Breast Cancer

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.

Choline, an essential nutrient found in foods such as eggs, is associated with a 24% reduced risk of breast cancer, according to a study supported by a grant from the US National Institutes of Health (NIH), to be published in the Federation of American Societies for Experimental Biology (FASEB) Journal's print issue in June.This study adds to the growing body of evidence that links egg consumption to a decreased risk of breast cancer.

CPM may be a rational choice for patients with known BRCA mutations, patients who have received therapeutic chest radiation, and some mastectomy patients.

This article reviews recent findings from clinical trials of epothilones and discusses future directions for the use of these agents in cancer therapy, with a focus on the two most-studied epothilones to date: ixabepilone and patupilone.

Epothilones, representing a newer class of naturally occurring antimicrotubule macrolides, have emerged as cytotoxic agents with significant antitumor activity against tumors that are resistant to taxanes.

Ms. Donovan and Dr. Vahdat present a review of the literature on a novel class of agents, the epothilones, focusing in particular on the two most-investigated agents to date-patupilone and ixabepilone (Ixempra).

Xoft, Inc’s Axxent Electronic Brachytherapy System, initially FDA approved for accelerated partial breast irradiation in patients with resected early-stage breast cancer, has now received expanded FDA clearance for the treatment of other cancers or conditions where radiation therapy is indicated.

Pilot studies presented at the 2007 San Antonio Breast Cancer Symposium have found robust activity for the multi-targeted tyrosine kinase inhibitor sunitinib (Sutent) when given with docetaxel (Taxotere) (abstract 6079) or paclitaxel (abstract 6078) as first-line treatment for patients with advanced breast cancer.

An international team of researchers has developed a predictive model that accurately estimates which breast cancer patients may relapse after neoadjuvant endocrine therapy, Matthew Ellis, MD, PhD, said at the 2007 San Antonio Breast Cancer Symposium (abstract 62).

Digital tomosynthesis appears to be more sensitive than digital mammography for detecting breast cancer in a clinical setting, Debra M. Ikeda, MD, of Stanford University, reported at the 2007 San Antonio Breast Cancer Symposium (abstract 46).

About one-third of metastatic breast cancer patients with HER2 overexpression develop metastases to the brain, compared with 5% to 20% of the general metastatic breast cancer population, according to findings from a large observational study in newly diagnosed HER2-positive breast cancer.

Among women at high risk for breast cancer, screening with magnetic resonance imaging is clearly cost-effective in those with BRCA 1/2 mutations but somewhat less so in those whose elevated risk is due to other factors, according to a new study.

Circulating tumor cells (CTCs) can help stratify patients with metastatic breast cancer in terms of likely survival and should therefore be considered for incorporation into the current AJCC staging system, according to a study presented at the 2007 San Antonio Breast Cancer Symposium (abstract 111).

The patient, DB, is a 47-year-old woman who has been married 24 years. Her daughter is away at college and her son is a high school senior. Last summer, DB was diagnosed with invasive ductal carcinoma of the breast. She had one positive lymph node with an estrogen receptor/progesterone receptor strongly positive tumor.

The patient, KC, is a 41-year-old Caucasian female. She has been married to SC for 16 years and has three children, aged 14, 11, and 9 years old. She has always been a homemaker with plenty of energy and says that she has been “the rock” during any crisis. KC was diagnosed with T2N1M0 poorly differentiated invasive ductal carcinoma of the breast with lobular features in 2007. She decided to have a mastectomy without immediate reconstruction because she did not know if reconstruction was what she wanted. She has also undergone four courses of chemotherapy (doxorubicin [Adriamycin] and paclitaxel [Taxol]) followed by radiation therapy.

The patient, RJ, a 61-year-old female, was diagnosed with stage IIIA, hormone-positive, HER2-negative infiltrating ductal breast cancer 4 years ago. Following a lumpectomy and axillary node dissection, she was treated with systemic chemotherapy, radiation therapy, and hormonal therapy with an aromatase inhibitor. At her 3-year follow-up visit, she complained of a persistent cough, dyspnea, and vague bone pain in her lower back and hips. Staging diagnostic exams revealed several pulmonary nodules and multiple bone metastases, primarily in the bilateral hips, left ribs, and left femur.

TOP2A FISH pharmDx assay has received FDA approval for use as an adjunct to existing clinical and pathological information in determining the prognosis for patients with relatively high-risk breast cancer.

Four-year follow-up of the French/Belgian PACS-04 trial in early breast cancer found a trend toward benefit with sequential trastuzumab (Herceptin) in the first 18 months but, somewhat surprisingly, no difference in disease-free survival at 4 years. Marc Spielmann, MD, of the Institute Gustave Roussy, Villejuif, France, reported the findings at the 2007 San Antonio Breast Cancer Symposium (abstract 72).

FDA has given Genentech's antiangiogenesis agent Avastin (bevacizumab) accelerated approval for use in combination with paclitaxel for the first-line treatment of metastatic HER2-negative breast cancer.

In one of the most ambitious clinical trial efforts to date, a phase III study involving 8,000 participants in 50 countries across six continents will provide a head-to-head comparison of trastuzumab (Herceptin) and lapatinib (Tykerb) in HER2-positive patients with early-stage breast cancer who have recently completed chemotherapy.

The HER2-positive breast cancer population appears to be a heterogeneous group with a wide variation in response to trastuzumab (Herceptin). Higher levels of HER2 expression as well as HER2:HER2 dimerization were independently correlated with high response rates and longer time to progression in a study reported at the 2007 San Antonio Breast Cancer Symposium (abstract 2007).

In the neoadju-vant setting, adding the investigational agent RAD001 (everolimus) to letrozole (Femara) improves antitumor activity in breast cancer patients, with a tradeoff of some increased toxicity, according to results presented at the San Antonio Breast Cancer Symposium (abstract 2066).