Breast Cancer

A chemotherapy regimen that is both dose dense and dose intense significantly improved relapse-free and overall survival

The combination of trastuzumab (Herceptin) and bevacizumab (Avastin) as first-line treatment of metastatic breast cancer showed promising results in the first phase II study to evaluate this regimen.

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Several issues raised in the article by Cianfrocca and Wolff and the accompanying reviews in the January issue of ONCOLOGY (21:63-80, 2007) deserve further comment. First, all authors address American resource-rich patient populations only. According to data from Parkin et al, nearly two-thirds of all new cases of breast cancer globally (a total of 1 million cases) occur among poor women. Half of these (500,000 cases) are in premenopausal women with hormone-receptor-positive tumors.[1] We need to broaden our horizons to consider these much larger populations whenever we discuss breast cancer therapies.

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Investigational vaccines to prevent breast cancer recurrence are showing promise in small clinical trials

A large proportion of human breast cancers may be associated with the human mammary tumor virus (HMTV), which is nearly identical to the murine mammary tumor virus (MMTV) that is implicated in breast cancer in mice.

A mobile mammography unit that links a digital mammography system with a commercial satellite service provides near real-time interpretation of breast imaging scans to Native American women on remote rural reservations

Two groups of researchers have separately concluded that use of Herceptin (trastuzumab) in combination with standard anthracycline-based chemotherapy is cost effective as adjuvant therapy for early-stage HER2-positive breast cancer

Proliferating macrophages (promacs) in invasive breast tumors predict worse outcomes and are particularly frequent in breast cancers from women in West Africa

Ultrasound-guided placement of a balloon catheter for partial breast brachytherapy can be safely delayed until after the final pathology report has confirmed that the patient is a candidate for the procedure, according to a new study.

Long-term (median, 51 months) follow-up data from the Breast International Group (BIG) I-98 trial support earlier findings that the aromatase inhibitor letrozole (Femara) is more effective than tamoxifen as initial postsurgery therapy for early breast cancer

A planned interimanalysis of a phase II internationalstudy of first-line nab-paclitaxel(Abraxane) vs docetaxel (Taxotere) inchemonaive patients with stage IV breastcancer shows nab-paclitaxel yielded longerprogression-free survival (PFS) at alldose levels tested.

A triplet of biweeklyneoadjuvant gemcitabine (Gemzar),epirubicin (Ellence), and nabpaclitaxel(Abraxane) (GEA) was "exceptionally well tolerated" andproduced a 94% overall pathologicresponse in women with locallyadvanced breast cancer.

A GermanAGO Group multicenter randomizedphase III trial by Volker J. Moebus, MD,et al has confirmed the benefit of dosedense(DD) ETC chemotherapy in highriskearly breast cancer.

In a phase II,multicenter open-label study, Lee S.Schwartzberg, MD, et al evaluated 50patients with metastatic breast cancertreated with nab-paclitaxel (Abraxane)at 125 mg/m2 on days 1 and 8 andcapecitabine (Xeloda) at 825 mg/m2 bidon days 1–14 of a q3wk cycle (abstract1096).

Weekly first-linetherapy with nab-paclitaxel (Abraxane)was well tolerated and showed strongclinical responses in taxane-refractorylocally advanced or metastatic breast cancer,report researchers from the InternationalOncology Network.

Progress continues in the investigation of cytotoxicchemotherapy for breast cancer, and recentdata have yielded important new insights.

Interest has been growing for several years in determining the prognostic significance of micrometastases and isolated tumor cells (ITCs) in the lymph nodes of breast cancer patients.

Postmenopausal breast cancer patients who received exemestane (Aromasin) after 5 years of tamoxifen cut their risk of relapse by half

Breast cancer patients across the nation will soon have a way to match themselves with a clinical trial

Accelerated partial breast irradiation (APBI) may be an effective and well-tolerated alternative to standard radiotherapy in early-stage breast cancer, and partial breast irradiation with interstitial brachytherapy also appears feasible in women who have had a recurrence after previous breast radiotherapy

An investigational gene-based diagnostic assessment for lymph node metastases may improve intraoperative pathology and surgical decision-making, and reduce the need for second axillary node surgeries

The standard treatment for early breast cancer—AC/T— was not as effective as two regimens used in Canada in preventing recurrences. Specifically, CEF and a novel regimen, dose-dense EC/T, were both more effective than AC/T in the MA.21 study

In younger patients with ductal carcinoma in situ (DCIS), boost irradiation reduced local recurrences by at least half when added to standard radiotherapy, Gunther Gruber, MD

The investigational agent lapatinib (Tykerb) when added to paclitaxel has significant clinical activity as neoadjuvant treatment of HER2-positive inflammatory breast cancer (IBC)

This month, we offer an example of persistence by the patient and her family resulting in a reversal of coverage denial.

In the clinical practice setting, almost a quarter of women treated for breast cancer stop tamoxifen within 1 year, a rate twice as high as indicated by previous studies.

Nanoparticle albumin-bound paclitaxel (nab-paclitaxel, Abraxane) given weekly outperformed docetaxel (Taxotere) given every 3 weeks as first-line treatment of metastatic breast cancer.