Breast Cancer

Tests carry a significant price tag, but reduction in chemotherapy use is potentially cost-saving.

Bone health is a critical issue in the management of women with breast cancer. Many women who develop breast cancer are postmenopausal, which already predisposes them to osteoporosis. Systemic treatments for breast cancer, including chemotherapy and endocrine therapy, decrease circulating levels of estrogen in both pre- and postmenopausal women, further accelerating the natural process of bone loss. The primary concern in breast cancer patients is that this accelerated bone loss, known as cancer treatment–induced bone loss (CTIBL), will lead to an increase in fractures, chronic pain, and loss of mobility. Bisphosphonates are highly effective at slowing the rate of bone loss in postmenopausal women with osteoporosis and at preventing skeletal-related events in women with metastatic breast cancer. Many studies are now focusing on the role of bisphosphonates in preventing CTIBL in the adjuvant setting. Both oral and intravenous bisphosphonates have shown promising activity in preventing CTIBL in patients receiving chemotherapy or hormonal therapy. In addition, emerging data indicate that the use of bisphosphonates in the adjuvant setting may prevent disease recurrence and prolong survival. Data from a number of ongoing trials will further elucidate the role of bisphosphonates in the adjuvant setting over the next few years.

A majority of the more than 190,000 women diagnosed with breast cancer each year in the US[1] will receive some form of adjuvant therapy. Many breast cancer treatments cause decreases in circulating estrogen levels, which in turn can have a significant effect on bone mineral density; this condition is known as cancer treatment-induced bone loss (CTIBL). In this issue of ONCOLOGY, Reeder and Brufsky review the role of bisphosphonates in the setting of adjuvant breast cancer treatment. Both oral and intravenous bisphosphonates are effective in the prevention and treatment of CTIBL, and emerging data suggest that adjuvant bisphosphonate therapy may also affect breast cancer recurrence and survival. In considering the role of these medicines in early stage breast cancer, however, a number of important questions remain.

Breast cancer is the most common noncutaneous cancer among women.[1] In 2009, an estimated 190,000 new cases occurred in the US. The 5-year survival rate for early-stage breast cancer has improved from approximately 63% in the early 1960s to almost 90% today, mainly as a result of early detection and treatment.[2] The improvement in survival from breast cancer treatments, however, which include chemotherapy, endocrine therapy, and/or ovarian ablation, does not come without the cost of potentially significant effects on bone mineral density (BMD).[3-5] The risk of having low bone mass increases significantly with age, as does the risk of developing breast cancer; consequently, the two diagnoses often overlap in the same individual. Additionally, women with breast cancer may be at increased risk for osteoporosis due to the effect on bone of certain anticancer therapies. Hence, some women with breast cancer may be at increased risk of osteoporosis.

The I-SPY 2 breast cancer trial features a novel design of uninterrupted enrollment and patient stratification using biomarkers in order to target therapy.

Trastuzumab (Herceptin) has dramatically changed the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer.

This review explores the use of several such agents, including lapatinib (Tykerb), HSP90 inhibitors, T-DM1, and other tyrosine kinase inhibitors. Emerging data from trials of these agents indicate that the HER2 pathway remains a valid therapeutic target following disease progression on trastuzumab.

An increasing number of women diagnosed with breast cancer chose to undergo contralateral prophylactic mastectomy, but this option only showed a real survival benefit in women who met certain criteria in terms of age, disease stage, and disease status.

The low-cost imaging technique has value for determining the relative aggressiveness of inflammatory and advanced disease.

While optimal adjuvant hormonal therapies for premenopausal women with operable breast cancer have yet to be defined, discussions and reviews of the state of the art and “areas of confusion” often fail to consider developments that are germane to keeping evidence-based clinical practice truly up-to-date.

The article “Adjuvant Hormonal Therapy in Premenopausal Women With Operable Breast Cancer: Not-So-Peripheral Perspectives” by Richard Love, published in this issue of ONCOLOGY,

Research and development of adjuvant therapies for premenopausal women with endocrine-responsive breast cancer is unfortunately lacking.

After malignancies of the skin, breast cancer is the most common cancer

Traditionally host factors such as weight and physical activity have not been considered in the overall treatment of breast cancer patients. In this issue of ONCOLOGY, Nagaiah and Abraham review the epidemiologic and biologic evidence evaluating the relationships among obesity, physical activity, and both breast cancer recurrence and mortality, and in doing so, advocate weight management and exercise for breast cancer patients.

A weekly course of paclitaxel has proved itself effective in breast cancer and is feasible in ovarian cancer as well. But questions remain as to the actual benefits of a shorter treatment course.

When she learned that she had breast cancer, Patricia Garrett did what many people with cancer do: she continued working.

More than 2.5 million breast cancer survivors live in the US today.[1] This number will continue to grow thanks to early detection and advances in treatment that are making early stage breast cancer an increasingly curable disease.

A combination of two targeted therapies already shown to be effective in breast cancer

The patient, “TB,” is a 44-year-old Caucasian, married woman with three daughters, 21, 18, and 10 years of age.

Why doesn't cisplatin work very well against breast cancer? The first response of most researchers would be to invoke something about genetic responses, but a pair of biologists from the University of Cincinnati have raised a quite different proposalr: The unique hormonal milieu of the breast may contribute to chemoresistance.

The regimented and inflexible protocols that have long served as hallmarks of clinical trials are giving way to personalized medical research. A clinical trial begun last week at the University of California, San Francisco will use genetic and biological markers drawn from the tumors of individual patients to identify the treatments most likely to be effective for those participating in the trial.

Over the past decade, the oncology community has made significant progress in the development of highly effective treatment modalities for breast cancer. Moreover, our increasing knowledge of the molecular biology of cancer has engendered the potential to use gene expression profiling, molecular fingerprinting, and biomarkers to add increased, patient-specific value to our clinical decision making. More than ever, today’s clinician must keep up to date on the rapid scientific advances in breast cancer management.

Study in Asian population runs counter to previous concern that phytoestrogen in soy may increase disease risk.

Next-generation genomic assay technologies are revolutionizing our ability to characterize cancers at the genomic levels, providing critical prognostic and predictive information for individual patients with breast cancer, thereby helping to guide treatment decisions. According to Harold J. Burstein, MD, PhD, Associate Professor of Medicine, Harvard Medical School, these emerging technologies will change the way we treat breast cancer.

For oncologists battling breast cancer in the clinic, one of the most difficult decisions is choosing the optimal adjuvant therapy, one that balances the fine line between efficacy and toxicity. Clifford A. Hudis, MD, Chief, Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center, tackled this difficult clinical discussion in an interview with ONCOLOGY.