Breast Cancer

Jay R. Harris, MD, will present the Gianni Bonadonna Breast Cancer Award lecture at the upcoming 2008 ASCO Breast Cancer Symposium being held September 5-7 in Washington DC. Dr. Harris is professor and chair of the Department of Radiation Oncology at the Dana-Farber Cancer Institute and the Brigham and Women’s Hospital at Harvard Medical School.

Breast Cancer is a unique effort in the world of breast cancer texts: Compact and concise, this 214-page book deals exclusively with breast cancer therapeutics, and strives to accomplish the difficult task of being as current as possible within the limited capabilities of the printed word in a rapidly evolving field. Dr. Seidman has assembled a distinguished group of authors, each of whom was assigned a topic, in the end covering all aspects of the medical oncologic scope of breast cancer treatment in one relatively short text. The book does not address issues of breast cancer epidemiology, screening, prevention, or surgical or radiation treatment-this was not the intent of this publication.

This practical review on the use of serum markers and circulating tumor cells (CTCs) focuses on the role of these assays in the management of patients with breast cancer and contains important information and perspectives for the practicing oncologist. The varying roles of these markers in early-stage and advanced disease are presented, and the implications in management are quite different in each setting.

Important therapeutic innovations within the past several years have resulted in only modest survival benefits for women with metastatic breast cancer. In this setting, cancer remains incurable and treatment is mainly palliative, involving judiciously applied multiple endocrine, chemotherapeutic, or biologic therapies in an attempt to induce a series of remissions and, ultimately, adequate palliation. At present, we lack both a consensus management algorithm and an ideal treatment model of specific subsets of women.

A large, international trial has shown that adding the targeted therapy bevacizumab (Avastin) to the chemotherapy drug docetaxel (Taxotere) slows disease progression in patients without prior chemotherapy for locally advanced or metastatic breast cancer. The results were presented by David Miles, md, a professor and medical oncologist at the Mount Vernon Cancer Centre in Middlesex, UK, and the study’s lead author (abstract LBA1011).

A large, international trial has shown that adding the targeted therapy bevacizumab (Avastin) to the chemotherapy drug docetaxel (Taxotere) slows disease progression in patients without prior chemotherapy for locally advanced or metastatic breast cancer. The results were presented by David Miles, md, a professor and medical oncologist at the Mount Vernon Cancer Centre in Middlesex, UK, and the study’s lead author (abstract LBA1011).

Researchers report that zoledronic acid (Zometa), a drug used to treat bone metastases and recently approved to treat osteoporosis, also lowers the risk of breast cancer recurrence in premenopausal patients with early-stage disease who have undergone surgery and are receiving ovarian suppression and hormone therapy. All women in this multicenter phase III trial had cancer that was estrogen-receptor– or progesterone-receptor–positive. The study was presented at the ASCO plenary session by lead author Michael Gant, md, professor of surgery at the Medical University of Vienna and the president of the Austrian Breast and Colorectal Cancer Study Group, or ABCSG (abstract LBA4).

Along with various imaging modalities, serologic tumor markers such as CA 15-3 and CA 27.29 have been used for decades to monitor treatment response in patients with metastatic breast cancer (MBC). Despite the frequent use of these markers, they lack high sensitivity and specificity for breast cancer progression. The prognostic significance of these markers remains indeterminate because of the conflicting outcome of many clinical trials. The circulating tumor cell (CTC) test has recently been studied in clinical trials in patients with MBC. Some of the studies showed that high levels of CTCs are correlated with poor survival in MBC. An intergroup trial is underway to determine the implication of changing treatment based on the CTC level. This article will discuss the current data on these markers, with special emphasis on the CTC test. The potential clinical utility of these markers will also be discussed.

CHICAGO-Zoledronic acid (Zometa) and adjuvant endrocrine therapy lowered the risk of disease recurrence in premenopausal women with early-stage breast cancer, according to the results of a major European trial. The bisphosphonate is already used to prevent bone loss in women undergoing adjuvant endocrine therapy for breast cancer.

The Cancer International Research Group (CIRG), a division of TRIO (Translational Research in Oncology) announced that, based on its study BCIRG 006, the US Food and Drug Administration (FDA) has approved a new regimen known as TCH (docetaxel [Taxotere] and carboplatin combined with trastuzumab [Herceptin]) for the adjuvant treatment of HER2-positive early breast cancer. The AC-TH regimen (doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab), also investigated in the BCIRG 006 study, received approval at the same time. This is the first taxane-based non–anthracycline-containing chemotherapy combined with trastuzumab to receive FDA approval.

Many women with a faulty breast cancer gene could be at greater risk of the disease due to extra risk-amplifying genes, according to research published recently in the American Journal of Human Genetics.

A novel biweekly dosing schedule of capecitabine (Xeloda) enabled safe delivery of higher daily doses in the treatment of advanced breast cancer, according to an investigational study published in the Journal of Clinical Oncology.

Genetic variations in the body’s receptor for vitamin D could increase the risk of breast cancer in postmenopausal women, according to a study published in the journal Breast Cancer Research.

In this issue of ONCOLOGY we honor and celebrate the career and contributions of Martin D. Abeloff, MD, who died last year. Marty saw his first patient with breast cancer in 1972 and cared for his last such patient shortly before his death in 2007.

Neoadjuvant lapatinib (Tykerb) decreased tumorigenic stem cells in primary breast cancers, Jenny Chang, MD, of Baylor College of Medicine, Houston, reported at the 6th European Breast Cancer Conference.

SAN DIEGO-Even one alcoholic drink a day can raise the risk of breast cancer, according to an analysis of 184,418 postmenopausal women in the NIH-AARP Diet and Health Study presented at the 2008 American Association of Cancer Research annual meeting (abstract 4168).

A HER2/neu peptide–based T-cell immunotherapy that reduces recurrences in low HER2 expressors could be important for patients ineligible for trastuzumab.

Breast cancer treatments today are likely to cause less physical deformity from surgery than a half-century ago, but are more complex and extend over a longer period of time. Women today are often well informed about the details of their cancer diagnosis and prognosis, and are increasingly involved in shared decision-making regarding treatment.

In her article on the psychological and social aspects of breast cancer, Dr. Ganz pays fitting tribute to the pioneering and prescient efforts of a great man who tried hard to bring more humanity into the management of the disease.

The first generation of clinical trials addressing adjuvant treatment questions in breast cancer has confirmed the important role of endocrine manipulations and chemotherapy, improving disease-free and overall survival.

Worldwide, breast cancer is by far the most frequent cancer affecting women, with over 1 million new cases each year, and the leading cause of female cancer-related deaths. During the past decade, substantial progress has been made in the treatment of breast cancer, due to focused collaborative efforts in education, practice, and research.

The paper by Vogel is an interesting personal review of the use of selective estrogen-receptor modulators (SERMs) to prevent breast cancer, raising many important issues and concerns related to this controversial topic.

Novel agents are adding to the wide choices of standard chemotherapies already available. This review offers an approach to the selection of individualized and rational therapies for patients with metastatic breast cancer.

In order to frame this commentary on Higgins and Wolff’s review of current treatment options for metastatic breast cancer, I started with a PubMed search of Dr. Marty Abeloff’s work from more than 3 decades ago. This was partly motivated by my own curiosity about a leader whose early career was largely unknown to me, and partly by the desire to see whether “the more things change, the more they remain the same.”

Women in the Northeast US are more likely to receive breast-conservation therapy, while those in the South are more often recommended for mastectomies for the treatment of invasive breast cancer, according to a study presented at the 9th Annual Meeting of the American Society of Breast Surgeons (ASBS), held April 30 to May 4 in New York.

A novel intraoperative breast cancer probe is showing significant promise in the reduction of repeat procedures in patients undergoing breast-conserving surgeries, according to a study presented at the ASBS meeting.

Breast cancer is the most common cancer in women living in the developed world. One in eight women will be diagnosed with breast cancer during their lifetime. The majority of newly diagnosed patients have early-stage disease.

The treatment of microscopic metastatic breast cancer with adjuvant systemic therapy has undergone significant changes in recent years. At the same time, our understanding of the biology of breast cancer has also improved, predominantly as a consequence of data obtained from cDNA microarrays.

Several large, prospective trials have evaluated tamoxifen compared with placebo for breast cancer risk reduction in women at increased risk for breast cancer. Analysis of the large, prospective breast cancer risk-reduction trials that used tamoxifen estimated that tamoxifen decreased breast cancer incidence by 38% on average and estrogen receptor–positive tumors by 48%.

Victor Vogel’s excellent review of the clinical basis for preventing breast cancer in high-risk women demonstrates the significant advances that have been made through the clinical trials mechanism. However, it is the progress in deciphering the link between hormones and the development and growth of breast cancer that is the true success story in this setting.