Breast Cancer

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Two new studies reported at this year’s ASCO meeting demonstrated the effect of a new class of targeted therapy called poly (ADP-ribose) polymerase (PARP) inhibitors on traditionally difficult-to-treat breast cancers-so-called “triple-negative” breast cancer and BRCA1/2-deficient breast cancers.

Many women have turned to natural forms of hormone replacement for menopause since learning that conventional hormone replacement therapy (HRT) may increase their risks of breast cancer and other health problems. Most women have assumed that “natural” or “bioidentical” HRT is safer than conventional HRT. However, recent research has shown that this is not the case and that, in fact, the risks are probably similar.

The American Civil Liberties Union and the Public Patent Foundation at Benjamin N. Cardozo School of Law filed a lawsuit charging that patents on two human genes associated with breast and ovarian cancer stifle research that could lead to cures and limit women’s options regarding their medical care.

Breast cancer is the most common cancer in women, with over 180,000 new diagnoses of invasive disease annually in the United States, based on recent estimates.[1] Despite advances in therapy, over 40,000 women still die of breast cancer each year in the US.[1] While most women with breast cancer present with early-stage, potentially curable disease, young women face higher risks of recurrence and death compared to older women, which leads to challenges in selecting the optimal treatment strategy for these patients. The clinician is typically confronted with an otherwise healthy patient facing a life-threatening disease, and we are inclined to offer therapies with maximal benefit and minimal longterm toxicity, in the face of frequently inadequate or evolving data on how to achieve this.

Asian-American women who consumed large amounts of soy as children have a 58% reduced risk of breast cancer, according to a study conducted at National Cancer Institute’s Clinical Genetics Branch.

The majority of postmenopausal breast cancer patients have tumors that express hormone receptors, so advances in endocrine therapy are clearly important. The optimal use of an expanding array of agents is the subject of active investigation, and presentations at SABCS 2008 added insight regarding the relative efficacy of the various approaches in hormone-sensitive early breast cancer patients.

Estrogen-receptor positive advanced breast cancer patients who have become resistant to endocrine therapies can derive clinical benefit from 6-mg daily doses of estradiol, according to a phase II study from St. Louis’ Washington University .

Tumor angiogenesis, an important step in breast cancer development, invasion, progression, and metastasis, is regulated by the expression of proangiogenic factors such as vascular endothelial growth factor (VEGF).[1-6] Higher levels of VEGF expression are associated with poor clinical outcomes and decreased survival in patients with breast cancer.

One of the potential side effects of chemotherapy is cardiac toxicity. The resulting damage to the heart can range from non–life-threatening events to devastating heart failure. The spectrum of these events can occur almost immediately, during a drug infusion, or as a delayed complication later in the patient’s life. Oncology nurses not only need to be familiar with identifying and intervening in acute cardiac events, but also in some instances will need to monitor for delayed cardiac toxicities during the continuum of the patient’s life.

Ixabepilone is indicated in combination with capecitabine (Xeloda) for the treatment of patients with metastatic or locally advanced breast cancer resistant to prior anthracycline and paclitaxel treatment (or for whom this treatment is contraindicated). Anthracycline resistance is defi ned as progression within 6 months of adjuvant therapy or 3 months of treatment for metastatic breast cancer; paclitaxel resistance is defi ned as progression on therapy or within 12 months of adjuvant therapy, or 4 months of treatment for metastatic breast cancer.

In 2008, more than 184,000 new patients were diagnosed with breast cancer, the most commonly diagnosed malignancy in women in the United States. Despite great advances over the past few years in screening, detection, and treatment, more than 40,000 women died from the disease in 2008.[1] Early breast cancer is considered a curable disease, but the curative potential of patients with locally advanced or metastatic disease is limited.

The National Comprehensive Cancer Network (NCCN) has announced the addition of a survivorship section to the NCCN Clinical Practice Guidelines in Oncology for colon and rectal cancers, as well as other key updates in colorectal cancer. The NCCN also recently updated its guidelines for breast cancer and breast cancer risk reduction. These changes reflect leading developments in the treatment of cancer patients and represent the standard of clinical policy in oncology in both community and academic settings.

A recently published study in The New England Journal of Medicine (360:679-691, 2009) shows that in premenopausal women with early breast cancer, administering zoledronic acid (Zometa) along with postsurgical hormone therapy provided a reduction in risk of recurrence or death that was 36% beyond that achieved with hormone therapy alone.