Breast Cancer

An update of a long-term denosumab (Xgeva) trial offers another bisphosphonate as an alternative to zoledronic acid (Zometa) that is more convenient, less toxic, and more effective in bone metastases. But oncologists need to perform an oral exam of patients with bone metastases before placing them on denosumab.

As the FDA considers whether to rescind approval for bevacizumab (Avastin) in the adjuvant setting, “disappointing” results from the GeparQuinto study indicate the agent may be best reserved for patients with triple-negative disease.

Results from the GINECO group study demonstrate Afinitor’s ability to buy more time for patients while Xgeva makes everyday life less painful.

Exemestane provides a new option for upfront, five-year endocrine therapy in postmenopausal women, based on results of the first definitive early breast cancer trial to compare nonsteroidal and steroidal therapy.

An analysis of multiple ECOG trials found that obese women with hormone receptor-positive breast cancer experience worse outcomes. But an exploratory analysis of the international TEAM trial indicated that obesity does not exert a negative influence on the efficacy of adjuvant endocrine therapy.

C. Kent Osborne, MD, codirector of SABCS 2010, spoke with Oncology NEWS International about what to watch for at this year’s meeting. Dr. Osborne highlights key studies in adjuvant therapy and aromatase inhibitor therapy and discusses some of the future challenges that the breast cancer community faces.

For women with triple-negative breast cancer, BRCA mutations can be a boon: These patients have a significantly lower risk of relapse than their counterparts who do not carry BRCA mutations, according to a study out of Houston’s M.D. Anderson Cancer Center. SABCS 2010 will feature an education session on the clinical utility of genetic testing for inherited predisposition to breast cancer.

For women with hereditary breast cancer, deciding on the best treatment option can be challenging. Three specialists, including medical oncologist Susan M. Domchek, MD, discuss the different approaches to managing breast cancer patients with a family history of BRCA mutations. Dr. Domchek will give a talk at SABCS 2010 on the management of women with a significant predisposition to breast cancer.

ASCO recently released updated guidelines on the use of adjuvant endocrine therapy in hormone-receptor-positive breast cancer. While the guidelines focus on all postmenopausal women, those who are age 75 and older require special consideration. Unfortunately, meaningful data to help healthcare providers make treatment decisions for these patients are scarce, according to Peter Ravdin, MD, PhD, an executive committee member and scientific program planning member of SABCS 2010.

The BHGI is working to collaborate with colleagues in LMCs to develop practical strategies to improve outcome, applying implementation research methodology to promote early detection strategies in settings where appropriate care can be administered.

Anderson et al highlight the Breast Health Global Initiative for guideline development and discuss how developments in low and middle income countries have parallels in the delivery of health care to underserved populations in industrialized countries. Guidelines for appropriate breast cancer treatment must address early detection, accurate diagnosis, and the delivery of timely and appropriate treatment modalities.

Breast cancer is a significant global health issue: An updated analysis by the International Agency for Research on Cancer estimated that there were 1.38 million new breast cancer cases diagnosed in 2008 and confirmed that it remains the most frequent cause of cancer death in women worldwide.

This effort has already brought important contributions to countries of low and middle incomes: the basic guidelines, which not only indicate how patients with breast cancer can be treated even with modest resources, but also provide a minimum level of care below which countries, governments and health care systems cannot even pretend that they provide care for women with breast cancer.

The search for a magic bullet against cancer historically has glowed bright then dimmed, depending on the stage of discovery. Developments surrounding monoclonal antibodies and angiogenesis inhibitors have followed this cycle, as exuberance for their potential has bowed to the nuances that underlie the complex mechanisms on which they depend.

Research at George Washington University in Washington DC has found that African-American women diagnosed with breast cancer between 2001 and 2003 were significantly more likely to wait for treatment than if they had been diagnosed between 1998 and 2000. And the gap between diagnosis and treatment is getting wider. Those diagnosed between 2004 and 2006 waited longer for treatment than those between 2001 and 2003.

San Antonio Breast Cancer Symposium to Hold 33rd Annual SymposiumHIGHLIGHTS BREAKTHROUGHS IN RESEARCH AND TREATMENT

FDA recently came close to taking away hope for thousands of terminally ill women. But at the last minute, the agency announced it was postponing until December whether to revoke approval of Avastin for advanced-stage breast cancer treatment.

Proponents of targeted intraoperative radiotherapy say the technique matches whole-breast alternative for reducing recurrence.

Interviewer, Ron Piana,: Hello, this is Ron Piana, executive editor of the journal Oncology. October is National Breast Cancer Awareness Month (NBCAM), an annual health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention and cure.

Mammaprint and Oncotype DX are on the market many years before results are due from the large multicenter studies that should clarify their roles. In the meantime, oncologists and their patients face uncertainties about their best uses. Reports at the ASCO breast cancer symposium may resolve a few of them.

What the U.S. is doing wrong in the fight against breast cancer among African Americans continues to elude the medical community.

Dr. Conant is a pioneer in the development of digital mammography, and a leader in research on the use and benefits of early mammography screening and on the role of MRI and PET scanning. She is also the recipient of grants from the National Institutes of Health to compare standard surgical biopsy with digital mammography and stereotactic core breast biopsy.

E board review in Breast Cancer February 2008

Studies done decades ago found that mammograms reduced the breast cancer death rate by 15 to 25%. But that was when treatment was much less effective. A new study looks at an aging question: Should mammograms still be the “gold standard?”

ASTRO has published evidence-based guidelines to define appropriate fractionation of whole-breast irradiation.

An advisory panel recommended revoking bevacizumab’s approval in breast cancer. Oncologists and patients express concern about what the future holds for those who do benefit from bevacizumab.

According to ONCOLOGY contributor, Debu Tripathy, MD, FDA's process for the final approval of Avastin for advanced breast cancer raises many questions about the standards on drug approval in this changing era of targeted therapy and personalized medicine.

Adjuvant hormonal deprivation therapy is often administered long-term to patients with hormone receptor–positive cancers for primary prevention of breast cancer and secondary prevention of a recurrence.[1,2] This treatment modality is of particular importance to the elderly for two reasons: 1) the incidence of hormone-sensitive cancers (eg, prostate cancer and breast cancer) increases with age,[3] and 2) the systemic treatment regimens for elderly patients with hormone-responsive cancers are often limited to long-term hormonal deprivation therapy (HDT), most commonly androgen deprivation therapy for prostate cancer and aromatase inhibitor therapy for breast cancer, with chemotherapy often omitted.[2,4]

The incidence of metabolic syndrome is rapidly increasing. Metabolic syndrome is associated with elevated morbidity and mortality secondary to cardiovascular disease, insulin resistance, and hepatic dysfunction. A body of evidence has already implicated metabolic syndrome as a cancer risk factor; emerging evidence now suggests that cancer survivors themselves may be at risk for developing metabolic syndrome as a result of their anti-cancer therapy. Treatment of both breast cancer and prostate cancer often involves hormone-modifying agents that have been linked to features of metabolic syndrome. Androgen suppression in men with prostate cancer is associated with dyslipidemia, increasing risk of cardiovascular disease, and insulin resistance. Anti-estrogen therapy in women with breast cancer can affect lipid profiles, cardiovascular risk, and liver function. Similar findings have been noted in men with testicular cancer treated with chemotherapy. In addition, several emerging therapies, including mammalian target of rapamycin (mTOR) inhibitors and targeted kinase inhibitors, are increasingly associated with some features of metabolic syndrome. As the number of cancer survivors continues to grow, consideration of these factors and of the risk of metabolic syndrome will become increasingly important when choosing between therapy options and managing long-term follow-up.

Each year in the United States, more than 200,000 women are diagnosed with breast cancer, and 40,000 women die of the disease.[1] Approximately two-thirds of breast cancers are hormone receptor–positive, and medications that suppress estrogen are the cornerstone of adjuvant therapy for these tumors. Tamoxifen, a selective estrogen receptor modulator, was the first agent developed for this purpose and is still used widely in premenopausal women. Aromatase inhibitors (AIs), which prevent peripheral conversion of adrenal androgens into estrogen, have largely become the agents of choice for postmenopausal women. Current guidelines recommend that all postmenopausal women with hormone receptor–positive early-stage breast cancer who do not have a contraindication to AIs be treated with one of these agents, either as primary therapy or after 2 to 5 years of tamoxifen treatment as part of a cross-over strategy.[2] These recommendations are based on five large adjuvant trials that demonstrated a 3% to 4% absolute reduction in subsequent breast cancer events in patients who received an AI as part of adjuvant breast cancer treatment compared with patients treated with 5 years of tamoxifen alone.[3-7] However, it is notable that despite the lower rates of recurrence in these trials in the patients who received AIs, most studies have not demonstrated a survival advantage for AIs.