Your AI-Trained Oncology Knowledge Connection!
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.
One of the primary challenges in the treatment of patients with early-stage breast cancer is determining which patients will benefit from adjuvant chemotherapy. Traditionally, treatment decisions have been made based on a combination of tumor characteristics and patient and physician perspectives regarding risks and benefits. Recent technologic advances, including the development of gene-expression arrays, have led to the identification of molecular signatures that provide prognostic information in addition to the basic clinicopathologic features of individual tumors. While these new methods allow for more refined determination of prognosis for an individual patient, few data are available to support use of these new technologies in the clinic for treatment decision-making. At present, data from a single retrospective study are available to support the use of one assay, the 21-gene recurrence score, for decision-making regarding adjuvant chemotherapy. Large, multinational clinical trials are currently ongoing to evaluate the use of two of the multiparameter assays, although it will be many years before oncologists can apply the results of these trials in the clinic.
In general, metastatic breast cancer (MBC) is treated systemically using chemotherapy, hormonal therapy, and newer targeted therapies when appropriate. About 75% of breast cancers test positive for estrogen receptors (ER) and progesterone receptors (PR), and estrogen stimulation of these receptors plays an important role in the proliferation of these tumors.
One of the primary challenges in the treatment of patients with early-stage breast cancer is determining which patients will benefit from adjuvant chemotherapy. Traditionally, treatment decisions have been made based on a combination of tumor characteristics and patient and physician perspectives regarding risks and benefits. Recent technologic advances, including the development of gene-expression arrays, have led to the identification of molecular signatures that provide prognostic information in addition to the basic clinicopathologic features of individual tumors. While these new methods allow for more refined determination of prognosis for an individual patient, few data are available to support use of these new technologies in the clinic for treatment decision-making. At present, data from a single retrospective study are available to support the use of one assay, the 21-gene recurrence score, for decision-making regarding adjuvant chemotherapy. Large, multinational clinical trials are currently ongoing to evaluate the use of two of the multiparameter assays, although it will be many years before oncologists can apply the results of these trials in the clinic.
One of the primary challenges in the treatment of patients with early-stage breast cancer is determining which patients will benefit from adjuvant chemotherapy. Traditionally, treatment decisions have been made based on a combination of tumor characteristics and patient and physician perspectives regarding risks and benefits. Recent technologic advances, including the development of gene-expression arrays, have led to the identification of molecular signatures that provide prognostic information in addition to the basic clinicopathologic features of individual tumors. While these new methods allow for more refined determination of prognosis for an individual patient, few data are available to support use of these new technologies in the clinic for treatment decision-making. At present, data from a single retrospective study are available to support the use of one assay, the 21-gene recurrence score, for decision-making regarding adjuvant chemotherapy. Large, multinational clinical trials are currently ongoing to evaluate the use of two of the multiparameter assays, although it will be many years before oncologists can apply the results of these trials in the clinic.
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.
The patient, DB, is a 51-year-old white, married female with a strong family history of breast cancer. She presented for high-risk assessment and genetic testing following the discovery of a deleterious mutation in a family member.
Overall survival of Hodgkin lymphoma (HL) is 90%; however, survival decreases with time owing to late complications, including subsequent malignancy. Female survivors of pediatric HL have increased morbidity and mortality associated with secondary effects of radiation therapy, most specifically the development of secondary breast cancer. It is estimated that female HL survivors have a 35- to 75-fold excess risk of developing breast cancer, with the greatest risk occurring 15 to 20 years after initial diagnosis. This risk time frame is more than 20 years before the median age (61 years) of breast cancer diagnosis among the general population. This equates to an HL survivor reaching the cumulative lifetime incidence of breast cancer by 40 years of age when compared with the general population.
s. L is a married 41-year-old woman with recently diagnosed stage I breast cancer. She comes to her oncologist's office for a routine visit following her third cycle of preoperative doxorubicin hydrochloride (Adriamycin) and cyclophosphamide (Cytoxan). Ms. L's major complaint is fatigue. The oncologist had started Ms. L on paroxetine (Paxil), a selective serotonergic reuptake inhibitor (SSRI), at 20 mg qhs 2 months earlier because of concerns that Ms. L might be depressed, based on her complaints about depressed mood, difficulties sleeping, and other depressive symptoms.
In a breast cancer screening population, magnetic resonance imaging (MRI) was more effective than mammography in detecting ductal carcinoma in situ (DCIS), especially high-grade lesions that are most likely to progress
As a first-line treatment of advanced breast cancer, the combination of bevacizumab (Avastin) and capecita-bine (Xeloda) was moderately active in the phase II XCALIBr trial
Lapuleucel-T (Neuvenge, Dendreon Corporation), an autologous active cellular immunotherapy designed to stimulate cellular immune responses against HER2/neu, proved feasible and well tolerated with evidence of anticancer activity in a phase I trial.
The future of breast cancer therapies will involve agents targeting multiple aspects of the signaling pathway. At ASCO 2007, investigators reported encouraging preliminary activity for numerous agents in the pipeline.
In the late 1980s, based on limited studies, high-dose chemotherapy with autologous bone marrow transplantation (HDCT/ABMT) emerged as a prominent procedure in the treatment of metastatic and early-stage breast cancer. Subsequent randomized clinical trials showed that HDCT/ABMT had no benefit, compared with standard chemotherapy; however, in the interim, some 30,000 women had undergone unnecessary treatment.
It was a serendipitous discovery, indeed. Tan A. Ince, MD, PhD, of Harvard Medical School, set out to develop a breast cancer cell line with cells that looked more like the actual disease under a microscope and behaved more like cancer cells in patients. Instead, he created a line of extraordinarily potent cancer stem cells
Recent data suggest that HER2 positivity predicts for the development of CNS metastases in breast cancer patients. Studies presented at the ASCO 2007 annual meeting found that risk of brain metastases is indeed increased in HER2-positive patients but does not appear to compromise survival.
It may soon be possible to determine which breast cancer patients will respond to adjuvant endocrine therapy, based on the level of cell-cycle response in the surgical specimen after neoadjuvant endocrine therapy
I will never forget the moment when I first found out about my wife's breast cancer. She had noticed an abnormal thickening in her breast and even though we were spending most of our attention focused on an adenoma on the opposite side, the surgeon felt that a biopsy would be prudent. It was a Monday morning, and I was at my desk. Because of my position within our institution, I happened to be on the distribution list of my wife's pathology report. However, before I got to that point in the mail, my close colleague came to my office to notify me of her diagnosis of invasive breast cancer.
Approximately 212,920 new cases of invasive breast cancer were estimated to occur in the United States in 2006.1 The incidence rate has continued to rise slowly over the past 20 years due to the continued increase of breast cancer in women aged 50 and older (375 cases per 100,000 women), peaking at 75 to 79 years of age (525 per 100,000 women).
