Breast Cancer

Data published recently in the Journal of the American Medical Association showed that in the estrogen-alone substudy of the Women's Health Initiative (WHI), conjugated estrogens at a dose of 0.625 mg did not increase breast cancer incidence in postmenopausal women.

The Journal of Clinical Oncology has published results of a large-scale trial conducted with the National Surgical Adjuvant Breast and Bowel Project (NSABP) confirming that the Oncotype DX 21-gene panel, which quantifies the risk of breast cancer recurrence, also predicts the likelihood of response to chemotherapy in a large portion of women with early-stage breast cancer. This study successfully challenges the common assumption that

The 20th anniversary feature article on "Twenty Years of Systemic Therapy for Breast Cancer" and its reviews in the January 2006 issue of ONCOLOGY are incomplete from a global perspective. I must gently protest the suggestion that the "end of breast cancer as a serious cause of human mortality is now in sight."

During the past 18 months, researchers have developed substantial evidence supporting the notion that stem cells play a critical role in the development of at least some cancers, their progression, and the prognosis of patients, including breast, brain, lung, and prostate cancer, multiple myeloma, and melanoma.

A survey of 121 breast cancer patients attending a breast cancer clinic found that 59% had received their "bad news" diagnosis over the telephone (mainly in their local area). Brianna J. Crawford, research coordinator at the Breast Diagnostic and Cancer Clinic, Mayo Clinic, Rochester, Minnesota, reported the study results in a poster session at the American Psychosocial Oncology Society (APOS) Third Annual Conference (P14-3).

Postmenopausal breast cancer patients given the intravenous bisphosphonate zoledronic acid (Zometa) twice a year at the start of adjuvant therapy with the aromatase inhibitor letrozole (Femara) had significantly increased bone mineral density (BMD) at 12 months, compared with a delayed-therapy group. Nigel Bundred, MD, of University Hospital, South Manchester, UK, presented the findings at the 5th European Breast Cancer Conference (EBBC) (abstract 12).

Raloxifene (Evista, Eli Lilly) has proven as effective as tamoxifen in reducing the risk of invasive breast cancer in postmenopausal women who are at increased risk of the disease. Initial findings from the Study of Tamoxifen and Raloxifene (STAR) showed that both drugs reduced breast cancer risk by about 50% but that patients in the raloxifene arm had 36% fewer uterine cancers and 29% fewer blood clots than those on tamoxifen.

STAR Trial Shows Raloxifene to Be as Effective as Tamoxifen in Preventing Invasive Breast Cancer

Twenty years ago, antiestrogen therapy with tamoxifen played only a secondary role in breast cancer care. All hopes to cure metastatic breast cancer were still pinned on either the discovery of new cytotoxic drugs or a dose-dense combination of available cytotoxic drugs with bone marrow transplantation. A similar strategy with combination chemotherapy was employed as an adjuvant for primary breast cancer. Simply stated, the goal was to kill the cancer with nonspecific cytotoxic drugs while keeping the patient alive with supportive care. However, medical research does not travel in straight lines, and an alternative approach emerged to solve the problem of controlling tumor growth with minimal side effects: targeted therapy. The approach of using long-term antihormone therapy to control early-stage breast cancer growth would revolutionize cancer care by targeting the tumor estrogen receptor (ER). The success of the strategy would contribute to a decrease in the national mortality figures for breast cancer. More importantly, translational research that targeted the tumor ER with a range of new antiestrogenic drugs would presage the current fashion of blocking survival pathways for the tumor by developing novel targeted treatments. But a surprise was in store when the pharmacology of "antiestrogens" was studied in detail: The nonsteroidal "antiestrogens" are selective ER modulators—ie, they are antiestrogens in the breast, estrogens in the bone—and they lower circulating cholesterol levels. This knowledge would establish a practical approach to breast cancer chemoprevention for women at high risk (tamoxifen) and low risk (raloxifene).

The Breast Cancer International Research Group (BCIRG) and the Sanofi-Aventis group announced the results from the first interim efficacy and updated safety analyses from the BCIRG 006 phase III breast cancer study, which show that trastuzumab (Herceptin) combined with docetaxel (Taxotere)-based regimens significantly improved disease-free survival for women with early HER2-positive breast cancer.

Surveillance screening for colon and breast cancer appears to diminish 5 years after the original diagnosis.

Two analyses from the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) MA.17 letrozole (Femara) trial strongly support the ability of this aromatase inhibitor to significantly reduce disease recurrence among postmenopausal women previously treated with tamoxifen.

Ten-year results from the TAM-01 trial indicate that maximal benefits of tamoxifen are achieved within 5 to 6 years of treatment.

The National Cancer Institute (NCI) has begun the largest, most comprehensive effort to identify genetic risk factors for two major cancers, a 3-year initiative aimed at deciphering which genetic alterations put people at increased risk of developing breast and prostate cancer.

Biopsy remains the gold standard for diagnosing breast cancer in women whose mammograms or physical exams yield abnormal findings, according to a new federal report

Two studies presented at the 28th Annual San Antonio Breast Cancer Symposium suggest researchers are getting closer to developing patient-specific prognostic assays for breast cancer recurrence.

Researchers have found that mammography coupled with magnetic resonance imaging (MRI) is extremely sensitive in the detection of ductal carcinoma in situ (DCIS).

Marked reductions in breast cancer recurrence were achieved with a shorter standard adjuvant chemotherapy regimen, augmented by weekly doses of paclitaxel, in a study by the Spanish Group for Breast Cancer Research, the GEICAM 9906 trial, presented at the 28th Annual San Antonio Breast Cancer Symposium (abstract 39).

The first comprehensive assessment of cancer care quality in the United States indicates adherence to recommended care for patients with breast or colorectal cancer is excellent overall, but specific areas need improvement. Overall, breast cancer patients received 86% of generally recommended care, based on 36 quality-care measures. Patients with colorectal cancer received 78% of generally recommended care, based on 25 quality-care measures.

Adjuvant dose-dense chemotherapy for breast cancer was validated by the updated results of Intergroup C9741, most notably in women with estrogen-receptor (ER)-negative disease.

Nine weeks of trastuzumab (Herceptin) given concurrently with single-agent docetaxel (Taxotere) or vinorelbine (Navelbine) prior to combination chemotherapy improves survival in HER2-positive breast cancer patients, compared with no trastuzumab, with the docetaxel regimen having a slight advantage over vinorelbine.

The risk for a new cancer in the unaffected breast substantially increases in women diagnosed with unilateral, hereditary (non-BRCA) breast cancer, according to a new study. Published in the March 15, 2006, issue of Cancer, the study reveals that women under age 50 diagnosed with hereditary (non-BRCA) breast cancer are at significantly greater risk for developing cancer in the other breast. Adjuvant hormonal therapy, however, reduces contralateral breast cancer risk.

Investigators at Johns Hopkins University Kimmel Comprehensive Cancer Center have begun phase I studies of intraductal chemotherapy in women with breast cancer scheduled for mastectomy. The chemotherapy agent is injected via hair-thin catheters into the milk ducts.

In patients with noninflammatory locally advanced breast cancer (LABC), hyperfractionated radiation of the chest wall does not improve clinical outcomes relative to conventional radiation, according to long-term results of a trial presented at the 47th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 2008).

Discussing decades of work in developing trastuzumab (Herceptin), and looking to the future based on techniques that led to the understanding of HER2/neu, Dennis J. Slamon, MD, PhD, presented the William L. McGuire Memorial Lecture at the 28th Annual San Antonio Breast Cancer Symposium. Dr. Slamon is director of clinical and translational research at the UCLA Jonsson Comprehensive Cancer Center.

Surgical biopsy for the initial evaluation of breast lesions should be discouraged, according to Stephen D. Edge, MD, of Roswell Park Cancer Institute, Buffalo, New York, who presented a study comparing biopsy techniques at the 28th Annual San Antonio Breast Cancer Symposium .

Use of adjuvant chemotherapy with docetaxel (Taxotere) and cyclophosphamide (TC) is associated with a 33% improvement in disease-free survival and trend for improvement in overall survival in early-stage breast cancer, compared with the standard doxorubicin (Adriamycin)/cyclophosphamide (AC) regimen, according to the final analysis of a study from US Oncology Research, Houston

Femara (letrozole, Novartis) has received FDA approval for use in treating early breast cancer in postmenopausal women following surgery. The agency based its approval on findings from the BIG I-98 study, the only trial designed to compare the safety and efficacy of Femara vs tamoxifen when used as adjuvant therapy in postmenopausal women with hormone-receptor-positive early disease.

Bevacizumab (Avastin), a monoclonal antibody targeting vascular endothelial growth factor (VEGF), conferred additional benefit to paclitaxel when the combination was used as first-line therapy in locally recurrent and metastatic breast cancer patients in the Eastern Cooperative Oncology Group (ECOG) phase III E2100 study.

When breast cancer recurs locally after breast-conserving therapy, prognosis is better for patients whose recurrence is "elsewhere" in the breast than for those whose recurrence is in the primary tumor bed, new research shows. However, regardless of the type, control of the local recurrence is the most significant predictor of subsequent distant metastasis and survival.