Breast Cancer

Rubinstein and colleagues provide an excellent review of mathematical models for estimating breast cancer risk, including the risk of carrying inherited mutations of BRCA1 and BRCA2. Since we and others reviewed early models to predict the likelihood of inherited susceptibility to breast cancer,[1] newer quantitative tools, most notably by Parmigiani and colleagues,[2] have been developed. These models have been made available on CD-ROM, over the Internet, and in other electronic versions that are accessible to most clinicians and researchers. These quantitative resources constitute useful and important aids in genetic counseling.

Breast and ovarian carcinomas pose major public health problems in most Western countries. Countless attempts have been made to better understand a patient’s lifetime risk of breast cancer. The most significant etiologic risk is increasing age, followed by family history. In addition, hormonal and reproductive factors-ie, early menarche and later age at menopause, nulliparity (and, therefore, a greater number of ovulations over the patient’s lifetime), and late age at first pregnancy (greater than age 30 years)-also increase a patient’s breast cancer risk.

Women at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]

LOS ANGELES-A large German multicenter study has shown that sentinel lymph node (SLN) biopsy for breast cancer accurately predicts the status of the axillary lymph node. In addition, the study found that physician experience and the choice of lymphography technique-blue dye or scintigraphy-influence the detection rate significantly.

MANHASSET, New York-Early clinical results suggest that capecitabine (Xeloda) may work well in several new combinations for metastatic breast cancer, according to Daniel R. Budman, MD, professor of medicine at New York University and associate director of medical oncology at North Shore University Hospital, Manhasset, New York

NANTES, France-Results of a large phase II European trial validate the antitumor activity of capecitabine (Xeloda) in metastatic breast cancer and present a strong rationale for its use earlier in the disease course, said Pierre Fumoleau, MD,

ORLANDO-With an ever-expanding list of active agents for metastatic breast cancer and even more potential combinations, choosing the best therapy for each patient can be a challenge, according to Clifford Hudis, MD, chief of the

LONDON-Intermittent dosing with R115777 (tipifarnib, also known as Zarnestra) is equally effective as continuous dosing in advanced breast cancer patients, but has significantly less hematologic toxicity, according to a study presented at the American Society of Clinical Oncology 38th annual meeting (ASCO abstract 138).

ALBUQUERQUE, New Mexico-Carboplatin (Paraplatin), vinorelbine (Navelbine), and capecitabine (Xeloda) given in combination to patients with anthracycline- and taxane-pretreated metastatic breast cancer appears active and well tolerated, according to an interim analysis reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 1960).

SEOUL, Korea-Use of capecitabine (Xeloda) plus vinorelbine (Navelbine) is effective in metastatic breast cancer patients previously treated with anthracycline and taxane drugs, according to preliminary data from a phase II study. The study

PALO ALTO, California-Treatment with oral chemotherapy for metastatic breast cancer showed promising efficacy with minimal toxicity and warrants further investigation, according to results of a phase I trial conducted at Stanford University.

ORLANDO-Adding capecitabine (Xeloda) to docetaxel (Taxotere) (XT) significantly improves response rates, time to progression, and overall survival, compared with docetaxel alone in patients with metastatic breast cancer, according to results of a phase III study of the combination.

BARCELONA, Spain-In patients with metastatic breast cancer, weekly dosing with docetaxel (Taxotere) appears to provide benefits equal to those of every-3-week dosing, according to results of a multicenter, randomized, European phase II

JACKSONVILLE, Florida-An encouraging study reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 206) suggests that irinotecan (CPT-11, Camptosar) may prove valuable in advanced breast cancer.

MAYWOOD, Illinois-A novel fixed-dose schedule of uracil/tegafur (UFT) plus leucovorin (UFT/LV, also known as Orzel, investigational) achieved significant disease stabilization in advanced breast cancer, according to a phase II multicenter study reported at ASCO (abstract 240).

The addition of paclitaxel before surgery to primary systemic therapy with doxorubicin, followed by CMF

ORLANDO-Data from a massive pathologic reanalysis of breast cancer patients with apparently negative lymph nodes show that women with occult micrometastases have shorter disease-free survival and are more likely to die from breast cancer than are women whose nodes are negative on immunohistochemistry.

LOS ANGELES-Early data from a Breast Cancer International Research Group (BCIRG) study showed that docetaxel (Taxotere)-based combination therapy was significantly more effective than standard FAC (fluorouracil/doxorubicin

SAN FRANCISCO-Insulin resistance, as determined by C-peptide levels, appears to be linked to increased breast cancer risk, Celia Byrne, PhD, said at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 1179). In a study of 1,226 women, those who developed breast cancer were more likely than controls to have elevated concentrations of C-peptide, considered an indication of insulin secretion.

HOUSTON-Weekly paclitaxel (Taxol) as part of a primary systemic chemotherapy regimen for operable breast cancer improves pathologic complete remission rates when compared with every 3-week paclitaxel therapy, according to results of a prospective phase III trial (ASCO abstract 135).

WASHINGTON-Uninsured Americans confront a greater likelihood of poorer health and premature death than those with private medical and hospital coverage, a committee of the National Academy of Sciences’ Institute of Medicine (IOM) has concluded.

MUNICH-Preoperative treatment of primary breast cancer with dose-dense sequential epirubicin (Ellence) and paclitaxel (Taxol) led to significant increases in breast-conserving therapy and in response rates compared to epirubicin and paclitaxel

ORLANDO-The National Initiative on Cancer Care Quality (NICCQ) has presented preliminary results from its ongoing survey of breast and colorectal cancer patients in five cities. The study, now in its second year, was prompted by a 1999 Institute of Medicine report that found serious gaps in the quality of care for many people.

NEW YORK-Weekly injections of epoetin alfa (Procrit) might protect breast cancer patients against anemia and improve their quality of life during adjuvant chemotherapy.

ATLANTA-When used to distinguish benign and malignant solid masses, high-resolution ultrasound may reduce the number of breast biopsies by as much as 28%, said Karen Hunt, MD, assistant professor of radiology, University of Michigan, Ann Arbor. Dr. Hunt, who is also senior staff radiologist at Henry Ford Hospital, presented the findings at the 102nd Annual Meeting of the American Roentgen Ray Society’s (abstract 138).

ORLANDO-ABI-007, an alternative, Cremophor-free intravenous paclitaxel (Taxol), developed using nanoparticle technology, provided pronounced single-agent efficacy in two multicenter phase II trials in metastatic breast cancer, according to data presented at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 209). In preclinical studies, ABI-007 resulted in significantly less toxicity than paclitaxel (abstract 462).

CHICAGO-Giving tamoxifen concurrently with adjuvant chemotherapy halves the benefit of the chemohormonal combination compared to giving tamoxifen after completion of chemotherapy in postmenopausal patients with node-positive, hormone-receptor positive breast cancer (ASCO abstract 143). These initial results from North American Breast Intergroup Trial 0100 (INT 0100, SWOG 8814), presented by Kathy S. Albain, MD, are expected to establish a new standard of care for treating breast cancer in postmenopausal women.

Two studies published recently in the Journal of Clinical Oncology showed promising response rates for docetaxel (Taxotere)-based therapy over existing therapies for several types of cancer

Over the past 2 decades, two major trends in the treatment of breast cancer-breast-conserving therapy and neoadjuvant (or preoperative) chemotherapy-have converged to stimulate interest in the use of neoadjuvant chemotherapy to facilitate breast conservation in women presenting with large tumors. After being established as the treatment of choice for locally advanced or inoperable breast cancer, theoretical considerations and the desire to extend breast-conserving therapy to more patients with large tumors have resulted in an increase in the use of neoadjuvant chemotherapy in operable patients. Drs. Green and Hortobagyi have provided us with a comprehensive review of the background and the current state of neoadjuvant chemotherapy for breast cancer.

It is nearly 30 years since the start of clinical trials of adjuvant chemotherapy in patients with operable breast cancer.[1] The rationale for using adjuvant chemotherapy at that time was that surgery and radiotherapy could only control local disease and cure patients who did not already have metastases. Chemotherapy could be used in patients with a poor prognosis to treat undetected micrometastatic disease and thereby reduce the risk of metastatic relapse and death from breast cancer.