Breast Cancer

LOS ANGELES--A monoclonal antibody directed at the HER2 receptor greatly enhances the effect of chemotherapy for women whose breast cancer overexpresses the HER2 gene. This encouraging finding comes as experts are beginning to suspect that increasing dose intensity of conventional chemotherapy may have "gone about as far as it can go," said Dennis Slamon, MD, PhD, chief, Division of Hematology-Oncology, UCLA School of Medicine.

EDMONTON, Alberta--Final results of a multicenter phase III trial show that docetaxel (Taxotere) improves survival more than mitomycin (Mutamycin)/vinblastine (MV) in anthracycline-resistant advanced breast cancer.

Women who adhere to a low-fat diet with plenty of vegetables and fruits may decrease their risk of developing breast cancer, according to a new study published in the May 1998 issue of The Journal of the American Dietetic Association. The study

CHICAGO--A monoclonal antibody expected to be approved by the FDA before year’s end is as potent as taxane therapy in certain virulent refractory breast cancers, according to research presented at an integrated symposium at the 34th Annual Meeting of the American Society of Clinical Oncology.

SAN FRANCISCO--Raloxifene (Evista), an estrogen-receptor modulator used to treat osteoporosis, also has a protective effect against breast cancer, according to a 2-year randomized study and an overview analysis reported at ASCO. These findings require some caution in interpretation, since they were mainly observed in women with osteoporosis, a population that has a lower breast cancer risk than the general population.

Mammotome biopsy causes significantly less internal breast scarring than open surgical biopsy and is less likely to interfere with a radiologist’s ability to read subsequent mammograms, according to a new study presented at the third annual

NEW YORK--Avon’s Breast Cancer Awareness Crusade is combining health and beauty with the introduction of its newest fundraising product, the Avon Pink Ribbon Cosmetics Case.

SAN FRANCISCO--Interim results of a major intergroup study of paclitaxel (Taxol) as adjuvant treatment of node-positive breast cancer "will change the standard of care for node-positive breast cancer patients," I. Craig Henderson, MD, of the University of California, San Francisco, said at ASCO.

NEW YORK--There is a soap opera scenario surrounding breast cancer survivors that goes something like this: "Breast cancer ruins the woman’s life. Her husband leaves her for another woman. She loses her job. She considers suicide but bravely goes on, knowing no man will ever want her. Looking in the mirror is her worst nightmare."

ORLANDO--Preoperative chemotherapy in breast cancer patients can leave a surgeon in the dark as to the specific amount of normal tissue to remove if the chemotherapy eliminates the tumor or renders it no longer palpable. A simple tattoo outlining the original tumor site can be a great aid in helping surgeons determine the type of surgery to be performed after the therapy.

LOS ANGELES--Taxane therapy lengthens survival in breast cancer patients, both in the metastatic and adjuvant settings, according to the results of two phase III trials presented at the 34th Annual Meeting of the American Society of Clinical Oncology (ASCO).

ASCO--Fewer than half of women with early-stage breast cancer are treated with breast-conserving lumpectomy, even though up to 75% are eligible. Almost one-quarter of those who have lumpectomy are not given radiotherapy to improve local control.

BUFFALO, NY--Studies have shown that only 15% to 20% of patients with metastatic breast cancer have a long-term disease-free survival following administration of high-dose chemotherapy with autologous bone marrow or stem cell support. "We have therefore decided to explore immunotherapy for this patient population," said Meir Wetzler, MD, of the Division of Medicine, Roswell Park Cancer Institute.

BALTIMORE--Adjuvant chemotherapy regimens for breast cancer are often reduced for patients over age 65 due to concerns about toxicity. These reductions may not be necessary in most cases. Elizabeth Claire Dees, MD, and her colleagues at the Johns Hopkins Oncology Center found that although older women had more neutropenia, this seldom resulted in clinical complications.

SAN ANTONIO--The first results of a large Intergroup study show that adjuvant chemotherapy with CAF is superior to CMF in high-risk node-negative patients, Laura Hutchins, MD, of the University of Arkansas, reported at the ASCO plenary session for SWOG. The study also suggests that S phase fraction can be used to stratify patients into risk groups.

AVIANO, Italy--Elderly women with node-positive breast cancer are more vulnerable to chemotherapy-related toxicity. Physicians should be prepared to help older patients prevent or manage these problems and should not be too quick to reduce scheduled dosages, Diana Crivellari, MD, said at her ASCO poster presentation for the International Breast Cancer Study Group (IBCSG) Trial VII.

PITTSBURGH--Five years of prophylactic tamoxifen (Nolvadex) cut the risk of breast cancer almost in half in women at high risk for the disease. D. Lawrence Wickerham, MD, associate chairman of the National Surgical Adjuvant Breast and Bowel Project (NSABP), gave the first formal presentation of the results of the Breast Cancer Prevention Trial (BCPT) at the ASCO plenary session.

The article by Manjeet Chadha and Deborah Axelrod on routine axillary dissection in invasive breast cancer (11: 1463-1468, 1997) is a well-presented discussion of a timely subject. The authors make a good case that nodal disease (pN+) is no

PROVIDENCE, RI--Weekly high-dose paclitaxel (Taxol) produces response rates similar to those seen with combination chemotherapy in patients with advanced breast cancer and merits further study, William M. Sikov, MD, said at an ASCO poster session.

HOUSTON--Adding paclitaxel (Taxol) to adjuvant therapy may improve survival in inflammatory breast cancer, Massimo Cristofanilli, MD, of M.D. Anderson Cancer Center, reported at the ASCO meeting.

We agree with the need to reexamine the routine use of axillary dissection in the management of breast cancer patients, as advocated by Manjeet Chadha and Deborah Axelrod, in their article, "Is Axillary Dissection Always Indicated in Invasive

OXFORD, UK--The latest 5-year metaanalysis by the Early Breast Cancer Clinical Trialists’ Collaborative Group suggests that up to 20,000 additional lives could be saved each year worldwide if physicians prescribed adjuvant tamoxifen (Nolvadex) to all early breast cancer patients who could benefit, including premenopausal women.

ASCO--In two phase III trials, the anti-HER-2/neu monoclonal antibody (MoAB) Herceptin (trastuzumab, Genen-tech) showed significant activity both as a single agent and in combination with traditional cytotoxic chemotherapy in the treatment of HER-2/neu overexpressing metastatic breast cancer.

WASHINGTON--Feedback indicates that the National Cancer Institute did quite well in equipping counselors in advance to deal with questions posed by women about the ability of tamoxifen (Nolvadex) to prevent breast cancer, NCI director Richard D. Klausner, MD, told a Senate subcommittee.

ASCO--Postmenopausal women with osteoporosis who took raloxifene (Evista) for 2½ years to prevent fractures also had a significant 70% reduction in breast cancer risk, according to results of the Multiple Outcomes of Raloxifene Evaluation (MORE), reported at ASCO.

A Carnegie Mellon University study of women with breast cancer has shown that those with strong social or family networks and a good relationship with their oncologist may not benefit from participation in emotional support groups and may, in fact,

Women with common variations in the class of enzyme known as glutathione S-transferase (GST), which detoxify carcinogens, are at increased risk of developing breast cancer, according to researchers at the Johns Hopkins School of Public Health.

NUTLEY, NJ--Hoffmann-La Roche Inc. has received accelerated approval from the Food and Drug Administration for Xeloda (capecitabine), making it the first approved oral anticancer drug for patients with metastatic breast cancer whose tumors are resistant to standard chemotherapy with paclitaxel (Taxol) and an anthracycline-containing regimen.

In 1996, the total in-hospital charges for the primary treatment of women with breast cancer with a modified radical mastectomy averaged $10,000 throughout the United States. The total charge (hospital plus physician’s fees) varied by 95% between the high charge reported in New York ($12,690) and the low charge in Michigan ($6,510). The hospital portion of the bill averaged 65% of the total and ranged from 51% in New York to 74% in Virginia. The average length of stay for these women was 2.39 days and ranged from 3.18 days in New York to 1.69 and 1.66 days in Washington and Arizona, respectively. The average charge for a partial mastectomy was $8,760, with notable variations between states. The Texas total charge was the highest ($12,890, some 47% above the US norm) and more than twice the low charge in Ohio ($6,080, 31% below the US average). The physicians’ charges averaged $3,330 for the country as a whole and accounted for 38% of the bill. This proportion ranged from 46% of the total in New York to 70% in Indiana and Colorado. The average length of hospitalization for a partial mastectomy was 1.84 days. On average, women remained in the hospital for the longest time in New Jersey (2.78 days) and for the shortest time in Oregon and Massachusetts (1.40 days and 1.45 days, respectively).[ONCOLOGY 12(6):889-902, 1998]

Methods for detecting breast cancer are evolving as new technology provides a wider range of options for screening and definitive diagnosis. In addition to mammography and physical examination, screening techniques now include ultrasonography, technetium-99m sestamibi nuclear scanning, and magnetic resonance imaging.