Breast Cancer

It has been roughly 20 years since chemotherapy dose escalation was proposed as a possible strategy for improving outcomes in patients with breast cancer.[1,2] This concept has sustained a series of remarkable rollercoaster-like controversies, with heated arguments at national meetings, substantial lay press coverage, patients suing their insurance companies seeking coverage, legislative fiats requiring third-party payment long before critical data were available, and a well-publicized episode of clinical scientific fraud that is nearly unprecedented in its audacity. How did we get here from there?

Despite nearly 20 years of study, the importance of chemotherapy dose intensity in breast cancer remains unclear. Substantial preclinical data suggest a dose-response relationship, and consistent data document that

WASHINGTON-The technique of radioactive seed localization presents several important advantages over wire localization for the diagnostic or therapeutic excision of nonpalpable breast cancers, said Richard Gray, MD, of the H. Lee Moffitt Cancer Center and Research Institute, Tampa, at the 54th Annual Cancer Symposium of the Society of Surgical Oncology (SSO).

SAN ANTONIO-Chemotherapy dose reduction occurs frequently despite the risk of a poorer long-term outcome when the full dose is not received, according to an analysis of 20,799 patients with early breast cancer who received adjuvant chemotherapy. Gary H. Lyman, MD, MPH, reported the results at the 23rd Annual San Antonio Breast Cancer Symposium, for the Awareness of Neutropenia in Chemotherapy (ANC) Study Group.

Tamoxifen (Nolvadex) does not affect cardiovascular risk in healthy women or those with coronary heart disease, according to a study published in the Journal of the National Cancer Institute (93:16-21, 2001). The study is part of the National

Contrary to traditional medical advice that rest is the best medicine for fatigue caused by treatment for breast cancer, the largest study of its kind found that exercise improves physical functioning and weight control for many patients.

NEW YORK-Researchers at the Chemotherapy Foundation Symposium XVIII presented findings from two phase II studies of trastuzumab (Herceptin) in combination with chemotherapy agents with known synergistic activity. Trastuzumab is a monoclonal antibody shown to be effective in HER-2/neu-overexpressing breast cancer.

WASHINGTON-Three states have won approval of their plans to expand Medicaid benefits to uninsured women diagnosed through the National Breast and Cervical Cancer Early Detection Program, administered by the Centers for Disease Control and Prevention. Maryland, New Hampshire, and West Virginia were approved by the Department of Health and Human Services under the Breast and Cervical Cancer and Prevention and Treatment Act (BCCPT), which Congress enacted last year.

Breast Cancer On-Line (BCO) at www.bco.org is a multidisciplinary website based in the United Kingdom that may be useful to practicing oncologists, nurses, and scientists working in the field of oncology. The editor-in-chief is John Robertson,

The drug raloxifene (Evista) significantly reduces the risk of invasive breast cancer in postmenopausal women, according to the results of a large-scale study involving the University of Pittsburgh Graduate School of Public Health (GSPH) and

SAN ANTONIO-Follow-up studies from five clinical trials at M.D. Anderson suggest that postoperative supplemental radiotherapy to the axillae in patients with stage II-III breast cancer is often unnecessary, since failure in the dissected axillae is uncommon. The report was presented at the 23rd annual San Antonio Breast Cancer Symposium.

SAN ANTONIO-A pharmaceutical alternative to prophylactic oophorectomy as a means of inducing menopause and reducing the likelihood of breast cancer in young women at high genetic risk is under investigation at the City of Hope National Medical Center.

WASHINGTON-Surgeons in community hospitals as well as in university-based cancer centers can successfully find sentinel lymph nodes (SLNs) in breast cancer patients for biopsy, Douglas S. Reintgen, MD, of the H. Lee Moffitt Cancer Center, University of South Florida, Tampa, said at the 54th Annual Cancer Symposium of the Society of Surgical Oncology (SSO).

SAN ANTONIO-Fulvestrant (Faslodex), an estrogen-receptor (ER) downregulator (see Figure), appears to be at least as good as the aromatase inhibitor anastrozole (Arimidex) as second-line therapy in postmenopausal women with advanced breast cancer who had progressed or recurred on prior endocrine therapy.

CHICAGO-Magnetic resonance imaging (MRI) mammography was able to detect eight of nine breast malignancies, some of which had been missed on conventional film mammography, in 196 young women at high risk for hereditary breast cancer.

The 3rd Investigators’ Workshop, sponsored by The University of Texas M. D. Anderson Cancer Center, included five separate scientific sessions. The topics covered were colorectal carcinoma, lung carcinoma, breast carcinoma, miscellaneous

SAN ANTONIO-The gonadotropin hormone-releasing hormone agonist analog goserelin (Zoladex) is an alternative to adjuvant chemotherapy for women with early breast cancer who are pre- or perimenopausal and have estrogen-receptor (ER)-positive tumors, said Walter Jonat, MD, of the University of Kiel, Germany. He spoke at the 23rd Annual San Antonio Breast Cancer Symposium on behalf of the Zoladex Early Breast Cancer Research Association (ZEBRA).

Anecdotal reports of cognitive compromise among patients treated with chemotherapy are relatively common among breast cancer survivors and may play an important role in adversely affecting functioning in multiple domains. As noted by Dr. Olin,

Dr. Julie Olin has highlighted an important issue for patients and providers contemplating systemic therapy for breast cancer: how the brain works after such treatment. Her excellent article summarizes four important studies, identifies the research design problems and questions raised by these and other studies, and proposes a model for how chemohormonal therapy might affect cognitive functioning and quality of life (see Figure 1 of her article). Finally, she identifies how actual, as well as potential, cognitive impairment might influence patient decisions and care (the author’s Table 1).

Several trials have shown that anthracyclines and taxanes can be combined to achieve response rates ranging from 70% to 90%, with complete responses ranging from 19% to 41%. In an attempt to increase the activity while

Recently initiated is a phase III randomized trial (MA.21 trial) of adjuvant chemotherapy for node-positive and high-risk node-negative, premenopausal and postmenopausal (£ 60 years) women with breast cancer who have

Doxorubicin/paclitaxel (Taxol) combinations are very active in advanced breast cancer, with objective response rates up to 90%, but have shown a high incidence of cardiotoxicity. A phase I/II trial replacing

The aromatase inhibitors represent an important class of hormonal agents for the management of breast cancer. The third-generation aromatase inhibitors have replaced megestrol acetate as second-line hormonal

Tamoxifen (Nolvadex) has long been established as "standard" adjuvant therapy for receptor-positive, early-stage breast cancer. Results from clinical trials suggest that after approximately 5 years, tamoxifen may lose its

An underinvestigated area of breast cancer survivorship involves the possible impairment of cognitive function following adjuvant chemohormonal therapy. Numerous reports of disturbing and disruptive changes in short- and

Several attempts have been made to improve the survival rates of breast cancer patients. The benefit of adjuvant chemotherapy was clearly shown, but the absolute difference of 2% to 11% in overall survival, depending on the

According to data presented at the American Society of Hematology (ASH) meeting and the San Antonio Breast Cancer Symposium, elderly cancer patients may be up to two times as likely as younger patients to receive chemotherapy doses

FORT LAUDERDALE, Florida-A panel of breast cancer experts has revised the National Comprehensive Cancer Network (NCCN) breast cancer guideline to reflect an evolution rather than change. "The differences between this and last year’s guidelines are overall meaningful but subtle," Robert W. Carlson, MD, of Stanford Hospitals and Clinics, said at the Sixth Annual NCCN Conference.

SAN ANTONIO-By using a system combining color-based imaging and automated microscopy, pathologists were able to significantly improve their accuracy in evaluating HER-2 protein expression in breast cancer tissue, said Kenneth Bloom, MD, of Rush-Presbyterian-St. Luke’s Medical Center, Chicago.

NEW YORK-The jury may still be out on the value of adjuvant paclitaxel (Taxol) for early breast cancer (see article on page 3 on the updated NCCN breast cancer guideline), but a study from M.D. Anderson suggests it may have a small