Breast Cancer

Genentech, owner of Roche, submitted its response yesterday to the FDA’s proposal to withdraw approval for Avastin (bevacizumab) for the treatment of HER2-negative metastatic breast cancer.

“How long have I had this cancer, Doctor?” This is a question that patients frequently ask their oncologist.

In their article, Patrone et al utilize a modified version of Collins’ law to estimate the age of breast, lung, and colorectal cancers. Collins’ law, which states that the period of risk for recurrence of a tumor is equal to the age of the patient at diagnosis plus 9 months, has been applied primarily to pediatric tumors, in particular embryonal tumors.[1,2] The results from the application of Collins’ law to these tumors have been reasonable, although exceptions have been reported and the law is not applicable to all cancers.[3,4] Its utilization in adults in the manner used in this paper is therefore unique.

The cancer stem cell (CSC) theory was first proposed to explain the fact that only a small proportion of leukemia or solid tumor cells have the capacity to induce growing tumors in immunodeficient mice.[1,2]

The brief review by Federici et al in the current issue of this journal is a cogent restatement of an argument that has accompanied the cancer stem cell (CSC) hypothesis almost from its inception.

The authors of “How Long Have I Had My Cancer, Doctor?” have addressed a question often contemplated by patients when they receive a diagnosis of cancer.

The choices that patients and clinicians make when dealing with cancer are dictated by time, whether they are arranging for screening mammography and colonoscopy, compiling treatment plans, or determining follow-up intervals and the age of freedom from follow-up.

The publication of the landmark paper by Al-Hajj et al, which demonstrated that breast cancer cells capable of tumor outgrowth when transplanted into the cleared mammary fatpad of immunocompromised mice could be prospectively identified using cell surface markers,[1] galvanized the cancer stem cell debate among breast cancer researchers and launched an exponential increase in papers exploring “breast cancer stem cells.”

Researchers at Baylor and affiliated institutions reported in the January issue of the New England Journal of Medicine that the addition of iniparib to chemotherapy improves the clinical benefit and survival of patients with metastatic triple-negative breast cancer, without significantly increased toxic effects.

The number of patients in the U.S. treated with radiation has increased at an average annual rate of about 7% between 2007 and 2009, according to the “2010 Radiation Therapy Market Summary Report” by IMV. Breast, prostate, and lung cancers continue to be the cancer types treated most frequently with radiation.

In a data analysis involving more than 10,000 breast cancer patients, adding radiation therapy to breast-conserving surgery reduced the risk of breast cancer recurrence within 10 years by nearly 15% and reduced the overall chance of dying from the disease by nearly 4% (from 25.4% to 21.7%). These findings provide oncologists with specific numbers they can give their patients when discussing the use of post-lumpectomy radiation therapy and the risk of recurrence, according to the study authors.

Impressive results from an ongoing study of an anti-HER2 antibody-drug conjugate in HER2-positive metastatic breast cancer has already fast-tracked a phase III trial.Trastuzumab-DM1 (T-DM1) has demonstrated comparable results to standard treatment but with much less grade 3-4 toxicity in phase II trial results.

An interesting interview aired yesterday on NPR's Fresh Air. During a routine mammogram on Dr Marisa Weiss, a breast cancer oncologist and founder of breastcancer.org, a tumor was discovered.

Ten-year follow-up results from the BCIRG 001 trial make a case for TAC therapy over FAC. In another study, researchers suggested a link between aromatase inhibitor therapy and breast density.

Results from an observational study strongly indicated that circulating tumor cells (CTCs) are an independent prognostic marker in metastatic breast cancer at first-line chemotherapy, and an early predictive marker of clinical benefit after one cycle of chemotherapy. But questions remain about the value of CTCs for guiding treatment decision-making.

The SUCCESS adjuvant therapy trial enrolled 2,026 women with primary breast cancer and no clinical evidence of metastatic disease. Disease-free survival at three years was 88.1% in women with one or more circulating tumor cells (CTCs) in their peripheral blood before undergoing chemotherapy compared with 93.7% in women with no CTCs.

Researchers from the ATAC and BIG 1-98 trials reported that CYP2D6 testing is not ready for prime time for gauging response to tamoxifen. While of the leading researchers in the field of CYP2D6 genotyping posed some key questions that need to be answered before CYP2D6 can be officially ruled out, or embraced, in clinical practice, these study results strongly suggest that CYPD2D6 testing should not be part of the standard of care, said Claudine Isaacs, MD.

An update of a long-term denosumab (Xgeva) trial offers another bisphosphonate as an alternative to zoledronic acid (Zometa) that is more convenient, less toxic, and more effective in bone metastases. But oncologists need to perform an oral exam of patients with bone metastases before placing them on denosumab.

As the FDA considers whether to rescind approval for bevacizumab (Avastin) in the adjuvant setting, “disappointing” results from the GeparQuinto study indicate the agent may be best reserved for patients with triple-negative disease.

Results from the GINECO group study demonstrate Afinitor’s ability to buy more time for patients while Xgeva makes everyday life less painful.

Exemestane provides a new option for upfront, five-year endocrine therapy in postmenopausal women, based on results of the first definitive early breast cancer trial to compare nonsteroidal and steroidal therapy.

An analysis of multiple ECOG trials found that obese women with hormone receptor-positive breast cancer experience worse outcomes. But an exploratory analysis of the international TEAM trial indicated that obesity does not exert a negative influence on the efficacy of adjuvant endocrine therapy.

C. Kent Osborne, MD, codirector of SABCS 2010, spoke with Oncology NEWS International about what to watch for at this year’s meeting. Dr. Osborne highlights key studies in adjuvant therapy and aromatase inhibitor therapy and discusses some of the future challenges that the breast cancer community faces.

For women with triple-negative breast cancer, BRCA mutations can be a boon: These patients have a significantly lower risk of relapse than their counterparts who do not carry BRCA mutations, according to a study out of Houston’s M.D. Anderson Cancer Center. SABCS 2010 will feature an education session on the clinical utility of genetic testing for inherited predisposition to breast cancer.

For women with hereditary breast cancer, deciding on the best treatment option can be challenging. Three specialists, including medical oncologist Susan M. Domchek, MD, discuss the different approaches to managing breast cancer patients with a family history of BRCA mutations. Dr. Domchek will give a talk at SABCS 2010 on the management of women with a significant predisposition to breast cancer.

ASCO recently released updated guidelines on the use of adjuvant endocrine therapy in hormone-receptor-positive breast cancer. While the guidelines focus on all postmenopausal women, those who are age 75 and older require special consideration. Unfortunately, meaningful data to help healthcare providers make treatment decisions for these patients are scarce, according to Peter Ravdin, MD, PhD, an executive committee member and scientific program planning member of SABCS 2010.

The BHGI is working to collaborate with colleagues in LMCs to develop practical strategies to improve outcome, applying implementation research methodology to promote early detection strategies in settings where appropriate care can be administered.

Anderson et al highlight the Breast Health Global Initiative for guideline development and discuss how developments in low and middle income countries have parallels in the delivery of health care to underserved populations in industrialized countries. Guidelines for appropriate breast cancer treatment must address early detection, accurate diagnosis, and the delivery of timely and appropriate treatment modalities.

Breast cancer is a significant global health issue: An updated analysis by the International Agency for Research on Cancer estimated that there were 1.38 million new breast cancer cases diagnosed in 2008 and confirmed that it remains the most frequent cause of cancer death in women worldwide.

This effort has already brought important contributions to countries of low and middle incomes: the basic guidelines, which not only indicate how patients with breast cancer can be treated even with modest resources, but also provide a minimum level of care below which countries, governments and health care systems cannot even pretend that they provide care for women with breast cancer.