Breast Cancer

Ahead of the ASCO 2013 meeting we discuss neoadjuvant therapy options and clinical trials in breast cancer, as well as the opportunities for targeted therapies in post-neoadjuvant trials.

We speak with two experts to discuss breast cancer risk, genetics, and prevention options available to women at high risk of developing breast and ovarian cancer.

Palliative radiotherapy is an effective means of alleviating pain and improving overall quality of life in elderly patients with bone metastases, according to a new study.

Buy toxic chemicals and support breast cancer research! Not lying-just saw an ad on TV for weed killer and it had a pink ribbon logo on its packaging indicating, “A portion of every sale goes to support breast cancer research and awareness.” We have plenty of weed killer and a perfect lawn at our house, so I am no critic of the product. But have you noticed the pink ribbon logo on virtually every conceivable item or service?

Until better evidence is available for the effects of soy on women from non–soy-consuming countries, it seems reasonable to limit consumption to soyfoods, and to avoid high-dose supplements of processed soy components.

Soyfoods are consumed by many because of cultural factors, for potentialThere are strongly conflicting data regarding soy intake and breast cancer. As such, if women (with or without breast cancer) enjoyed partaking of soy products, then it seems quite reasonable for them to partake of them. As with most things, moderation in intake is probably wise. beneficial effects on overall health, and for the unproven hope that they will ease menopausal symptoms in women.[1]

Recently published research questions the need for the advised restriction against the use of soyfoods by women with a history of breast cancer.

In the HERA trial, benefit for invasive lobular breast cancer patients with 1 year of trastuzumab maintenance was similar to invasive ductal carcinoma patients.

A study confirmed that PIK3CA mutations negatively affect survival in patients with HER2-positive breast cancer treated with the anti-HER2 therapy trastuzumab.

The US Preventive Services Task Force, an influential panel of experts, said that women at high risk for breast cancer should consider taking breast cancer drugs to decrease their risk.

Hypofractionated external beam WBI seems like a great option until the APBI data mature from NSABP 39/RTOG 0413. In the meantime, we will have to see whether the ACA’s mission to bend the cost curve in the face of added demand for cancer care will succeed and how our treatment decisions will be affected by this new healthcare model.

APBI is a technique that offers women with early-stage breast cancer a choice. The preponderance of evidence supports the efficacy and safety of this technique, and it should continue to be offered to appropriately selected patients on and off protocol.

Accelerated partial-breast irradiation is a shorter, alternative radiation technique for select patients with favorable early-stage breast cancer. We review here the different modalities of delivery and discuss the possible benefits and harms associated with these treatments.

The use of estrogen plus progestin in postmenopausal women has once again been linked to an increased risk for breast cancer, according to the results from a Women’s Health Initiative observational cohort study, especially among women who initiated hormone therapy closer to menopause.

Trastuzumab (Herceptin) therapy may be useful for the treatment of luminal breast cancer stem cells, preventing them from growing into macrometastases, according to preclinical results presented at the 2013 American Association for Cancer Research Annual Meeting.

Washington, DC-“Triple-negative breast tumors are composed of mosaic cancer cells with distinct genetic aberrations,” said Jorge S. Reis-Filho, MD, PhD, a surgical pathologist at the Memorial Sloan-Kettering Cancer Center in New York, who combines traditional pathology, gene expression profiling, and genomics techniques to understand rare breast tumor types, including triple-negative diseases.

Researchers participating in the phase III EMILIA trial have identified tumor biomarkers that can identify patients that are more likely to benefit from T-DM1. In the trial, women whose tumors had higher HER2 expression were most likely to benefit from the therapy.

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.