Breast Cancer

SEATTLE, Washington-In a new endeavor, an international group of experts is creating detailed guidelines for the screening, diagnosis, and treatment of breast cancer in countries and regions of the world with limited resources. The endeavor began with the Global Summit Consensus Conference and will lead to the publication, dissemination, and translation of the first edition of the guidelines next year.

NEW ORLEANS-Having a previous pregnancy improves the prognosis for women who develop early-stage breast cancer later in life, according to a study presented at the 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 152). The findings suggest that a more aggressive treatment approach should be considered for those patients who have not had a pregnancy.

RESEARCH TRIANGLE PARK, North Carolina-Researchers have begun the first phase of a long-term, prospective epidemiological study designed to determine the role of genetic, environmental, and lifestyle factors in increasing the risk of breast cancer and several other diseases. The Sister Study is the first long-term follow-up study specifically designed to look at hereditary and environmental risk factors for the disease. It seeks to enroll 50,000 cancer-free women in the United States between the ages of 35 and 74 who have a sister diagnosed with breast cancer.

During the 1990s, perhaps no other therapy for women with breast cancer was more controversial than high-dose chemotherapy with autologous bone marrow and/or peripheral stem cell support. With encouraging results from late phase I and early phase II trials in the early to mid-1990s, high-dose chemotherapy was promoted by its many enthusiastic proponents as a potentially great leap forward for women with high-risk, node-positive or metastatic disease.

At first glance, high-dose chemotherapy for breast cancer makes sense. The disease is often sensitive to chemotherapy, potentially curable, and highly prevalent, which means that even a modest benefit would be tremendously important. Unfortunately, multiple clinical trials have failed to demonstrate that high-dose therapy is more effective than other chemotherapeutic approaches. Thus far, no prospective study has demonstrated a benefit based on its planned primary objective and planned analysis, and none has shown a survival advantage (see Table 1).[1-5]

Over the past decade, high-dose chemotherapy with autologous bone marrow and/or peripheral blood rescue has been increasingly used to treat women with breast cancer. Laboratory and clinical studies have shown that dose intensity may be important in treating selected patients with breast cancer. Initial phase I studies showed good response rates of short durations. Further trials in metastatic disease with high-dose chemotherapy and stem cell rescue earlier in the treatment course had been encouraging. However, the optimal timing of high-dose chemotherapy remains a question. In addition, randomized trials in high-risk early-stage breast cancer have completed accrual. Technologic improvements in stem cell procurement and hematopoietic growth factors have contributed to decreased morbidity and mortality. This review will discuss the role of such therapy in the treatment of women with breast cancer. [ONCOLOGY 16:1643-1656, 2002]

WASHINGTON-The blood of the human umbilical cord, although often discarded after childbirth, is a "very rich source" of lymphocytes potentially capable of killing cancer cells, according to Shantaram Joshi, PhD, professor of genetics, cell biology, and anatomy, University of Nebraska Medical Center, Omaha.

ORLANDO-A study reported at the Era of Hope Department of Defense Breast Cancer Program meeting adds more evidence supporting wider use of sentinel lymph node (SLN) biopsy by surgeons skilled in the technique.

ORLANDO-Weekly paclitaxel (Taxol) given as a neoadjuvant therapy for patients with locally advanced breast cancer resulted in regression of the primary tumor in 60% of patients. Albert S. Braverman, MD, professor of medicine, Downstate Medical Center of the State University of New York, Brooklyn, presented the results at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 278).

A phase II study found that the use of trastuzumab (Herceptin) in combination with docetaxel (Taxotere) and cisplatin shrank breast tumors so significantly that locally invasive cancers became undetectable in 1 of 4 women (26%) who participated in the

At the recent Department of Defense Breast Cancer Research Program "Era of Hope" meeting, held in Orlando, Fla, researchers presented a prototype for a simple test that can rapidly screen tiny samples of tissue for biomarkers of breast

EAST HANOVER, New Jersey-A phase III study to determine overall and disease-free survival of women with early breast cancer who take the aromatase inhibitor Femara (letrozole tablets) vs placebo in the adjuvant setting following 5 years of hormone therapy with tamoxifen (Nolvadex) has completed enrollment of 4,800 postmenopausal women.

NIAGARA-ON-THE-LAKE, Ontario, Canada-Female survivors of childhood cancer are generally at increased risk of developing secondary breast cancer years after their initial disease. New research, presented at the 7th International Conference for Long-Term Complications of Treatment of Children and Adolescents for Cancer, hosted by Roswell Park Cancer Institute, is shedding light on this issue and helping practitioners determine how to best screen this population.

As a result of the availability and clinical efficacy of trastuzumab (Herceptin), clinicians are now faced with a dilemma regarding the accurate identification of patients with HER2 overexpression. In the October 2002 issue of ONCOLOGY,

This supplement to ONCOLOGY includes a collection of papers focusing on the clinical development and use of capecitabine (Xeloda), a novel agent with significant activity in patients suffering from metastatic breast cancer. It is now clear that this

The demonstration of the activity of capecitabine (Xeloda) in advanced breast cancer and of the ability of capecitabine/docetaxel (Taxotere) to improve tumor response, time to disease progression, and survival in this

Available data on the use of active chemotherapy agents in advanced breast cancer suggest that sequential single-agent therapy is associated with outcomes similar to those achieved with concurrent combination therapy. Since

A recent phase III trial demonstrated that the combination of capecitabine (Xeloda) and docetaxel (Taxotere) significantly improved objective tumor response rate, time to disease progression, and overall survival compared

Capecitabine (Xeloda) offers a unique mode of action. The drug is currently being combined with other active agents in the treatment of advanced breast cancer. The recent demonstration of improved disease-free and overall

The US Food and Drug Administration has approved anastrozole (Arimidex) for the adjuvant treatment of hormone-receptor-positive early breast cancer in postmenopausal women. The approval is based on research from the Arimidex,

WILMINGTON, Delaware-AstraZeneca’s nonsteroidal aromatase inhibitor Arimidex (anastrozole) has received FDA approval for the adjuvant treatment of hormone-receptor-positive early-stage breast cancer in postmenopausal women. The agent was previously approved as first-line treatment of hormone-receptor-positive advanced breast cancer in postmenopausal women and as second-line treatment for those whose disease has progressed following treatment with tamoxifen (Nolvadex).

The results of a phase III trial of capecitabine (Xeloda) in combination with docetaxel (Taxotere) for the treatment of metastatic breast cancer were published in a recent issue of the Journal of Clinical Oncology (20:2812-2823, 2002). Based on

The results of two clinical trials evaluating fulvestrant (Faslodex) for the treatment of advanced breast cancer in postmenopausal women with disease progression following antiestrogen therapy were published in a recent issue of the Journal

ORLANDO-An open-label randomized study comparing letrozole (Femara) and anastrozole (Arimidex), the two US FDA-approved nonsteroidal aromatase inhibitors, found a higher overall response rate for letrozole as second-line therapy in women with metastatic breast cancer.

United States seems to have a predilection for declaring "war" on its internal problems, be they poverty, drugs, or cancer. In the latter part of the past century particularly, military metaphors became part of the vocabulary used by Americans to

In an international study of the two leading aromatase inhibitors, data demonstrate that 50% more women with advanced breast cancer respond to letrozole (Femara) than to anastrozole (Arimidex); ie, more women treated with letrozole achieved at

ROCKVILLE, Maryland-The Food and Drug Administration has approved the inclusion of the PathVysion HER-2 DNA Probe Kit, a new genedetection test, in the labeling of Herceptin (trastuzumab, Genentech). PathVysion is made and marketed by Vysis, Inc., a subsidiary of Abbott Laboratories. It joins HercepTest (DAKO) as the second screening test listed in the Herceptin labeling.

ORLANDO-Compared with the aromatase inhibitor anastrozole (Arimi-dex), mean duration of response is significantly greater with fulvestrant (Faslo-dex) in postmenopausal women with advanced breast cancer who have progressed on prior endocrine therapy. For other key endpoints, fulvestrant was at least as effective as anastrozole, according to a poster presentation at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 160).

Received approval from the US Food and Drug Administration (FDA) to include information about Abbott’s PathVysion-a fluorescence in situ hybridization (FISH) test-in the product insert for trastuzumab (Herceptin). FISH is used to detect human

With the advent of methods for determining genetic susceptibility to breast cancer, there is a growing focus on prevention as a primary strategy. In this context, more women will receive information about the role of prophylactic mastectomy as a definitive management strategy. Drs. Ghosh and Hartmann have provided a thorough review of the salient issues in prophylactic mastectomy. Their discussion of the procedure and its history set the stage for further discussion of the relative efficacy of prophylactic mastectomy in reducing the risk of breast cancer in women.