Breast Cancer

The search for a magic bullet against cancer historically has glowed bright then dimmed, depending on the stage of discovery. Developments surrounding monoclonal antibodies and angiogenesis inhibitors have followed this cycle, as exuberance for their potential has bowed to the nuances that underlie the complex mechanisms on which they depend.

Research at George Washington University in Washington DC has found that African-American women diagnosed with breast cancer between 2001 and 2003 were significantly more likely to wait for treatment than if they had been diagnosed between 1998 and 2000. And the gap between diagnosis and treatment is getting wider. Those diagnosed between 2004 and 2006 waited longer for treatment than those between 2001 and 2003.

San Antonio Breast Cancer Symposium to Hold 33rd Annual SymposiumHIGHLIGHTS BREAKTHROUGHS IN RESEARCH AND TREATMENT

FDA recently came close to taking away hope for thousands of terminally ill women. But at the last minute, the agency announced it was postponing until December whether to revoke approval of Avastin for advanced-stage breast cancer treatment.

Proponents of targeted intraoperative radiotherapy say the technique matches whole-breast alternative for reducing recurrence.

Interviewer, Ron Piana,: Hello, this is Ron Piana, executive editor of the journal Oncology. October is National Breast Cancer Awareness Month (NBCAM), an annual health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention and cure.

Mammaprint and Oncotype DX are on the market many years before results are due from the large multicenter studies that should clarify their roles. In the meantime, oncologists and their patients face uncertainties about their best uses. Reports at the ASCO breast cancer symposium may resolve a few of them.

What the U.S. is doing wrong in the fight against breast cancer among African Americans continues to elude the medical community.

Dr. Conant is a pioneer in the development of digital mammography, and a leader in research on the use and benefits of early mammography screening and on the role of MRI and PET scanning. She is also the recipient of grants from the National Institutes of Health to compare standard surgical biopsy with digital mammography and stereotactic core breast biopsy.

E board review in Breast Cancer February 2008

Studies done decades ago found that mammograms reduced the breast cancer death rate by 15 to 25%. But that was when treatment was much less effective. A new study looks at an aging question: Should mammograms still be the “gold standard?”

ASTRO has published evidence-based guidelines to define appropriate fractionation of whole-breast irradiation.

An advisory panel recommended revoking bevacizumab’s approval in breast cancer. Oncologists and patients express concern about what the future holds for those who do benefit from bevacizumab.

According to ONCOLOGY contributor, Debu Tripathy, MD, FDA's process for the final approval of Avastin for advanced breast cancer raises many questions about the standards on drug approval in this changing era of targeted therapy and personalized medicine.

Adjuvant hormonal deprivation therapy is often administered long-term to patients with hormone receptor–positive cancers for primary prevention of breast cancer and secondary prevention of a recurrence.[1,2] This treatment modality is of particular importance to the elderly for two reasons: 1) the incidence of hormone-sensitive cancers (eg, prostate cancer and breast cancer) increases with age,[3] and 2) the systemic treatment regimens for elderly patients with hormone-responsive cancers are often limited to long-term hormonal deprivation therapy (HDT), most commonly androgen deprivation therapy for prostate cancer and aromatase inhibitor therapy for breast cancer, with chemotherapy often omitted.[2,4]

The incidence of metabolic syndrome is rapidly increasing. Metabolic syndrome is associated with elevated morbidity and mortality secondary to cardiovascular disease, insulin resistance, and hepatic dysfunction. A body of evidence has already implicated metabolic syndrome as a cancer risk factor; emerging evidence now suggests that cancer survivors themselves may be at risk for developing metabolic syndrome as a result of their anti-cancer therapy. Treatment of both breast cancer and prostate cancer often involves hormone-modifying agents that have been linked to features of metabolic syndrome. Androgen suppression in men with prostate cancer is associated with dyslipidemia, increasing risk of cardiovascular disease, and insulin resistance. Anti-estrogen therapy in women with breast cancer can affect lipid profiles, cardiovascular risk, and liver function. Similar findings have been noted in men with testicular cancer treated with chemotherapy. In addition, several emerging therapies, including mammalian target of rapamycin (mTOR) inhibitors and targeted kinase inhibitors, are increasingly associated with some features of metabolic syndrome. As the number of cancer survivors continues to grow, consideration of these factors and of the risk of metabolic syndrome will become increasingly important when choosing between therapy options and managing long-term follow-up.

Each year in the United States, more than 200,000 women are diagnosed with breast cancer, and 40,000 women die of the disease.[1] Approximately two-thirds of breast cancers are hormone receptor–positive, and medications that suppress estrogen are the cornerstone of adjuvant therapy for these tumors. Tamoxifen, a selective estrogen receptor modulator, was the first agent developed for this purpose and is still used widely in premenopausal women. Aromatase inhibitors (AIs), which prevent peripheral conversion of adrenal androgens into estrogen, have largely become the agents of choice for postmenopausal women. Current guidelines recommend that all postmenopausal women with hormone receptor–positive early-stage breast cancer who do not have a contraindication to AIs be treated with one of these agents, either as primary therapy or after 2 to 5 years of tamoxifen treatment as part of a cross-over strategy.[2] These recommendations are based on five large adjuvant trials that demonstrated a 3% to 4% absolute reduction in subsequent breast cancer events in patients who received an AI as part of adjuvant breast cancer treatment compared with patients treated with 5 years of tamoxifen alone.[3-7] However, it is notable that despite the lower rates of recurrence in these trials in the patients who received AIs, most studies have not demonstrated a survival advantage for AIs.

An FDA advisory panel has recommended that bevacizumab (Avastin) no longer be approved for use in patients with breast cancer.

Cancer investigators at Vanderbilt-Ingram Cancer Center in Nashville, Tenn., have confirmed that the PI3-kinase (PI3K) pathway offers a promising therapeutic target in patients who develop resistance to standard endrocine therapies.

Patient preference needs to be weighed against overall societal benefits.

Advances in our understanding of the underlying molecular mechanisms in the development of breast cancer have been at the forefront of recent clinical research. Many of the ASCO 2010’s hottest sessions featured clinical trials that looked at combination therapies with targeted agents as well as clinical improvements in standard-of-care in breast cancer.

Postmastectomy radiation therapy increased five-year overall survival by almost 50% and reduced recurrence risk by nearly 30%, according to a study in the International Journal of Radiation Oncology, Biology, Physics.

If approved, oncologists will have a new therapeutic option with proven benefits, acceptable toxicity, said EMBRACE trial leader.

Advances in our understanding of the underlying molecular mechanisms in the development of breast cancer have been at the forefront of recent clinical research. Many of the ASCO 2010’s hottest sessions featured clinical trials that looked at combination therapies with targeted agents as well as clinical improvements in standard-of-care in breast cancer.

Modifiable-risk biomarkers are increasingly being used in early-phase research to guide larger prevention trials.

Breast cancer is predominantly a disease of older women. Many of these older patients with breast cancer have low-risk disease owing to low proliferation indices, positive hormone receptors, node-negativity, or p53-negative and HER-2 (human epidermal growth factor 2)-negative tumors.[1,2] They do well without chemotherapy and will receive adjuvant hormonal therapy with tamoxifen or an aromatase inhibitor. Yet there are older women who do not have these favorable tumor characteristics and so are potential candidates for chemotherapy. The review by Muss points out this issue, highlighting benefits of chemotherapy and describing appropriate treatment regimens for these patients.

Although increasing age is the major risk factor for breast cancer incidence and mortality, when adjusted for disease stage, breast cancer mortality is similar among younger vs older patients. Importantly, about 90% of older women with breast cancer present with early-stage disease. The biologic characteristics of breast tumors in older patients suggest they would derive benefit from adjuvant therapy, particularly endocrine therapy, but older women are still frequently undertreated, resulting in poorer survival. Studies suggest that focusing on comorbidity rather than “chronologic age” as a surrogate for life-expectancy is a key aspect of adjuvant decision-making for older patients. Morbidity and mortality from cancer in vulnerable patients with poorer health can be accurately predicted by the Comprehensive Geriatric Assessment (CGA), which evaluates comorbidities, functional status, cognition, social support, psychological state, nutritional status, and polypharmacy. Use of the CGA and newer versions of this tool can lead to interventions that maintain function and improve quality of life in older patients with breast cancer.

Dr. Hy Muss is a well recognized expert in the treatment of elderly women with breast cancer, and his article “Adjuvant Chemotherapy of Breast Cancer in the Older Woman” is an extremely important addition to the limited existing literature on this topic. As he points out, nearly half of all breast cancer diagnoses occur in women over 65 years of age. As the total number of women in that demographic increases with the aging of our population, medical oncologists will be faced with a growing number of elderly breast cancer patients, for whom evidence-based recommendations on treatment are needed. As any medical oncologist who sits face-to-face with these older women knows, it is not acceptable to simply tell the patient that there are inadequate data to guide recommendations for adjuvant chemotherapy in her age group, though this is what the EBCTCG (Early Breast Cancer Trialists Collaborative Group) overview has concluded.

There’s no shortage of controversy when it comes to mammography-based breast cancer screening.

Whole-body MRI should be the go-to imaging modality for detecting bone metastases in asymptomatic patients.