Breast Cancer

WILMINGTON, Delaware-The US Food and Drug Administration has granted approval to AstraZeneca’s breast cancer drug Faslodex (fulvestrant) Injection for treatment of hormone-receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy, such as tamoxifen (Nolvadex). Faslodex is a selective estrogen-receptor antagonist without known agonist effects.

Adjuvant chemotherapy is an integral component of the multidisciplinary curative treatment of primary breast cancers. The experience of the last 3 decades indicates that anthracycline-containing regimens provide the most effective cytotoxic treatment for this purpose.

Several clinical trials have explored the efficacy of docetaxel (Taxotere) as primary chemotherapy for breast cancer. Docetaxel has been evaluated as single-agent therapy, sequentially as a single agent following anthracycline-containing regimens, and in combination with anthracyclines, cisplatin, and trastuzumab (Herceptin) in patients with high-risk early breast cancer.

Docetaxel (Taxotere) has been intensively investigated for the treatment of metastatic breast cancer, where it has proved to be one of the most active agents. Initial phase II studies in anthracycline-resistant metastatic breast cancer demonstrated impressive response rates that have been confirmed in phase III randomized trials.

WASHINGTON-Medicare will soon cover image guidance techniques, such as stereotactic systems and ultrasound, used to biopsy palpable breast lesions that are difficult to biopsy with palpitation alone. However, contractors who administer Medicare benefits "have the discretion to decide what types of palpable lesions are difficult to biopsy using palpitation," the Centers for Medicare and Medicaid Services said. The new coverage will begin later this year and will not be retroactive. Medicare has covered image guidance to assist the biopsy of nonpalpable lesions since 1999.

The US Food and Drug Administration (FDA) has granted a 6-month priority review status to the supplemental new drug application filed by the AstraZeneca corporation for the use of anastrozole (Arimidex) in the adjuvant treatment of early breast cancer in postmenopausal women.

SAN ANTONIO-In the treatment of breast cancer, cardiomyopathy has represented a possible barrier to the use of trastuzumab (Herceptin) in the adjuvant setting. But a study by the Eastern Cooperative Oncology Group (ECOG) now suggests the risk is small when trastuzumab is combined with paclitaxel (Taxol), and, for the most part, cardiac changes are reversible.

A substantial minority of the women who see themselves as being at high risk for breast cancer because of family history suffer noticeable depressive symptoms and anxiety, and the anxiety can interfere with compliance with recommendations on breast self-examination (BSE), according to studies at the UCLA Revlon Breast Center.

HOLLYWOOD, Florida-The 2002 National Comprehensive Cancer Network (NCCN) breast cancer treatment guidelines include a number of important updates regarding the use of aromatase inhibitors, leuteinizing hormone-releasing hormone (LHRH) agonists, and sentinel lymph node biopsy. Robert W. Carlson, MD, chair of the NCCN Breast Cancer Panel, presented the guidelines at the Seventh Annual NCCN Conference.

Investigators recently reported the results of a study suggesting the benefits of identifying subgroups of breast cancer patients at high risk for hospitalization due to febrile neutropenia. Once identified, granulocyte colony-stimulating factor (G-CSF, Neupogen) might be administered prophylactically to these patients to help decrease the incidence of the side effect. The data were presented at the 24th annual San Antonio Breast Cancer Symposium.

The journal Lancet recently published an important analysis from six physicians at Weill Cornell Medical College (359:404-406, 2002), rebutting an article published in an earlier issue of Lancet (358:1340-1342, 2001) that cast doubt on the value of mammography in preventing death from breast cancer.

MIAMI BEACH, Florida-The Breast Cancer Risk Assessment Working Group is completing work on its consensus guidelines for stratifying patients into risk categories for breast cancer and managing their care accordingly. The model was outlined at the 19th Annual Miami Breast Cancer Conference.

New research presented at the 93rd annual meeting of the American Association for Cancer Research (AACR) suggests that monitoring with the serum HER2/neu oncoprotein test may help oncologists assess the effect of trastuzumab (Herceptin)-based therapy in patients with metastatic breast cancer.

The authors are to be complimented on a thoughtful and complete review of the application of the sentinel node paradigm to colorectal cancer. This paradigm is inherently quite different for colorectal cancer because, except for the occasional demonstration of variant anatomy, the technique will not alter the extent of surgery as it has done in melanoma and breast cancer.

The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.

When the BRCA1 and BRCA2 genes for breast and ovarian cancers were first identified and a screening blood test became available, a debate ensued as to whether there was an advantage to learning one’s risk. Recently, the value of such testing was demonstrated in a study in women who were followed after being identified as carriers of a BRCA genetic mutation. Researchers at Memorial Sloan-Kettering Cancer Center have provided strong evidence that breast and ovarian cancers can be detected at an early stage in women at highest hereditary risk. Results of the study were published in a recent issue of the Journal of Clinical Oncology (20:1260-1268, 2002).

SAN ANTONIO-The aromatase inhibitor letrozole (Femara) should be considered for first-line hormonal therapy in postmenopausal women with advanced breast cancer, according to the final analysis of a pivotal phase III trial comparing the agent with tamoxifen (Nolvadex).

WASHINGTON-In recent years online chat rooms and list servers devoted to a vast array of special interests have become a staple of American life. Now a pilot project has shown that an internet support group significantly benefits women coping with breast cancer, said Mitch Golant, PhD, vice president of research and development for The Wellness Community (TWC) National, Santa Monica, California.

ChromaVision Medical Systems, Inc, announced recently that investigators using their automated cellular imaging system (ACIS) concluded that the number of metastatic tumor cells found in the sentinel lymph node correlates with the size of the primary breast tumor.

SAN ANTONIO-Updated results from a major phase III study of docetaxel (Taxotere) plus capecitabine (Xeloda) in metastatic breast cancer confirmed the value of this new combination.

SAN ANTONIO-Novel regimens pairing gemcitabine (Gemzar) and vinorelbine (Navelbine) with trastuzumab (Herceptin) showed significant antitumor activity and good tolerability in heavily pretreated HER-2-positive patients with metastatic breast cancer, in studies reported at the 24th Annual San Antonio Breast Cancer Symposium.

SAN ANTONIO-In first-line hormonal therapy for advanced breast cancer, elevated levels of HER-2/neu predict lower response rates and shorter time to disease progression, compared with normal HER-2 levels, according to a large international study.

WASHINGTON-Amid continuing controversy over the effectiveness of screening mammography for breast cancer, the US Preventive Services Task Force (USPSTF) has extended its recommendations to include women between the ages of 40 and 49, after concluding that the procedure reduces breast cancer deaths.

WASHINGTON-Black women have long been known to suffer higher breast cancer mortality and to experience worse 5-year survival rates than whites. Even controlling for disease stage, they are more likely to fail treatment and have worse outcomes, said Lisa A. Newman, MD, MPH. The question therefore arises, she said, whether these differences reflect biological variation or social inequality.

BOSTON-Excessive sun exposure is a known risk factor for the development of skin cancer, but sun exposure appears to have a protective effect against a variety of other cancers, according to speakers at a symposium on sunlight at the 168th National Meeting of the American Association for the Advancement of Science (AAAS).

WASHINGTON-A definite link exists between mammography screening and lessened breast cancer mortality, but black women do not take full advantage of cancer screening, according to Janice S. Emerson, research associate, Center for Health Research, Tennessee State University, Nashville. Speaking at the American Psychological Association Conference on Enhancing Outcomes in Women’s Health, she presented findings from an HCFA-funded project, led by Dr. Baqar A. Husaini.

Recruitment for a challenging breast cancer trial has begun at sites in more than 40 countries. It is hoped that more than 3,000 patients from approximately 600 sites will participate in a study designed to determine whether earlier use of trastuzumab (Herceptin) increases disease-free survival in women with early breast cancer.

ROCKVILLE, Maryland-Members of the Oncologic Drugs Advisory Committee (ODAC) have unanimously recommended that the Food and Drug Administration approve Zometa (zoledronic acid for injection, Novartis) for the treatment of bone metastases in patients with multiple myeloma and breast cancer, prostate cancer, lung cancer, and other solid tumors.

SAN ANTONIO-A multicenter phase II study conducted in France has shown that epirubicin (Ellence) and docetaxel (Taxotere) (ET) offer better results as first-line chemotherapy than fluorouracil (5-FU), epirubicin, and cyclophosphamide (FEC) among patients with metastatic breast cancer.

CHICAGO-Brachytherapy devices that deliver radiation therapy directly to the lumpectomy site drastically reduce the time needed for radiotherapy after surgery for early-stage breast cancer, according to two studies presented at the 87th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).