In this slide show we highlight some of the top news on breast cancer in 2017, including long-term benefits of mammography, treatment advances, pregnancy in survivors, and more.
Risk of Breast Cancer Recurrence Can Last Up to 20 Years: The results of a new meta-analysis report a steady rate of recurrence for up to 20 years in women with early-state estrogen receptor (ER)-positive breast cancer despite 5-year treatment with adjuvant endocrine therapy. This risk extended to women with low-grade disease with a low risk of recurrence (absolute risk = 10%). Researchers noted a correlation between tumor node (TN) status and risk for metastatic recurrence. Women with T1N0 disease experienced a 13% risk for distant recurrence followed by 20% in T1N1-3 and 34% in those with T1N4-9. Risk of recurrence increased further in women with T2N0 (19%), T2N1-3 (26%), and T2N4-9 (41%). From study years 5 to 20, the absolute risk of distant recurrence among patients with T1N0 breast cancer was 10% for low-grade disease, 13% for moderate-grade disease, and 17% for high-grade disease. Corresponding risks for any recurrence or a contralateral breast cancer were 17%, 22%, and 26%, respectively. Read more. Image © Photographee.eu/Shutterstock.com
Acupuncture Reduced AI-Related Joint Pain in Early-Stage Breast Cancer: Results of the Southwest Oncology Group (SWOG) S1200 trial presented at the 2017 San Antonio Breast Cancer Symposium reported a significant reduction in aromatase inhibitors (AIs) in postmenopausal women. The study compared acupuncture to sham acupuncture and no treatment at all. Study results report that at 6 weeks, study subjects who received true acupuncture had a significantly lower Brief Pain Inventory–Short Form (BPI) compared with the other two study arms. Results also noted that more 58% of the true acupuncture participants had a 2-point change in pain versus the other arms (31% sham, 30% control). Researchers report that the differences remained significantly at the 24 week assessment point. Read more. Image © Leonardo da/Shutterstock.com
Long-Term Insulin Analog Use Linked With Increased Breast Cancer Risk: A recent study evaluating the risk of breast cancer in women with type 2 diabetes receiving glargine, detemir, or neutral protamine Hadedorn (NPH) insulin, reports an increased risk in women taking glargine. Breast cancer incidence risk in women taking detemir is unclear. Of the 9,575 women in the study who received glargine, 176 were diagnosed with breast cancer with an adjusted hazard ratio (HR) for breast cancer of 1.44 (95% CI, 1.11–1.85); the HR for detemir was 1.17 (95% CI, 0.77–1.77). Risk was noted to increase at the 5-year mark after starting glargine and after receiving more than 30 glargine prescriptions. Researchers report that the results in increased risk for breast cancer development were limited to women with a history of using insulin in the past: 1.53 (95% CI, 1.10–2.12) versus new users of insulin in which a significant risk was not seen. Read more. Image © Powerphotos/Shutterstock.com
Annual Mammography Starting at Age 40 Prevents Most Breast Cancer Deaths: Researchers from Weill Cornell Medicine and New York-Presbyterian Hospital report that annual mammography screening starting at age 40 prevents the most breast cancer deaths compared to other commonly recommended screening methods. Their results report that the mean mortality reduction rate was greatest with the recommendation of annual screening at ages 40 to 84 years (39.6%), compared with the hybrid recommendation of screening annually at ages 45 to 54 years, then biennially at ages 55 to 79 years (30.8%), and the recommendation of biennial screening at ages 50 to 74 years (23.2%). Study researchers point out that there is a need to improve breast screening and that limitations in mammography exist. Read more. Image © Tyler Olson/Shutterstock.com
Ipatasertib Improves PFS in Advanced Triple-Negative Breast Cancer: Results of a recent phase II randomized trial evaluating the oral AKT inhibitor ipatasertib showed an improvement in progression-free survival (PFS) versus placebo when used by women with locally advanced or metastatic breast cancer who have locally advanced or metastatic triple-negative breast cancer (TNBC) as first-line therapy. The median PFS for ipatasertib was 6.2 months versus 4.9 months in the placebo group with a hazard ratio (HR) of 0.60 (95% CI, 0.37–0.98; P = .037). Additionally, the median PFS in study participants with low PTEN expression was 6.2 months in the ipatasertib group versus 3.7 months in the placebo group. In participants with PIK3CA/AKT1/PTEN-altered tumors, they experienced a PFS of 9 months in the ipatasertib group versus 4.9 months in the placebo group. Read more. Image © royaltystockphoto.com/Shutterstock.com
Bisphosphonates Not Linked to Reduction in Breast Cancer Risk: Results of the recently published E3N cohort study report that bisphosphonates are not associated with a decrease in postmenopausal breast cancer incidence. Of the 64,438 person cohort study population, 12,935 were exposed to bisphosphonate therapy. Researchers report a total of 2,407 first primary breast cancer cases in the cohort; age adjusted hazard ratio was 0.89 (95% CI, 0.78–1.00) for breast cancer associated with exposure to bisphosphonate exposure versus 0.98 (95% CI, 0.85–1.12) in women who had never taken the medication. While there was a noted decrease in breast cancer risk the first year following treatment with bisphosphonates, researchers conclude that this is representative of screening bias. Read more. Image © Molekuul_be/Shutterstock.com
NCCN: Chest CT in Early-Stage Breast Cancer Occurring Despite Recommendations: A recent study reported that despite the National Comprehensive Cancer Network (NCCN) recommendations against chest CT for evaluation of distant metastasis in asymptomatic early-stage breast cancer, it is still being used. Results of the study report that only a small population of stage I or II breast cancers were diagnosed with pulmonary metastases from CT scan findings. Data compellation from a prospective database included evaluation of 3,321 patients with early-stage breast cancer. Six months following diagnosis, 11% of patients with stage I disease and 36% with stage II were evaluated with chest CT scan. Of the 26.9% of patients found to have pulmonary nodules, only 1.3% were diagnosed with pulmonary metastasis. Read more. Image © Pressmaster/Shutterstock.com
Adjuvant Capecitabine Improves Survival in Residual Invasive Breast Cancer: Results of the randomized CREATE-X study reveal that capecitabine offers benefit to patients with HER2-negative breast cancer with residual invasive disease following neoadjuvant chemotherapy. Of the patients randomized to the capecitabine arm, 82.8% were alive and disease-free by 3 years versus 73.9% in the control group. At 5 years, 74.1% of the participants in the capecitabine arm were alive and disease-free compared with 67.6% in the control arm. Recurrence, second cancer, or death hazard ratio (was 0.70 (95% CI, 0.53–0.92; P = .01). The 3- and 5-year overall survival (OS) for the capecitabine arm was 94.0% and 89.2% versus 88.9% and 83.6% in the control, respectively. Those with triple-negative disease who received capecitabine experienced a disease-free survival rate of 69.8% versus 56.1 in the control arm; the OS was 78.8% for the capecitabine arm versus 70.3% in the control. Read more. Image © Molekuul_be/Shutterstock.com
Olaparib Improves Outcomes in BRCA-Mutated Metastatic Breast Cancer: According to the results of a new phase III study presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, the PARP inhibitor olaparib increases progression-free survival (PFS) and improves quality of life in BRCA-mutated HER2-negative metastatic breast cancer patients. All of the participants enrolled had an inherited BRCA mutation with metastatic hormone receptor–positive or triple-negative breast cancer and had received up to two prior lines of chemotherapy for metastatic disease; hormone receptor–positive participants had received hormonal therapy. Study participants either received olaparib or standard chemotherapy until disease progression or development of severe side effects. In the olaparib group, a median 14-month follow-up reported a 2.8-month longer progression-free survival and a 42% lower risk of disease progression versus the chemotherapy group. Researchers reported an objective response rate of 60% in the olaparib group versus 29% in those who received chemotherapy. Read more.
Breast Cancer Survivors Can Safely Become Pregnant: According to a new study, women who are breast cancer survivors, even those with estrogen receptor (ER)-positive tumors, can safely become pregnant. Researchers report that pregnancy in women following an early breast cancer diagnosis did not result in an increased risk of disease recurrence or death than survivors who did not become pregnant. Additionally, there was no disease-free survival difference in women who became pregnant versus those who did not become pregnant at the 10-year mark following diagnosis. This was additionally irrespective their ER status. No overall survival difference was seen between the two cohort groups; however, it was noted that those who became pregnant after an ER-negative breast cancer experienced a 42% lower chance of death versus the women who did not become pregnant. Researchers suggest that pregnancy could possibly be protective in ER-negative breast cancer patients. Read more. Image © Syda Productions/Shutterstock.com
Metformin Improves Outcomes in HER2+ Breast Cancer Patients With Diabetes: According to the results of the randomized phase III ALTTO trial, treatment with metformin may improve outcomes in patients with human epidermal growth factor receptor 2 (HER2)–positive primary breast cancer and diabetes. Researchers examined whether study participants with diabetes at study entry fared better with metformin treatment. The study revealed that study participants with diabetes untreated with metformin experienced a significantly worse disease-free survival compared with participants without diabetes, which was restricted to hormone receptor–positive disease. The multivariate hazard ratio (HR) was 1.40 (95% CI, 1.01–1.94; P = .043). Those with diabetes treated with metformin experienced similar outcomes regardless of hormone status to non-diabetic patients, with an HR for DFS of 0.97 (95% CI, 0.70–1.35; P = .873). Read more. Image © Sherry Yates Young/Shutterstock.com
Gemcitabine Fails in Early Breast Cancer: Final 10-year follow-up results of the large randomized phase III TANGO trial report that there was no improvement in disease-free survival (DFS) in early breast cancer patients who received gemcitabine in addition to anthracycline and taxane-based adjuvant chemotherapy. These findings are similar to earlier trial analyses. Additionally, gemcitabine increased the frequency of grade 3 adverse events including neutropenia, myalgia, arthralgia, fatigue, infection, and others. At the 10-year follow-up, 914 of the 3,152 study participants had died and 1,087 experienced disease-free survival (DFS) with 65% DFS in both study groups. The adjusted analysis revealed similar findings as the 2- and 5-year follow-up results had a hazard ratio (HR) for DFS of 0.97 (95% CI, 0.86–1.10; P = .64) at 10 years. There was no difference in overall survival in either group (HR, 1.02; 95% CI, 0.89–1.16; P = .81). Read more. Image © Brian A Jackson/Shutterstock.com
Alcohol Intake Linked to Breast Cancer Risk in African American Women: The results of a recent study report that African American women who consume 7 or more alcoholic beverages a week experience an elevation in their risk for breast cancer of all subtypes. These results are noted to be similar to the risks seen in white women. The study of 22,338 women from the African American Breast Cancer Epidemiology and Risk (AMBER) Consortium included 5,108 with invasive breast cancer. Researchers noted an elevation in breast cancer risk in women who drank at least 14 drinks per week (DPW) versus light drinkers who reported drinking 0-4 DPW (adjusted odds ratio, 1.33; 95% CI, 1.07–1.64). Women who drank at least 7 DPW had an increased risk of breast cancer for each subtype of hormone receptor status. Read more. Image © WAYHOME studio/Shutterstock.com
FDA Approves Neratinib for HER2-Positive Breast Cancer: Neratinib was approved for extended adjuvant treatment in adult patients with early-stage HER2-postive breast cancer by the US Food and Drug Administration (FDA) based on the results of the randomized phase III ExteNet trial. Neratinib is intended to be given to qualifying patients after receiving adjuvant trastuzumab-based therapy. After 2 years, the primary endpoint of invasive disease-free survival was 94.2% in the neratinib group compared with 91.9% in the placebo group. Commonly experienced adverse events while on neratinib included diarrhea, nausea, abdominal pain, fatigue, vomiting, and others. Some cases of diarrhea and hepatotoxicity/increased liver transaminases resulted in discontinuation of the drug. Read more.