Breast Cancer

Lapuleucel-T (Neuvenge, Dendreon Corporation), an autologous active cellular immunotherapy designed to stimulate cellular immune responses against HER2/neu, proved feasible and well tolerated with evidence of anticancer activity in a phase I trial.

The future of breast cancer therapies will involve agents targeting multiple aspects of the signaling pathway. At ASCO 2007, investigators reported encouraging preliminary activity for numerous agents in the pipeline.

In the late 1980s, based on limited studies, high-dose chemotherapy with autologous bone marrow transplantation (HDCT/ABMT) emerged as a prominent procedure in the treatment of metastatic and early-stage breast cancer. Subsequent randomized clinical trials showed that HDCT/ABMT had no benefit, compared with standard chemotherapy; however, in the interim, some 30,000 women had undergone unnecessary treatment.

It was a serendipitous discovery, indeed. Tan A. Ince, MD, PhD, of Harvard Medical School, set out to develop a breast cancer cell line with cells that looked more like the actual disease under a microscope and behaved more like cancer cells in patients. Instead, he created a line of extraordinarily potent cancer stem cells

Recent data suggest that HER2 positivity predicts for the development of CNS metastases in breast cancer patients. Studies presented at the ASCO 2007 annual meeting found that risk of brain metastases is indeed increased in HER2-positive patients but does not appear to compromise survival.

It may soon be possible to determine which breast cancer patients will respond to adjuvant endocrine therapy, based on the level of cell-cycle response in the surgical specimen after neoadjuvant endocrine therapy

I will never forget the moment when I first found out about my wife's breast cancer. She had noticed an abnormal thickening in her breast and even though we were spending most of our attention focused on an adenoma on the opposite side, the surgeon felt that a biopsy would be prudent. It was a Monday morning, and I was at my desk. Because of my position within our institution, I happened to be on the distribution list of my wife's pathology report. However, before I got to that point in the mail, my close colleague came to my office to notify me of her diagnosis of invasive breast cancer.

Approximately 212,920 new cases of invasive breast cancer were estimated to occur in the United States in 2006.1 The incidence rate has continued to rise slowly over the past 20 years due to the continued increase of breast cancer in women aged 50 and older (375 cases per 100,000 women), peaking at 75 to 79 years of age (525 per 100,000 women).

patient is a 39-year-old premenopausal woman who presents with a new diagnosis of breast cancer to our multidisciplinary second opinion clinic.

Specifically, they looked at lapatinib (Tykerb), which was FDA approved last March for use in patients with metastatic HER2-positive breast cancer in combination with capecitabine (Xeloda).

AMA approves CPT code for Axxent electronic brachytherapy

The Food and Drug Administration has approved the GeneSearch Breast Lymph Node (BLN) Assay, an intraoperative, molecular-based test for determining whether breast cancer has metastasized to nearby lymph nodes

In the first overall survival analysis of the BCIRG 007 study in metastatic breast cancer, the addition of carboplatin to a docetaxel (Taxotere)/trastuzumab (Herceptin) regimen did not improve overall survival.

Eli Lilly and Co announced that the Oncologic Drugs Advisory Committee of the US Food and Drug Administration (FDA) voted to recommend approval of its osteoporosis drug raloxifene (Evista) for a new use, to reduce invasive breast cancer risk in two populations: postmenopausal women with osteoporosis and postmenopausal women at high risk for breast cancer.

After first-line treatment with chemotherapy for metastatic breast cancer, maintenance therapy with pegylated liposomal doxorubicin (Doxil) may significantly improve time to progression (TTP), according to a multicenter phase III study from the Spanish Cooperative group GEICAM reported at the 43rd Annual Meeting of the American Society of Clinical Oncology (abstract 1007).

Schering-Plough Corp announced results from a phase III study that showed maintenance chemotherapy with pegylated liposomal doxorubicin hydrochloride (Doxil, marketed in Canada and Europe as Caelyx) significantly prolonged time to progression (TTP) in patients with metastatic breast cancer with infrequent and manageable clinical toxicity after first-line chemotherapy.

Despite the concerns of some members of the Oncologic Drugs Advisory Committee (ODAC) and the opposition of several advocacy groups, the panel recommended that the Food and Drug Administration approve two cancer-related indications for Evista (raloxifene), Eli Lilly's selective estrogen-receptor modulator (SERM).

A first-in-class HER2 antibody-drug conjugate may represent an effective new strategy in breast cancer therapy, according to phase I data

Nanoparticle albumin-bound (nab) rapamycin (ABI-009) showed antitumor activity in xeno-graft models of breast and colon cancer, according to investigators from Abraxis BioScience

Breast cancer is the most commonly diagnosed cancer in women and is the second leading cause of cancer-related mortality, after lung cancer. The overall incidence of breast cancer was increasing until recently, but mortality has declined since 1990, presumably due to earlier detection and better treatments.

The National Cancer Institute (NCI) has rejected funding for the proposed P-4 clinical trial in which researchers planned to compare raloxifene (Evista) and letrozole (Femara) as breast cancer prevention agents.

In an ongoing phase I trial in patients with solid tumors and lymphomas, the small-molecule tumor vascular disrupting agent NPI-2358 (Nereus Pharmaceuticals, San Diego, California) was dose escalated without evidence of dose-limiting toxicity

Adding the investigational agent ixabepilone to capecitabine (Xeloda) resulted in a significant improvement in progression-free survival (PFS), compared with capecitabine alone

A new study indicates that the Oncotype DX Recurrence Score (RS) is being used to change treatment decisions regarding adjuvant therapy in patients with early-stage node-negative, estrogen-receptor-positive breast cancer

A biweekly dosing regimen of capecitabine (Xeloda) was well tolerated in a dose-escalation study of metastatic breast cancer patients, allowing safe delivery of higher daily doses than routinely used in practice

42-year-old Caucasian female who was in her usual state of health when her first mammogram showed suspicious calcifications and a spiculated mass in the upper outer quadrant of the right breast. An ultrasound-guided biopsy showed an invasive ductal carcinoma. She underwent a lumpectomy, with the excised tumor measuring 1.2 cm. The tumor was estrogen and progesterone positive and HER2/neu negative.

The recommended primary treatment approach for women with metastatic breast cancer and an intact primary tumor is the use of systemic therapy. Local therapy of the primary tumor is recommended only for palliation of symptoms. However, a series of retrospective studies examining practice patterns for this problem show that about half the women presenting with de novo metastatic disease undergo resection of the primary tumor, and suggest that women so treated survive longer than those who do not undergo resection of the intact primary. In analyses that adjust for tumor burden (number of metastatic sites), types of metastases (visceral, nonvisceral), and the use of systemic therapy, the hazard ratio for death is reduced by 40% to 50% in women receiving surgical treatment of the primary tumor. The benefit of surgical treatment appears to be confined to women whose tumors were resected with free margins. However, these results may simply reflect a selection bias (ie, younger, healthier women with a smaller tumor burden are more likely to receive surgical treatment). In addition, the role of other locoregional therapy such as axillary dissection and radiotherapy is not addressed in these studies. In view of these data, the role of local therapy in women with stage IV breast cancer needs to be reevaluated, and local therapy plus systemic therapy should be compared to systemic therapy alone in a randomized trial.

The US Food and Drug Administration (FDA) has accepted, for filing and priority review, the New Drug Application (NDA) for Bristol-Myers Squibb's investigational compound ixabepilone, an epothilone B analog.

Bristol-Myers Squibb reported results from a large randomized phase III study of the investigational compound ixabepilone in patients with breast cancer whose disease had rapidly progressed through, or did not respond to, prior treatment with chemotherapies (anthracycline and taxane). Results showed that patients treated with ixabepilone in combination with capecitabine (Xeloda), experienced a statistically significant improvement in progression-free survival, the primary endpoint, compared to patients treated with capecitabine alone.

The recommended primary treatment approach for women with metastatic breast cancer and an intact primary tumor is the use of systemic therapy. Local therapy of the primary tumor is recommended only for palliation of symptoms. However, a series of retrospective studies examining practice patterns for this problem show that about half the women presenting with de novo metastatic disease undergo resection of the primary tumor, and suggest that women so treated survive longer than those who do not undergo resection of the intact primary. In analyses that adjust for tumor burden (number of metastatic sites), types of metastases (visceral, nonvisceral), and the use of systemic therapy, the hazard ratio for death is reduced by 40% to 50% in women receiving surgical treatment of the primary tumor. The benefit of surgical treatment appears to be confined to women whose tumors were resected with free margins. However, these results may simply reflect a selection bias (ie, younger, healthier women with a smaller tumor burden are more likely to receive surgical treatment). In addition, the role of other locoregional therapy such as axillary dissection and radiotherapy is not addressed in these studies. In view of these data, the role of local therapy in women with stage IV breast cancer needs to be reevaluated, and local therapy plus systemic therapy should be compared to systemic therapy alone in a randomized trial.