Breast Cancer

Hypofractionated external beam WBI seems like a great option until the APBI data mature from NSABP 39/RTOG 0413. In the meantime, we will have to see whether the ACA’s mission to bend the cost curve in the face of added demand for cancer care will succeed and how our treatment decisions will be affected by this new healthcare model.

APBI is a technique that offers women with early-stage breast cancer a choice. The preponderance of evidence supports the efficacy and safety of this technique, and it should continue to be offered to appropriately selected patients on and off protocol.

Accelerated partial-breast irradiation is a shorter, alternative radiation technique for select patients with favorable early-stage breast cancer. We review here the different modalities of delivery and discuss the possible benefits and harms associated with these treatments.

The use of estrogen plus progestin in postmenopausal women has once again been linked to an increased risk for breast cancer, according to the results from a Women’s Health Initiative observational cohort study, especially among women who initiated hormone therapy closer to menopause.

Trastuzumab (Herceptin) therapy may be useful for the treatment of luminal breast cancer stem cells, preventing them from growing into macrometastases, according to preclinical results presented at the 2013 American Association for Cancer Research Annual Meeting.

Washington, DC-“Triple-negative breast tumors are composed of mosaic cancer cells with distinct genetic aberrations,” said Jorge S. Reis-Filho, MD, PhD, a surgical pathologist at the Memorial Sloan-Kettering Cancer Center in New York, who combines traditional pathology, gene expression profiling, and genomics techniques to understand rare breast tumor types, including triple-negative diseases.

Researchers participating in the phase III EMILIA trial have identified tumor biomarkers that can identify patients that are more likely to benefit from T-DM1. In the trial, women whose tumors had higher HER2 expression were most likely to benefit from the therapy.

This article reviews clinical data informing the effective management of HER2-positive metastatic breast cancer, including the optimal sequence of HER2-targeted agents.

Additional insight into the biology of ER-positive breast cancers, particularly the higher risk luminal B cancers, could aid in identifying potential targets and new, effective therapies. And though the majority of triple-negative breast cancers are the “basal-like” subtype, significant proportions are in other subtypes.

If MGTs could predict which patients were most prone to late recurrence and thus might benefit from extended adjuvant endocrine therapy, it would be a huge advancement in the care and survivorship of our patients. More studies of MGTs are required to clarify their role in evaluating prognosis and predicting response to therapy in breast cancer.

Clinicians and bioinformatics experts must learn to speak the same language, starting with basic principles regarding analytical validity, clinical validity, and clinical utility. More than ever, a true partnership between clinical, laboratory, and bioinformatics scientists as part of a multidisciplinary team is needed to benefit our patients.

As more drugs become available in the HER2 arena, clinicians will be faced with increasing challenges regarding which sequences and combinations of drugs will be the best for their patients. In the era in which we practice, a great deal of this is likely to be dictated by the payers.

Third, how much do we really know about de novo and acquired resistance to trastuzumab and lapatinib? There are several possible clinical relevant mechanisms of trastuzumab resistance, including crosstalk with other receptors, amplification of the PI3K/AKT pathway, alteration of the trastuzumab binding domain, and loss of HER2 expression.

Last month brought the accelerated approval by the US Food and Drug Administration (FDA) of a fourth agent targeting the human epidermal growth factor receptor 2 (HER2) oncogene product: TDM-1 (Kadcyla), a conjugate of trastuzumab and a cytotoxic, emtansine.

Researchers have demonstrated that mammary tumor development can be directly inhibited by lifelong exposure to n-3 polyunsaturated fatty acid in mice. The new study directly shows the anticancer activity of omega-3s.

A new study from cancer stem cell experts at the University of Michigan is challenging the notion that trastuzumab (Herceptin) only works for HER2-positive breast cancer.

Ado-trastuzumab emtansine, formerly known as T-DM1, improved progression-free survival as first-line treatment for patients with HER2-positive metastatic breast cancer, when compared with the standard treatment of trastuzumab plus docetaxel in a randomized phase II multicenter study.

At the 30th Annual Miami Breast Cancer Conference, Lisa Carey, MD, presented the major questions in managing triple-negative breast cancer. This type of breast cancer makes up approximately 15% of all breast cancer cases, is typically more aggressive, and has a higher risk of early relapse.

Most breast cancer patients are treated with some form of chemotherapy, and because women with breast cancer are now surviving longer, the long-term effects of chemotherapy have become a major issue.

Risk factors for breast cancer can be parsed into genetic and biological factors, and environmental and lifestyle factors; and the general consensus is that screening and prevention strategies should be tailored based on an individual’s risk assessment.

How best to manage patients who present with ductal carcinoma in situ (DCIS), a noninvasive and early form of breast cancer, remains unclear. Treatment options range from minimal, breast-conserving surgical intervention and no follow-up treatment, to surgical intervention followed by additional treatment.

It used to be so easy. Patients with ER-positive breast cancer got 5 years of tamoxifen. You could anticipate most of the side effects. No one showed up with an armload of internet downloads ready to debate the utility of hormone therapy, the risks, and metabolism or drug interactions. No more.

As part of our coverage for the 30th Annual Miami Breast Cancer Conference, we bring you an interview with Dr. Mark Pegram, director of the breast cancer program at the Stanford Women’s Cancer Center and codirector of the molecular therapeutics program. Dr. Pegram will be discussing the potential for novel HER2 combination therapies at the conference.

New technologies and techniques are in development to use blood samples to detect biological material in the blood that can differentiate a patient with cancer from one who does not have cancer and to aid in the treatment of breast cancer patients.

A new study by researchers at the Scripps Research Institute has identified a metabolic mechanism by which breast tumor cells control tumor aggressiveness.

The FDA has approved ado-trastuzumab emtansine (Kadcyla), known as T-DM1 in development, for the treatment of women with metastatic HER2-positive breast cancer.

The prospect of even more compressed radiotherapy options for women requiring adjuvant breast radiotherapy is exciting. However, we urge readers to be cautious in their interpretation of the current intraoperative literature as they implement their programs.

Due to the fact that we do not have mature long-term data regarding efficacy, we are still several years away from declaring IORT to be a viable alternative to the current standard of care in patients with early-stage breast cancer.

With many centers seeking to adopt IORT, there are licensing, proctoring, staffing, technical support, and reimbursement issues that need to be considered. We have reviewed the current international experience and describe one community cancer center’s experience with initiating an IORT breast cancer program.

Consuming more vegetables is associated with a lower risk of estrogen receptor (ER)-negative breast cancer, according to a new study published in the Journal of the National Cancer Institute.