Breast Cancer

MIAMI BEACH-Use of aggressive induction therapy followed by high-dose chemotherapy with autologous bone marrow transplantation (ABMT) yielded a 40% complete remission rate among 425 women with metastatic breast cancer treated at Duke University Medical Center. Of these women, 11% remained in complete remission 5 years after therapy, David A. Rizzieri, MD, reported at the 40th Annual Meeting of the American Society of Hematology (ASH).

Dr. Cody presents a very thorough review of the use of sentinel lymphadenectomy in breast cancer. The article raises key issues related to a procedure that is becoming more widespread and may indeed replace axillary dissection for the staging of breast cancer.

Sentinel node surgery for breast cancer has generated considerable interest, and the timely article by Dr. Cody provides a concise, well-written review of the topic. This commentary will add a few relatively minor points and will offer some alternative viewpoints to the author’s conclusions.

Sentinel lymph node (SLN) biopsy is a rapidly emerging treatment option for patients with early-stage invasive breast cancer and a clinically negative axilla. In the era of mammographic detection, SLN biopsy has the potential to eliminate axillary dissection for the enlarging cohort of breast cancer patients who are node-negative. Using radioisotope, blue dye, or both methods, experienced surgeons can successfully localize SLNs in more than 90% of cases. The effects of isotope and blue dye may be additive. Sentinel lymph node biopsy reliably predicts axillary node status in 98% of all patients and 95% of those who are node-positive. The operation is best learned under a formalized protocol in which a backup axillary dissection is performed to validate the technique during the surgeon’s early experience. Enhanced pathologic analysis, including serial sections and immunohistochemical (IHC) staining, is an essential element of the procedure. In experienced hands, SLN biopsy has less morbidity and greater accuracy than conventional axillary dissection. [ONCOLOGY 1(13):25-34, 1999]

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed with breast cancer in 1997, and approximately 97,000 of these women have an extremely low chance of suffering a recurrence of their cancer. With an average age at diagnosis of 60 years and a 25-year expected duration of survival, the current number of breast cancer survivors in the United States may approach 2.5 million women. Since breast cancer is now being detected at an earlier stage than previously and since adjuvant chemotherapy may cause ovarian failure, an increasing number of women are becoming postmenopausal at a younger age after breast cancer treatment. This conference was convened in September 1997 to consider how menopausal breast cancer survivors should be treated at the present time and what future studies are needed to develop improved therapeutic strategies. A total of 47 breast cancer experts and 13 patient advocates participated. The proceedings of the conference will be published in six installments in successive issues of oncology. This first part defines the problem and explores its magnitude and ramifications for patient management. [ONCOLOGY 1(13):109-136, 1999]

FLORENCE, Italy-Long-term follow-up of node-negative postmenopausal breast cancer patients has shown that using tamoxifen (Nolvadex) as an adjunct to breast-conserving surgery and postoperative radiotherapy markedly improves event-free survival in these low-risk women.

In a recently issued statement, Frances M. Visco, president of the National Breast Cancer Coalition (NBCC), commended Genentech for partnering with breast cancer advocates in all aspects of the HER-2 clinical trial. “It is clear that we will only

COLUMBUS, Ohio-The Arthur G. James Cancer Hospital and Research Institute at Ohio State University was recently added to the National Comprehensive Cancer Network (NCCN) Oncology Outcomes Database, bringing the total number of medical centers participating in the database to six. The database is currently collecting data on new breast cancer patients and their treatment.

BUFFALO, NY-One use of cancer practice guidelines will be to raise the standard of care in a community and create partnerships between cancer centers and payers, Stephen Edge, MD, told the President’s Cancer Panel.

In the United States, breast cancer is the most commonly diagnosed malignancy among women and the second leading cause of cancer death. Lack of health insurance coverage often is an important financial barrier to seeking preventive health care,

DALLAS-More than 2,100 guests attended the Susan G. Komen Foundation’s 16th Annual National Awards luncheon. Candice Bergen, star of the former CBS sitcom, Murphy Brown, received the Foundation’s most prestigious honor-the Betty Ford Award-for her portrayal of the character’s battle with breast cancer during the show’s final season.

FLORENCE, Italy-Boosting both the dose intensity and dose density of adjuvant chemotherapy significantly prolongs survival in women with high-risk breast cancer, according to a multicenter trial presented at the First European Breast Cancer Conference. “A twofold dose increase in epirubicin is possible with G-CSF [Neupogen] support,” said Dr. G. Konecny of the University of Munich. “It is a feasible outpatient treatment, quality of life is good during treatment, and treatment duration is especially short.”

WASHINGTON-Times change. Twenty years ago, the word cancer was barely mentioned in the media, and the words cancer and prevention were rarely put together, Carolyn Aldige, founder of the Cancer Research Foundation of America (CRFA), said at the Foundation’s Frontline Awards ceremony. The awards went to four women whose communications activities have been instrumental in raising awareness about breast cancer.

NEW YORK-Almost half the women age 65 and over in the United States think they are not at risk for breast cancer or that they are at low risk, according to a national survey from the sponsors of National Breast Cancer Awareness Month (NBCAM).

ROCKVILLE, Md-The FDA has approved two new indications for Zeneca’s tamoxifen (Nolvadex): For reducing the incidence of breast cancer in high-risk women, and for the reduction of contralateral breast cancer. In addition, data from clinical trials that support 5 years of adjuvant Nolvadex for breast cancer patients were added to the Nolvadex label.

The FDA recently licensed a biological approach for the treatment of metastatic breast cancer. The intravenous monoclonal antibody, trastuzumab (Herceptin), is approved for use alone in certain patients who have tried chemotherapy with little

WILMINGTON, Del-After the publicity surrounding the Breast Cancer Prevention Trial (BCPT), many doctors were besieged by questions from women about whether to take tamoxifen (Nolvadex) to reduce their breast cancer risk. The queries may accelerate now that Nolvadex has received FDA approval for this use. A new software program from the National Cancer Institute can help by providing an easy way to estimate a woman’s 5-year and lifetime breast cancer risk.

FLORENCE, Italy-A mass voting session at the First European Breast Cancer Conference (EBCC-1) has generated the first pan-European consensus statement on breast cancer research, treatment, and quality of care.

NEW YORK-The Comprehensive Breast Center of St. Luke’s Roosevelt Hospital in Manhattan joined forces with the Vidal Sassoon Salon to kick off National Breast Cancer Awareness Month in October with free beauty makeovers for breast cancer patients.

PITTSBURGH--The National Surgical Adjuvant Breast and Bowel Project (NSABP) has selected 193 institutions to participate in its second major breast cancer prevention trial--the Study of Tamoxifen and Raloxifene (STAR)--which is expected to begin in early 1999.

AMELIA ISLAND, Fla--Do the available data support the use of high-dose chemotherapy with peripheral blood stem cell support (HDC/PBSC) in advanced breast cancer? That was the question for debate at a session of the Southern Association for Oncology (SAO) meeting.

NEW YORK--Memorial Sloan-Kettering Cancer Center and the Wake Forest University School of Medicine are seeking women recently diagnosed with breast cancer for a study of the determinants of premature menopause and its effects on quality of life. Jeanne Petrek, MD, is the principal investigator.

HOUSTON--A survival update of two mature phase III trials shows that postmenopausal women with advanced breast cancer who received anastrozole (Arimidex) after failing therapy with tamoxifen (Nolvadex) survived significantly longer than those given megestrol acetate (Megace). In addition, patients treated with anastrozole had fewer side effects.

WASHINGTON--Genetic research has produced a growing body of information about the mutations related to breast cancer, but, so far, "no clear algorithm" to help clinicians decide how to use the new findings in the interests of patients, reported Francis S. Collins, MD, PhD, director of the National Human Genome Research Institute.

BETHESDA, Md--The National Cancer Institute should increase funding for studies aimed at understanding the fundamental biology of breast cancer and increase emphasis in a dozen other areas, an outside panel concluded after a sweeping review of the Institute’s basic, clinical, and population-based breast cancer research.

WASHINGTON--Though the number of new breast cancer diagnoses has risen steadily in the United States for several years--now reaching approximately 200,000 a year--epidemiologic analysis reveals a number of hopeful trends, said Robert A Smith, PhD, senior director of detection programs for the American Cancer Society, Atlanta.

SAN FRANCISCO--Establishing clinical care guidelines for hereditary (BRCA1 or BRCA2) breast cancer is increasingly important for managed care organizations as well as private physicians, Susan Kutner, MD, said at the American Cancer Society Second National Conference on Cancer Genetics.

WASHINGTON--A highly publicized journal article about the rate of false positives in mammography distorts both the state of the field and the goals and methods of breast cancer screening, said Edward A. Sickles, MD, chief of the Breast Imaging Section, University of California at San Francisco (UCSF).

The bisphosphonates have now joined an elite group of drugs that have annual sales greater than $1 billion. Although the major therapeutic target of these agents is osteoporosis, their use in cancer, particularly in osteolytic bone disease due to breast cancer and myeloma, is growing very rapidly. Pamidronate (Aredia), the only bisphosphonate currently approved for this indication in the United States, is now prescribed for the majority of patients with myeloma, as well as a substantial number of patients with breast cancer.

BETHESDA, Md--The Oncologic Drugs Advisory Committee (ODAC) has concluded that the Breast Cancer Prevention Trial (BCPT) was a risk-reduction and not a prevention trial. The panel specifically rejected the word prevention in recommending that the Food and Drug Administration approve Nolvadex (tam-oxifen citrate, Zeneca Pharmaceuticals) for "reducing a risk of breast cancer" in otherwise healthy women at high-risk of developing the disease. The drug is currently approved as adjuvant therapy for early and advanced breast cancer.