Breast Cancer

This installment of Second Opinion examines the case of a patient with a new diagnosis of breast cancer presenting to our multidisciplinary breast cancer second opinion clinic.

Carcinomas arising from the breast represent a heterogeneous group of tumors of distinct biologic subtypes that have been shown to be diverse in terms of response to therapy and prognostic outcomes.

The Metastatic Breast Cancer Advocacy Working Group, a cooperative of patient advocates from seven countries, released a consensus report urging other advocacy groups, health-care corporations and professionals, government, academia, community/religious organizations, and all other relevant breast cancer stakeholders worldwide to take action on three priority areas for women living with metastatic breast cancer (MBC)

As Calabrich and colleagues illustrate in their comprehensive review in this issue of ONCOLOGY, there is a seemingly endless array of mechanisms by which the HER2-positive breast cancer cell can escape the control of trastuzumab (Herceptin).

WASHINGTON-Molecular breast imaging appears to be a promising adjunctive modality for breast cancer screening among women with an elevated risk of breast cancer who have dense breast tissue, according to a report at the ASCO 2008 Breast Cancer Symposium (abstract 68).

In 2008, it is estimated that over 1 million women worldwide will be diagnosed with breast cancer, of which 172,695 will be classified as “triple-negative.”[1] The triple-negative phenotype encompasses a breast tumor subtype that is clinically negative for expression of the estrogen and progesterone receptors (ER and PR) and lacks overexpression of the HER2 protein, with unique prognostic and therapeutic implications.

Some clinical trials of HER2-targeted therapies have found that patients assessed to have HER2-negative breast cancer nonetheless derive benefit. Is this a real benefit stemming from unrecognized biological factors in the adjuvant setting?

Measuring a woman’s bone mineral density (BMD) can provide additional information that may help to more accurately determine a woman’s risk of developing breast cancer, according to a new study in the journal Cancer.

A meta-analysis by Australian and European researchers indicates that MR staging identifies additional disease in nearly one of five women previously diagnosed with breast cancer. It also suggests that women may undergo more extensive surgeries than originally planned because of false-positive MR findings.

Factors such as age at menopause and a woman’s breast-feeding practices can influence her risk of developing certain types of breast cancer. That was the conclusion of a new study to be published in the October 1, 2008, issue of CANCER. The study’s results suggest that there are distinct and separate hormonal risk factors associated with different subtypes of breast cancer.

CHICAGO-In the adjuvant setting, capecitabine (Xeloda) proved inferior to standard chemotherapy in older women with early-stage breast cancer, according to study results from the University of Vermont College of Medicine, Burlington.

CHICAGO-The addition of trastuzumab (Herceptin) to the arsenal of breast cancer agents has elevated the prognosis of HER2-positive patients to that of HER2-negative patients, according to an institutional review from M.D. Anderson Cancer Center.

In this article, we review the underlying biology and pharmacology behind lapatinib and summarize clinical trials with lapatinib. We also describe the ongoing clinical trials that use lapatinib as part of adjuvant and neoadjuvant therapy. These trials could change the standard of care in the next few years.

Measuring a woman's bone mineral density can provide additional information that may help to more accurately determine a woman's risk of developing breast cancer. That is the conclusion of a new study to be published in the September 1, 2008, issue of CANCER.

Mastectomy rates have been on the upswing at the Mayo Clinic in Rochester, Minnesota, and researchers cited MRI as a factor influencing the increase.

There is no doubt women at high risk for breast cancer need to be screened more aggressively than the general population. Thanks to extensive research-not to mention a nod from the American Cancer Society as a screening tool-MRI has leapt ahead of other imaging modalities as the preferred modality in a high-risk population.

Anthracyclines have been a cornerstone in the adjuvant treatment of breast cancer for more than 25 years and have well-established risks and benefits. But new molecular assays may make it possible to predict which women will benefit from this therapy, and new agents may offer better alternatives.

CHICAGO-The insulin sensitizer metformin may increase the response to neoadjuvant chemotherapy in diabetic patients with breast cancer, according to a retrospective study presented at ASCO 2008 (abstract 528).

Two years after her first mammogram the patient, EC, noticed swelling and skin changes in one breast. A bone scan, chest and abdomen CT, and PET scan were negative for metastatic spread, staging the cancer at IIIB.

CHICAGO-In recurrent or metastatic breast cancer, the addition of bevacizumab (Avastin) significantly improved progression-free survival over treatment with docetaxel (Taxotere) alone, European investigators reported at ASCO 2008 (abstract LBA-1011).

Positive data were reported from the first-ever randomized, multicenter, open-label phase III trial of the combination of two targeted agents, lapatinib (Tykerb) and trastuzumab (Herceptin), in women with HER2-positive metastatic breast cancer. The study results, which were presented at the annual ASCO meeting in Chicago, demonstrated a benefit from the combination (abstract 1015).

CHICAGO-For breast cancer patients whose tumors have become resistant to available agents, restoring the sensitivity to treatment is an important goal. Preclinical studies have suggested that drugs that inhibit the mTOR protein kinase-which acts as a central regulator of tumor cell division, cell metabolism, and blood vessel growth-may be able to do so.

A novel intraoperative breast cancer probe developed in Israel is showing significant promise in the reduction of repeat procedures in patients undergoing breast-conserving surgeries, according to a study presented at the American Society of Breast Surgeons Annual Scientific Meeting.

Using intensity-modulated radiation therapy for breast cancer patients after lumpectomy can reduce the incidence of acute dermatitis, compared with traditional whole-breast radiotherapy, reported Jean-Philippe Pignol, MD, of Sunnybrook Health Sciences Centre, Toronto, and colleagues.

Jay R. Harris, MD, will present the Gianni Bonadonna Breast Cancer Award lecture at the upcoming 2008 ASCO Breast Cancer Symposium being held September 5-7 in Washington DC. Dr. Harris is professor and chair of the Department of Radiation Oncology at the Dana-Farber Cancer Institute and the Brigham and Women’s Hospital at Harvard Medical School.

Breast Cancer is a unique effort in the world of breast cancer texts: Compact and concise, this 214-page book deals exclusively with breast cancer therapeutics, and strives to accomplish the difficult task of being as current as possible within the limited capabilities of the printed word in a rapidly evolving field. Dr. Seidman has assembled a distinguished group of authors, each of whom was assigned a topic, in the end covering all aspects of the medical oncologic scope of breast cancer treatment in one relatively short text. The book does not address issues of breast cancer epidemiology, screening, prevention, or surgical or radiation treatment-this was not the intent of this publication.

This practical review on the use of serum markers and circulating tumor cells (CTCs) focuses on the role of these assays in the management of patients with breast cancer and contains important information and perspectives for the practicing oncologist. The varying roles of these markers in early-stage and advanced disease are presented, and the implications in management are quite different in each setting.

Important therapeutic innovations within the past several years have resulted in only modest survival benefits for women with metastatic breast cancer. In this setting, cancer remains incurable and treatment is mainly palliative, involving judiciously applied multiple endocrine, chemotherapeutic, or biologic therapies in an attempt to induce a series of remissions and, ultimately, adequate palliation. At present, we lack both a consensus management algorithm and an ideal treatment model of specific subsets of women.

A large, international trial has shown that adding the targeted therapy bevacizumab (Avastin) to the chemotherapy drug docetaxel (Taxotere) slows disease progression in patients without prior chemotherapy for locally advanced or metastatic breast cancer. The results were presented by David Miles, md, a professor and medical oncologist at the Mount Vernon Cancer Centre in Middlesex, UK, and the study’s lead author (abstract LBA1011).

A large, international trial has shown that adding the targeted therapy bevacizumab (Avastin) to the chemotherapy drug docetaxel (Taxotere) slows disease progression in patients without prior chemotherapy for locally advanced or metastatic breast cancer. The results were presented by David Miles, md, a professor and medical oncologist at the Mount Vernon Cancer Centre in Middlesex, UK, and the study’s lead author (abstract LBA1011).