Women’s Cancer Center and codirector of the molecular therapeutics program. Dr. Pegram will be discussing the potential for novel HER2 combination therapies at the conference.

New technologies and techniques are in development to use blood samples to detect biological material in the blood that can differentiate a patient with cancer from one who does not have cancer and to aid in the treatment of breast cancer patients.

A new study by researchers at the Scripps Research Institute has identified a metabolic mechanism by which breast tumor cells control tumor aggressiveness.

The FDA has approved ado-trastuzumab emtansine (Kadcyla), known as T-DM1 in development, for the treatment of women with metastatic HER2-positive breast cancer.

The prospect of even more compressed radiotherapy options for women requiring adjuvant breast radiotherapy is exciting. However, we urge readers to be cautious in their interpretation of the current intraoperative literature as they implement their programs.

Due to the fact that we do not have mature long-term data regarding efficacy, we are still several years away from declaring IORT to be a viable alternative to the current standard of care in patients with early-stage breast cancer.

With many centers seeking to adopt IORT, there are licensing, proctoring, staffing, technical support, and reimbursement issues that need to be considered. We have reviewed the current international experience and describe one community cancer center’s experience with initiating an IORT breast cancer program.

Consuming more vegetables is associated with a lower risk of estrogen receptor (ER)-negative breast cancer, according to a new study published in the Journal of the National Cancer Institute.

Researchers discovered that in triple-negative breast cancer, an inhibitor of metastasis, miR-708, is repressed, results that could lead to novel therapies.

An analysis of 164 phase III breast cancer trials shows bias in reporting the primary endpoint and toxicity results, according to results of a recent study.

Such a systematic review of the current status of mTOR inhibitors in the treatment of breast cancer demonstrates holes in our knowledge of the role of the tumor, the host, and metabolic factors in breast cancer progression.

Efforts to identify clinical biomarkers of response or resistance to mTOR inhibitors are ongoing. This review will summarize results of preclinical and clinical studies as well as ongoing clinical trials with mTOR or dual PI3K/mTOR inhibitors.

Knowing the genetic makeup of patient tumors permits the development of new DNA-based diagnostics, such as BEAMing and PARE. By incorporating these new tools into future trials, we should be able to concurrently learn about drug resistance and significantly improve patient responses.

The risk of triple-negative breast cancer appears to be lower for women who delayed childbirth and who chose to breast feed according to a new study.

Women who have higher levels of pigments found in fruits and vegetables called carotenoids may have a lower risk of breast cancer. This inverse relationship was found to be particularly strong for more lean women, those with ER-negative tumors, and current smokers.