Breast Cancer

The decision to treat metastatic breast cancer with combination or single-agent chemotherapy may depend on the patient's and the clinician's perception and definition of the goals of such therapy, according to speakers at the 3rd Annual Oncology Congress.

By the year 2030 most patients with breast cancer will be aged 65 years or more and many will be frail. Frailty implies diminished physiologic reserve; contributors include diminished organ function, comorbidities, impaired physical function, and geriatric syndromes. Time-efficient tools for assessing frailty are being developed and, once validated, can be used to identify frail cancer patients and help direct therapy. Screening mammography in frail patients is questionable, and a clinical breast exam is likely to identify breast cancers that warrant intervention. Hormonal therapy may be a reasonable primary therapy in older frail women with hormone receptor–positive lesions. For estrogen receptor– and progesterone receptor–negative lesions, excision of the primary tumor may be adequate. Adjuvant hormonal therapy may be appropriate in frail elders with high-risk hormone receptor–positive breast cancer; chemotherapy is rarely indicated regardless of tumor status. The majority of frail elders with metastases will have hormone receptor–positive breast cancers, and endocrine therapy should be considered; those with receptor-negative tumors may be treated with single-agent chemotherapy or supportive care measures. Oncologists need to acquire the skills to appropriately identify frail elders so they select appropriate therapies that will minimize toxicity and maintain quality of life.

Women who live in urban areas have denser breasts, making them more likely to develop breast cancer, according to a study presented recently at the annual meeting of the Radiological Society of North America (RSNA).

By the year 2030 most patients with breast cancer will be aged 65 years or more and many will be frail. Frailty implies diminished physiologic reserve; contributors include diminished organ function, comorbidities, impaired physical function, and geriatric syndromes. Time-efficient tools for assessing frailty are being developed and, once validated, can be used to identify frail cancer patients and help direct therapy. Screening mammography in frail patients is questionable, and a clinical breast exam is likely to identify breast cancers that warrant intervention. Hormonal therapy may be a reasonable primary therapy in older frail women with hormone receptor–positive lesions. For estrogen receptor– and progesterone receptor–negative lesions, excision of the primary tumor may be adequate. Adjuvant hormonal therapy may be appropriate in frail elders with high-risk hormone receptor–positive breast cancer; chemotherapy is rarely indicated regardless of tumor status. The majority of frail elders with metastases will have hormone receptor–positive breast cancers, and endocrine therapy should be considered; those with receptor-negative tumors may be treated with single-agent chemotherapy or supportive care measures. Oncologists need to acquire the skills to appropriately identify frail elders so they select appropriate therapies that will minimize toxicity and maintain quality of life.

10 notable developments and events in cancer research and care

A growing number of novel antiangiogenic agents are entering clinical trials to study their clinical safety and efficacy. A few, such as bevacizumab (Avastin), sorafenib (Nexavar), and sunitinib (Sutent), have received US Food and Drug Administration approval and are already in widespread clinical use. As knowledge about the intricacies of intracellular signaling within multiple tumor types expands, agents with the capacity to impact these pathways are being incorporated into additional clinical trials alone and in combination with other targeted and/or traditional antineoplastic agents. Early clinical trials have focused on highly vascular tumor types, as well as those known to significantly overexpress the VEGF (vascular endothelial growth factor) receptor family. This article aims to review the status of antiangiogenic therapy in selected tumor types and discuss areas for further research.

US Food and Drug Administration (FDA) has granted approval of ixabepilone (Ixempra) as monotherapy for the treatment of patients with metastatic or locally advanced breast cancer in patients whose tumors are resistant or refractory to anthracyclines, taxanes, and capecitabine (Xeloda)

FDA has approved Bristol-Myers Squibb's Ixempra (ixabepilone) for treatment of resistant or refractory metastatic or locally advanced breast cancer.

ASCO has added the Oncotype DX gene expression assay to its updated guideline for the use of tumor markers in breast cancer

Clinical trials have shown significant improvements in disease-free survival when trastuzumab (Herceptin) is added to standard adjuvant chemotherapy in HER2-positive breast cancer patients, but is it appropriate for all such patients, specifically low-risk patients with tumors 1 cm or smaller in size?

A widely publicized study shows that paclitaxel administered after adjuvant chemotherapy with doxorubicin plus cyclophosphamide (AC-T) provides no or only slight benefit to women with HER2-negative, ER-positive, node-positive breast cancer.

A surprisingly high percentage of women with breast cancer who start adjuvant therapy with an aromatase inhibitor stop taking these drugs because of associated musculo-skeletal side effects

For clinicians, MRI may offer a more in-depth view than mammography for planning surgery and screening for contralateral breast cancers, but does use of MRI actually benefit patients?

A new study shows that more women with unilateral breast cancer are electing to have the other breast removed as well.

The treatment of primary breast cancers by cryoablation could offer a cosmetically appealing alternative to surgical lumpectomy if outcomes prove equivalent

Increasing experience with magnetic resonance imaging (MRI) has raised important questions about how it should be used in breast cancer screening, and for presurgical evaluation and posttherapy follow-up of women with this disease. Overall, the availability of MRI as an adjunct to mammography and ultrasound offers clear clinical benefit to women at increased risk of breast cancer development due to BRCA1 and BRCA2 mutations, and to women presenting with axillary adenopathy and an occult primary breast tumor. In contrast, its benefit for routine selection of breast conservation or further assessment of lobular carcinoma in women of average risk has not been demonstrated.This article reviews the use of MRI in these settings, with an emphasis on the clinical outcomes that have been observed to date.

Increasing experience with magnetic resonance imaging (MRI) has raised important questions about how it should be used in breast cancer screening, and for presurgical evaluation and posttherapy follow-up of women with this disease. Overall, the availability of MRI as an adjunct to mammography and ultrasound offers clear clinical benefit to women at increased risk of breast cancer development due to BRCA1 and BRCA2 mutations, and to women presenting with axillary adenopathy and an occult primary breast tumor. In contrast, its benefit for routine selection of breast conservation or further assessment of lobular carcinoma in women of average risk has not been demonstrated.This article reviews the use of MRI in these settings, with an emphasis on the clinical outcomes that have been observed to date.

Recently published study results in The Breast Journal indicate that breast-specific gamma imaging (BSGI) may be more specific than magnetic resonance imaging (MRI) for evaluating patients with equivocal mammographic findings.

Researchers have found that the breast cancer susceptibility gene BRCA1 plays a significant role in non-small-cell lung cancer.

Gemcitabine (Gemzar), which is approved in combination with paclitaxel (Taxol) in the first-line, postsurgical treatment of metastatic breast cancer, was the subject of a study presented at the 43rd annual meeting of the American Society of Clinical Oncology (ASCO), with encouraging results in the presurgical treatment of breast cancer.

In patients with locally advanced breast cancer, adding trastuzumab (Herceptin) to chemotherapy prior to surgery significantly increases pathologic complete response rates, compared with chemotherapy alone.

Martin D. Abeloff, MD, the chief oncologist and director of the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, died September 14, 2007, of leukemia. Dr. Abeloff, 65, an international authority on the treatment of breast cancer, was co-Editor-in-Chief of ONCOLOGY and founding Editor-in-Chief of Oncology News International.

;Breast cancer patients who skip 30% of their tamoxifen doses increase their risk of death from breast cancer by 16%, Scottish researchers reported at the first annual ASCO Breast Cancer Symposium

After 16 years conducting breast cancer research at UCLA, Mark Pegram, MD, has joined the faculty at the University of Miami Miller School of Medicine where he will collaborate with a stellar research team tackling new challenges in the field of breast cancer.

In a phase I study, 7 of 18 patients with measurable advanced breast cancer receiving sunitinib (Sutent) and paclitaxel as first-line therapy had an objective response (38.9%), including two complete responses, researchers reported at the ASCO Breast Cancer Symposium

Genentech has resubmitted a supplemental biologics license application to FDA for Avastin (bevacizumab) in combination with paclitaxel as first-line therapy for locally recurrent or metastatic breast cancer

There may be a small subset of women with DCIS who may not benefit from radiation therapy, but researchers maintain that this particular group has not yet been defined, and until they are clearly defined, radiation therapy remains the standard of care for those patients with DCIS who opt for breast-conserving surgery.

Conventional wisdom holds that DCIS consists of malignant cells that have not invaded other tissue, but László Tabár, MD, has identified subtypes that he thinks are actually invasive and merely mimic DCIS. Fragmented casting (as seen on the page 1 image) and "snakeskin-like" calcifications, appearing either alone or with a mass on the mammogram, are particularly menacing, he maintains.

Small field of view positron imaging, optimized for breast cancer, is jockeying for position among several adjuncts to x-ray mammography. A proponent of the technology, Kathy Schilling, MD, believes it has an edge over MRI.

Disease-free and overall survival have improved significantly for women diagnosed with early-stage breast cancer. At the same time, systemic therapy has only slightly enhanced long-term outcomes in advanced breast cancer, a disease that remains largely incurable. Several single-agent and combination chemotherapy approaches are available to women with hormone-insensitive advanced disease that may improve overall survival and progression-free survival, minimize symptoms and complications related to the disease, and improve overall quality of life. In addition, new cytotoxic and targeted agents have been recently introduced into practice and have improved both survival outcomes and quality of life. In this review, we will provide an update on commonly used chemotherapy-based regimens for the treatment of metastatic breast cancer, with a focus on tailoring therapy to different subtypes of the disease.