ONCOLOGY Vol 20 No 9 | Oncology

Gene Screen for Breast Cancer Better Than Pathologist's 'Eye'

August 01, 2006

Johns Hopkins scientists have found that a method they developed to screen body fluids for certain kinds of cells and some of their genetic blueprint is twice as accurate at spotting breast cancer cells as a pathologist's view with a microscope.

First-Line Pemetrexed Studied in Metastatic Breast Cancer

August 01, 2006

At the 42nd American Society of Clinical Oncology (ASCO) annual meeting in Atlanta, Eli Lilly and Co announced results of a phase II trial evaluating its thoracic cancer drug pemetrexed (Alimta) in first-line treatment of metastatic breast cancer.

Commentary (Lipton): Aromatase Inhibitors and Bone Loss

August 01, 2006

The aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.

Enhanced Breast MRI System Shows Promise in Early Detection and Treatment of Breast Cancer

August 01, 2006

Researchers from Florida Atlantic University, the Center for Breast Care at the Women's Center at Boca Raton Community Hospital, and MeVis, the Center for Diagnostic Systems and Visualization at the University of Breman, Germany, have developed new techniques to aid clinicians in the diagnosis and treatment of breast cancer.

LED Photomodulation Reduces Skin Damage From Radiation Therapy in Breast Cancer Patients

August 01, 2006

Dr. Maitland DeLand, a radiation oncologist at LSU School of Medicine, New Orleans, and president of OncoLogics, Inc, in Lafayette, La, has found that following radiotherapy for breast cancer, exposing women to low-energy nonthermal light-emitting diode (LED) photomodulation can significantly reduce painful, treatment-interrupting skin reactions.

Commentary (Chlebowski): Aromatase Inhibitors and Bone Loss

August 01, 2006

The aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.

Grant Awarded to Test Effect of Tibetan Yoga on Women With Breast Cancer

August 01, 2006

Researchers at The University of Texas M. D. Anderson Cancer Center, Houston, have received a $2.4 million grant from the National Cancer Institute to study the effects of Tibetan yoga in women with breast cancer who are undergoing chemotherapy.

Serum HER2/neu Change Predicts Clinical Outcome to Trastuzumab-Based Therapy

August 01, 2006

Bayer HealthCare announced findings from a study using Bayer Diagnostics' serum HER2/neu test that demonstrated metastatic breast cancer patients whose serum HER2/neu levels decreased by less than 20% experienced decreased benefit from trastuzumab (Herceptin)-based therapy.

Switching From Tamoxifen to Exemestane Extends Survival in Early Breast Cancer

August 01, 2006

Researchers from the Intergroup Exemestane Study have shown for the first time that postmenopausal women with early-stage breast cancer who switched to the drug exemestane (Aromasin) after taking tamoxifen for 2 to 3 years following initial treatment had a 15% lower risk of dying than those who continued to take tamoxifen.

Systemic Treatment of Breast Cancer

August 01, 2006

Over the past 20 years we have witnessed the emergence of a new generation of aromatase inhibitors as valuable antiestrogens in the management of both advanced and early-stage breast cancer. In addition, the list of cytotoxic chemotherapeutic agents useful in the control of breast cancer has grown considerably. The emergence of anthracyclines was a major chemotherapeutic step forward in the 1980s, and the taxanes have clearly been the agents with the greatest impact on breast cancer treatment over the past decade. The end of the past 2 decades has been characterized by a greater understanding of the molecular biology of breast cancer, rational drug design, and the development of agents that disrupt specific cellular targets and pathways. The development of better prognostic and predictive assays that employ a panel of genes involved in the malignant and metastatic phenotype promises to allow clinicians to better select patients who could forgo adjuvant chemotherapy. Finally, adjunctive and supportive therapy of breast cancer has evolved substantially over the past 20 years. This review will highlight some of the landmark accomplishments during this time, and offer a glimpse at where we might be 20 years from now.

Commentary (Berenson/Yeh): Osteonecrosis of the Jaw in Cancer Patients Receiving IV Bisphosphonates

August 01, 2006

Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past few years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate therapy but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. The condition involves exposed bone of the maxilla or mandible. Although it is often associated with a recent dental surgical procedure, spontaneous ONJ can also occur. Patients commonly present with symptoms. Through case reporting and clinical experience, there is a suggestion that the incidence of ONJ in patients with cancer receiving intravenous bisphosphonates ranges between 1% and 10%. Management of ONJ focuses on maximizing oral health, conservative actions with mouth rinses, antibiotics, and avoidance of unnecessary invasive dental procedures. The currently available data on ONJ are reviewed here.

Boosting Killer Cells Might Improve Breast Cancer Drug

August 01, 2006

Preliminary research suggests that the substance interleukin (IL)-21 might improve the effectiveness of the drug trastuzumab (Herceptin) in treating HER2-positive breast cancer. Laboratory and animal study findings suggest that this happens because the IL-21 boosts the cancer-killing activity of immune cells called natural killer (NK) cells, which attack the tumor.

Cancer Risk Reduction With Ovary Removal Varies According to Type of BRCA Mutation

August 01, 2006

A long-term, multicenter study has shown that the reduction in breast and ovarian cancer risk resulting from oophorectomy&#151;the removal of the ovaries and fallopian tubes in women at genetically high risk for these diseases&#151;varies according to the type of genetic mutation present. Specifically, women with mutations in the BRCA1 gene have a greater reduction in ovarian cancer risk following the surgery, while those with BRCA2 mutations have a larger decrease in breast cancer risk. The study results were presented in Atlanta at the American Society of Clinical Oncology annual meeting.

HERA Trial Follow-up Continues to Demonstrate Significant Patient Benefits From Herceptin

August 01, 2006

New 23-month follow-up data from the HERceptin Adjuvant (HERA) study, one of the largest breast cancer trials ever carried out, show that trastuzumab (Herceptin) following standard chemotherapy significantly reduced the risk of death by 34% for women with early-stage HER2-positive breast cancer.

A STAR Is Born

August 01, 2006

The Study of Tamoxifen and Raloxifene (STAR) compared and contrasted the efficacy and side effects of tamoxifen, the established agent, with raloxifene (Evista)&#151;a medicine that is currently used for the prevention of osteoporosis in high-risk postmenopausal women, but also reduces the incidence of breast cancer.

Commentary (Misra/Kimmick): Managing Early-Stage Breast Cancer in Your Older Patients

August 01, 2006

As the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.

Commentary (Mortimer): Managing Early-Stage Breast Cancer in Your Older Patients

August 01, 2006

As the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.

Managing Early-Stage Breast Cancer in Your Older Patients

August 01, 2006

As the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.

Aromatase Inhibitors and Bone Loss

August 01, 2006

The aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.

Understanding Breast Cancer Management and Treatment

August 01, 2006

This month ONCOLOGY presents a special desk reference on the treatment and management of women with breast cancer, including discussion about adjuvant treatment of early disease and first-line cytotoxic chemotherapy for metastatic breast cancer.

Commentary (Dawood/Buzdar): Systemic Treatment of Breast Cancer

August 01, 2006

Over the past 20 years we have witnessed the emergence of a new generation of aromatase inhibitors as valuable antiestrogens in the management of both advanced and early-stage breast cancer. In addition, the list of cytotoxic chemotherapeutic agents useful in the control of breast cancer has grown considerably. The emergence of anthracyclines was a major chemotherapeutic step forward in the 1980s, and the taxanes have clearly been the agents with the greatest impact on breast cancer treatment over the past decade. The end of the past 2 decades has been characterized by a greater understanding of the molecular biology of breast cancer, rational drug design, and the development of agents that disrupt specific cellular targets and pathways. The development of better prognostic and predictive assays that employ a panel of genes involved in the malignant and metastatic phenotype promises to allow clinicians to better select patients who could forgo adjuvant chemotherapy. Finally, adjunctive and supportive therapy of breast cancer has evolved substantially over the past 20 years. This review will highlight some of the landmark accomplishments during this time, and offer a glimpse at where we might be 20 years from now.

Osteonecrosis of the Jaw in Cancer Patients Receiving IV Bisphosphonates

August 01, 2006

Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past few years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate therapy but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. The condition involves exposed bone of the maxilla or mandible. Although it is often associated with a recent dental surgical procedure, spontaneous ONJ can also occur. Patients commonly present with symptoms. Through case reporting and clinical experience, there is a suggestion that the incidence of ONJ in patients with cancer receiving intravenous bisphosphonates ranges between 1% and 10%. Management of ONJ focuses on maximizing oral health, conservative actions with mouth rinses, antibiotics, and avoidance of unnecessary invasive dental procedures. The currently available data on ONJ are reviewed here.

Systemic Treatment of Breast Cancer

August 01, 2006

Over the past 20 years we have witnessed the emergence of a new generation of aromatase inhibitors as valuable antiestrogens in the management of both advanced and early-stage breast cancer. In addition, the list of cytotoxic chemotherapeutic agents useful in the control of breast cancer has grown considerably. The emergence of anthracyclines was a major chemotherapeutic step forward in the 1980s, and the taxanes have clearly been the agents with the greatest impact on breast cancer treatment over the past decade. The end of the past 2 decades has been characterized by a greater understanding of the molecular biology of breast cancer, rational drug design, and the development of agents that disrupt specific cellular targets and pathways. The development of better prognostic and predictive assays that employ a panel of genes involved in the malignant and metastatic phenotype promises to allow clinicians to better select patients who could forgo adjuvant chemotherapy. Finally, adjunctive and supportive therapy of breast cancer has evolved substantially over the past 20 years. This review will highlight some of the landmark accomplishments during this time, and offer a glimpse at where we might be 20 years from now.

Breast Cancer Screening and Socioeconomic Status: 35 Metropolitan Areas, 2000 and 2002

August 01, 2006

Studies have suggested that women with low incomes residing in metropolitan areas might be less likely to be screened for breast cancer than more affluent women residing in the same areas.[1,2] However, few studies have examined the associations between breast cancer screening and both individual and area-based measures of socioeconomic status among women in metropolitan areas.[3,4] To examine these associations, the Centers for Disease Control (CDC) analyzed the percentage of women who had a mammogram by using individual data (ie, household income and education level) from the 2000 and 2002 Behavioral Risk Factor Surveillance System (BRFSS) surveys and area-based data (ie, percentages classified as living in poverty [annual family income below the federally defined poverty line] or at a low education level [less than a high school education]) from the 2000 US Census.

A Woman With Primary Breast Cancer and a Solitary Sternal Metastasis

August 01, 2006

The patient presented to her primary care physician 3 months prior with an inverted left nipple and a palpable lump that was highly suggestive of neoplasm on mammogram. An ultrasound-guided core biopsy revealed an infiltrating solid-type ductal carcinoma in situ. The estimated size of the mass was approximately 1 cm. She had no symptoms suggestive of metastatic disease.