Breast Cancer

Celebrating 20 years of providing practical reviews and peer commentaries to the oncology community in an effort to promote optimal cancer education and quality care for persons with cancer

Anthracycline- and taxane-based adjuvant chemotherapy regimens have become the most commonly used regimens in the United States for high-risk, early-stage breast cancer. Growth factor support is an essential component of therapy for several of the most commonly used adjuvant chemotherapy regimens that frequently cause substantial myelosuppression and anemia. Extensive data now exist to demonstrate the efficacy of both long- and short-acting myeloid growth factors in patients receiving dose-dense AC → paclitaxel. This article will explore prophylactic use of both filgrastim (Neupogen) and pegfilgrastim (Neulasta) in recent clinical trials.

Up to 25% of patients diagnosed with breast cancer have tumors that overexpress HER2. HER2-positive breast cancer is highly proliferative, difficult to treat, and confers a poor prognosis. The advent of the anti-HER2 monoclonal antibody trastuzumab (Herceptin) has markedly altered the clinical course of both early and advanced HER2-driven breast cancer. Despite the use of trastuzumab, however, patients with HER2-positive breast cancer still experience disease progression. Overcoming that resistance to therapy is our next challenge. This review examines the current understanding of HER2 biology, the mechanisms of action of and resistance to trastuzumab, as well as new therapies on the horizon.

Grade 3 and 4 neutropenia as well as febrile neutropenia have been demonstrated to occur in all tumor types and are clearly associated with major morbidity and significant mortality; this is particularly true when myelosuppressive regimens are used with curative intent as is the case in most breast cancer and non-Hodgkin's lymphoma regimens. Myeloid colony-stimulating factors (CSFs) substantially decrease the risk of severe and febrile neutropenia. Although the white cell growth factors might not be cost-effective at lower risks of febrile neutropenia, they clearly benefit other outcomes such as the incidence of severe neutropenia and febrile neutropenia, hospitalization, and mortality. Updated guidelines from the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the European Organisation for Research and Treatment of Cancer now recommend primary prophylaxis or first-cycle use of white cell growth factors with regimens where the occurrence of febrile neutropenia is approximately 20% (as well as when other risk factors are present). This article briefly describes the rationale for the development of several of the guideline changes as well as highlights some of the ongoing issues related to the use of CSFs.

Gene expression arrayshave extended the identification ofmolecular subtypes of breast cancerbeyond the presence or absence of theestrogen receptor (ER) and revealed themultiplicity of diseases within the breastcancer umbrella that have different prognoses.

White women havea higher incidence of breast cancer thanAfrican-American women, but African-American women develop the disease ata younger age, are diagnosed later, andare more likely to die of the disease, accordingto the National Cancer Institute.

The oral small-molecule lapatinib (Tykerb), a reversible dual tyrosine kinase inhibitor of HER1 (epidermal growth factor) and HER2 receptors (see mechanism of action image on page 1), produced clinical responses in some women with inflammatory breast cancer (IBC), a rare but aggressive form of the disease that is not usually detected by mammograms or ultrasound.

There is a role forultrasound in breast cancer screening anddiagnosis, but many physicians do notseem to know what it is, according toAnnette Brown, MD, a radiologist in theMammography Division of Long IslandCollege Hospital in Brooklyn. A

Although mastectomy is the preferred method of treatment for most patients with local recurrence of breast cancer in the preserved breast, repeat breast-conserving surgery followed by partial-breast radiotherapy is “generating a lot of excitement,” Seema A. Khan, MD, said at the 8th Annual Lynn Sage Breast Cancer Symposium.

Adding trastuzumab (Herceptin) to anastrozole (Arimidex) as adjuvant therapy for postmenopausal women with so-called copositive (hormone-receptor-positive, HER2-positive) metastatic breast cancer signficantly improved progression-free survival (PFS), compared with anastrozole alone, according to a study presented at the 31st Congress of the European Society for Medical Oncology (ESMO) (Late Breaking Abstract 2).

Trials in the past decade offer the first evidence that some of the most prevalent cancers in the population are preventable, and a host of ongoing trials are testing new prevention strategies, Peter Greenwald, MD, DrPH, director of the National Cancer Institute's Division of Cancer Prevention, said at the 50th Annual Meeting of the Southwest Oncology Group (SWOG).

Aromatase inhibitors (AIs) have an unquestioned role to play in the treatment of postmenopausal women with breast cancer, but there is no single best approach for their use in all patients, Eric Winer, MD, said at the 8th Annual Lynn Sage Breast Cancer symposium.

BioLucent, Inc. has received 510(k)clearance from the FDA for its SAVIapplicator. The SAVI device offersa multicatheter, single-entry approachto breast brachytherapy.

A multinationalphase II study, known as CHAT,has shown that a three-drug combinationincluding docetaxel (Taxotere),trastuzumab (Herceptin), and capecitabine(Xeloda) provides significantlylonger time to progression (TTP) and atrend toward longer progression-free survival,compared with docetaxel plustrastuzumab, in patients with HER2-positivemetastatic breast cancer.

So-called "DES daughters," born to mothers who used the antimiscarriage drug diethylstilbestrol (DES) during pregnancy, are at a substantially greater risk of developing breast cancer compared to women who were not exposed to the drug in utero.

Cytogen Corporation recently announced that Soltamox (tamoxifen citrate, oral solution 10 mg/5 mL), the first liquid form of the hormonal breast cancer therapy tamoxifen, is currently being introduced in the United States and is available in US pharmacies nationwide.

Women who reported the highest levels of physical activity in the year before they were diagnosed with breast cancer may have higher survival

The science supporting molecularly targeted therapies for the treatment of patients with solid tumors continues to evolve. Nurses are challenged to understand cell signaling, molecular targeting, and the mechanism of action of targeted agents. Two cell signal transduction pathways regulate the development, proliferation, and metastasis of solid tumors: the human epidermal growth factor (HER) receptor pathway and the vascular endothelial growth factor (VEGF) receptor pathway. Several novel pharmacologic agents with distinct indications and methods of administration target the HER and VEGF molecular pathways.

a brief overview of the dosing and administration guidelines for the various targeted therapy agents discussed in this supplement to the ONCOLOGY Nurse Edition. Please consult the manufacturer's package insert for more information.

Attendees at the 42nd Annual Meeting of the American Society of Clinical Oncology were eager to learn whether calcium and vitamin D supplementation has beneficial effects on breast cancer, mammograms, and arthralgias.

The risk reduction for breast and ovarian cancer associated with salpingo-oophorectomy (SO) in high-risk women varies according to the type of BRCA mutation,

GlaxoSmith-Kline (GSK) has announced the submission of a New Drug Application to the US Food and Drug Administration (FDA) for approval to market Tykerb (lapatinib ditosylate), in combination with capecitabine (Xeloda), for the treatment of advanced or metastatic HER2-positive breast cancer

The Oncologic Drugs Advisory Committee (ODAC) has recommended that FDA work with Abraxis Bioscience to design a well-controlled, randomized, reasonably sized clinical trial of Abraxane-paclitaxel protein-bound particles for injectable suspension (albumin bound)—to support a future supplemental application for the drug as an alternative to standard paclitaxel (Taxol) in the adjuvant treatment of node-positive breast cancer.

a new treatment model for breast cancer to reverse the eventual development of resistance to antiestrogen therapy, including an intriguing strategy that involves the use of very small doses of estrogen itself

Results of the multicenter Italian phase III Taxit 216 trial show marginally better disease-free survival (DFS) with the addition of sequential docetaxel (Taxotere) to standard epirubicin→CMF (cyclophosphamide/methotrexate/fluorouracil) as adjuvant treatment for high-risk early breast cancer, with acceptable toxicity.