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Breast Cancer

Risk-Based Breast Cancer Screening: Studies Suggest Alternatives to Age-Based Guidelines

Measuring certain hormone levels could help determine a woman’s risk for breast cancer and add a key factor to current risk-prediction models, according to investigators from Harvard Medical School. Their new study results were presented at the American Association for Cancer Research (AACR) Annual ...

Breast Cancer

Artemis Project® for a Preventive Breast Cancer Vaccine

I read with interest the article, “Breast Cancer Vaccines for Primary Prevention Move Toward Clinical Use,” which appeared in the December 15th issue of The ASCO Post (page 28). However, information presented regarding the National Breast Cancer Coalition’s (NBCC’s) Artemis Project for a breast...

Breast Cancer

Final Overall Survival Data Show Better Results With Higher Dose of Fulvestrant

Among patients with locally advanced or metastatic estrogen receptor–positive breast cancer, fulvestrant (Faslodex) given at 500 mg “is associated with a 19% reduction in risk of death and a 4.1-month difference in median overall survival compared with fulvestrant 250 mg,” according to final...

Breast Cancer

Drugging PI3K in Breast Cancer: Findings From SABCS 2013

Components of the phosphatidylinositide 3-kinase/mammalian target of rapamycin (PI3K/mTOR) pathway are deregulated in many human cancers, with about 30% of breast cancers harboring PIK3CA gene mutations. Emerging research shows that these mutations may render estrogen receptor alpha-positive tumors ...

Breast Cancer

Common Mutations May Impact Neoadjuvant Treatment Outcomes in Breast Cancer

Emerging research is suggesting that outcomes from neoadjuvant chemotherapy may be correlated with two genetic mutations that are common in breast cancer—PIK3CA and TP53. Their presence may affect response to treatment, and mutational shift after treatment may affect survival, according to studies...

Breast Cancer

Addition of Carboplatin to Standard Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer Supported by SABCS Studies

The achievement of a pathologic complete response in patients with triple-negative breast cancer was boosted by the addition of carboplatin to a standard neoadjuvant chemotherapy regimen, and by the addition of veliparib, an investigational oral PARP inhibitor, plus carboplatin to a standard...

Breast Cancer
Issues in Oncology

Confronting Uncertainty About the Harms and Benefits of Screening Mammography

“If women are to truly participate in the decision of whether or not to be screened [for breast cancer using mammography], they need some quantification of its benefits and harms,” asserted H. Gilbert Welch, MD, MPH, Professor of Medicine, and Honor J. Passow, PhD, Instructor, at The Dartmouth...

Breast Cancer

HER2 Testing: The Next Chapter

Late last year, the American Society of Clinical Oncology and College of American Pathologists published a comprehensive update of guidelines for HER2 testing,1 the first such update since their initial landmark publication in 2007.2 This new report, summarized in this issue of The ASCO Post,...

Breast Cancer

ASCO and College of American Pathologists Guideline Update: Recommendations for HER2 Testing in Breast Cancer

The American Society of Clinical Oncology (ASCO) and College of American Pathologists (CAP) recently convened an Update Committee to conduct a systematic literature review and update recommendations for optimal HER2 testing. In particular, the Committee identified criteria and areas requiring...

Breast Cancer

Switching Chemotherapy Based on Elevated Circulating Tumor Cells Does Not Change Outcome in Metastatic Breast Cancer

Elevated circulating tumor cells were prognostic for survival but did not pan out as a marker for switching after one cycle of chemotherapy in patients with metastatic breast cancer. The phase III Southwest Oncology Group (SWOG) S0500 clinical trial, presented at the 2013 San Antonio Breast Cancer...

Breast Cancer

Addition of Novel Antiangiogenic Agent of No Benefit in Metastatic Breast Cancer

Ramucirumab added to first-line docetaxel failed to improve progression-free survival in patients with metastatic breast cancer in the large, randomized, placebo-controlled ROSE/TRIO-12 trial.1 An interim analysis of overall survival showed no advantage for the addition of ramucirumab. This study,...

Breast Cancer
Pain Management

Postmastectomy Pain Effectively Treated With a Simple Injection

For postmastectomy neuropathic pain, perineural infiltration with a combination of bupivacaine and dexamethasone is a “simple, effective, practice-changing treatment that any surgeon can do,” according to Laura J. Esserman, MD, MBA, Professor of Surgery and Radiology at the University of...

Breast Cancer

SABCS Highlights Include Findings in Triple-Negative Disease, Protective Effects of Exercise, and the Adherence-Copay Link

The San Antonio Breast Cancer Symposium brings together specialists from all over the world who focus on management of breast cancer. We have covered many of the important presentations in the pages of The ASCO Post and in our online Evening News. Below are summaries of additional noteworthy...

Breast Cancer

Overdiagnosis of Breast Cancer: New Research Directions

Currently, one of the most challenging problems in oncology is to accurately predict whether neoplastic lesions detected by screening tests will progress. The focus on developing ever-more sensitive cancer screening tests has produced the clinical dilemma of overdiagnosis. Overdiagnosis occurs when ...

Breast Cancer

The Canadian National Breast Screening Trial Had So Many Flaws That Its Results Should Not Be Used to Guide Screening Recommendations

If a randomized, controlled trial of therapy for breast cancer was submitted for publication in which 1. The drug being tested was old and ineffective, and 2. prior to randomization, the women underwent a clinical breast examination and the study coordinators knew who had the largest cancers, and...

Breast Cancer

Flaws in CNBSS Are Vast, Impact on Screening Recommendations Is Nil

The recent report from the Canadian National Breast Screening Study (CNBSS)—published in BMJ and reviewed in The ASCO Post, early release online—concluded that annual mammography in women aged 40 to 59 does not result in a reduction in mortality from breast cancer beyond that of physical...

Breast Cancer

No Mortality Benefit of Breast Cancer Mammography Screening in 25-Year Follow-up of Canadian National Breast Screening Study

As reported in BMJ by Anthony B. Miller, MD, Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, and colleagues, the 25-year follow-up of the Canadian National Breast Screening Study has shown no mortality benefit of annual mammography screening for breast cancer...

Breast Cancer

In Stage IV Breast Cancer, the Primary May Not Need to Be Removed

Mastectomy is unnecessary in many women with stage IV breast cancer, according to a study from Indian investigators, reported at the 2013 San Antonio Breast Cancer Symposium.1 The study randomly assigned 350 patients with metastatic breast cancer to mastectomy, complete axillary dissection, plus...

Breast Cancer
Pain Management

Exercise Program Reduces Aromatase Inhibitor–Associated Joint Pain

Amid studies of novel targeted therapies, genetic analyses of tumors, and new ways to approach the treatment of breast cancer, a low-tech study presented at the 2013 San Antonio Breast Cancer Symposium found that a yearlong exercise program reduced joint pain associated with aromatase inhibitors in ...

Breast Cancer

Innovative I-SPY 2 Trial Yields First Results in Triple-Negative Breast Cancer

An innovative approach to streamlining the testing of novel agents in breast cancer has yielded some of its first results, which were reported at the 2013 San Antonio Breast Cancer Symposium.1 Adaptive Trial Design The veliparib/carboplatin plus standard neoadjuvant therapy regimen is currently...

Breast Cancer

HER2-Positive Breast Cancer Patients With Small Tumors Benefit From Low-Toxicity Regimen

There may be a benefit for treating small HER2-positive tumors—a breast cancer subset for whom treatment recommendations have not been established but for whom there is still risk of recurrence—and this can be done with little toxicity, according to a multicenter study presented at the 2013 San...

Breast Cancer
Supportive Care

Cognitive-Behavioral Therapy Plus Hypnosis Controls Fatigue in Breast Cancer Patients Receiving Radiotherapy

In a study reported in the Journal of Clinical Oncology,1 Guy H. ­Montgomery, PhD, Icahn School of Medicine at Mount Sinai, New York, and colleagues found that an intervention consisting of cognitive-behavioral therapy plus hypnosis produced better control of fatigue than supportive meetings with...

Breast Cancer
CNS Cancers

How to Approach the Problem of CNS Metastasis in HER2-Positive Patients

Central nervous system (CNS) metastasis is a pervasive problem in the setting of HER2-positive breast cancer. While some patients can be managed easily, others are challenging, said Eric P. Winer, MD, Chief of the Division of Women’s Cancers and the Thompson Senior Investigator for Breast Cancer...

Breast Cancer

SSO/ASTRO Release Consensus Guideline on Breast Cancer Treatment

The Society of Surgical Oncology (SSO) has announced the availability of a comprehensive consensus guideline for physicians treating breast cancer developed to help reduce health-care costs and improve the course of treatment. Developed in conjunction with the American Society of Radiation Oncology ...

Breast Cancer
Health-Care Policy

Affordable Care Act to Cover Chemoprevention for Women at High Risk for Breast Cancer

On January 9, 2014, Kathleen Sebelius, Secretary of the Department of Health and Human Services, announced that under the Patient Protection and Affordable Care Act, women at increased risk of breast cancer will be entitled to preventive medications without incurring out-of-pocket costs (with the...

Breast Cancer

Impact of Delayed Initiation of Adjuvant Chemotherapy for Breast Cancer Varies by Tumor Subtype

The optimal time interval between surgery and initiation of adjuvant chemotherapy for early-stage breast cancer is not well established. Although most physicians aim to initiate adjuvant chemotherapy within a few weeks of surgery, clinical factors may cause delay. The influence of delay on relapse...

Breast Cancer

Delayed Adjuvant Chemotherapy Associated With Poorer Overall Survival in Breast Cancer

In a study reported in the Journal of Clinical Oncology, de Melo Gagliato et al from The University of Texas MD Anderson Cancer Center, Houston, assessed the association between time to adjuvant chemotherapy and survival in breast cancer patients.1 They found that delay of therapy is associated...

Breast Cancer

National Program to Screen Ashkenazi Women in Israel for BRCA Mutations Is Being Explored

Citing a World Health Organization report that lists Israel as having one of the highest rates of breast cancer in the world, The New York Times reported on a proposed screening program to identify women with BRCA1 and BRCA2 mutations.1 “A number of influential geneticists and cancer doctors from...

breast cancer

Support from 1999 Career Development Award Launched Dr. Kornelia Polyak’s Quest to Advance Understanding of DCIS of the Breast

In 1999, Kornelia Polyak, MD, PhD, of the Dana-Farber Cancer Institute, received a Career Development Award from the Conquer Cancer Foundation for her project, “Isolation of Tumor Suppressor Genes Inactivated in DCIS of the Breast.” “The Career Development Award got me started,” she said. “When...

Breast Cancer

Zoledronic Acid Fails to Benefit Women With Chemoresistant Breast Cancer

Zoledronic acid does not improve outcomes in patients with early breast cancer who do not have a full response to neoadjuvant anthracycline/taxane–based chemotherapy, according to results of the Neo-Adjuvant Trial Add-On (NATAN) study presented at the 2013 San Antonio Breast Cancer Symposium.1 A...

Breast Cancer

Adding Bevacizumab to Adjuvant Chemotherapy/Trastuzumab Fails to Improve Survival in HER2-Positive Breast Cancer

The addition of bevacizumab (Avastin) to adjuvant chemotherapy did not improve invasive disease-free survival or overall survival in patients with high-risk HER2-positive breast cancer in the large randomized phase III BETH trial. Although not specifically designed to answer this question, BETH...

Breast Cancer

Immune Modulation May Aid Some Breast Cancer Subtypes

There may be an immunogenic phenotype in breast cancer that could benefit from immune modulation as part of treatment, according to results from studies that correlated high levels of tumor-infiltrating lymphocytes with both pathologic complete responses and long-term outcomes. Studies presented at ...

Breast Cancer

Breast Reconstruction Has Increased Over Time but Varies Widely by Region

Analysis of data from 20,560 women undergoing mastectomy for breast cancer found that breast reconstruction use “increased from 46% in 1998 to 63% in 2007 (P< .001), with increased use of implants and decreased use of autologous techniques over time (P < .001),” according to a report...

Breast Cancer

Study Shows Pathologic Complete Response to Neoadjuvant Therapy for Breast Cancer of Prognostic Value but Not for Use as Surrogate for Survival

Pathologic complete response to neoadjuvant therapy has been proposed as a surrogate endpoint for long-term clinical benefit in breast cancer. The U.S. Food and Drug Administration (FDA) established the international Collaborative Trials in Neoadjuvant Breast Cancer (CTNeoBC) working group to...

Breast Cancer

Determining Why Younger Women With Breast Cancer Are Less Likely to Survive Than Their Older Counterparts

Although cancer survival rates among pediatric and older adult patients continue to rise, survival rates for adolescents and young adults (AYAs), defined by the National Cancer Institute as those between the ages of 15 and 39, have remained stagnant for decades. In breast cancer especially, AYAs...

Breast Cancer

Targeting Cancer Stem Cells in Breast Cancer: A Potential Clinical Strategy

Preclinical models have suggested that cancer stem cells play a role in tumor recurrence and metastasis following adjuvant therapy, and Max S. Wicha, MD, and his research team are deciphering the mechanisms by which this might happen. A true understanding of cancer stem cells will have important...

Breast Cancer

Overdiagnosis of Breast Cancer: New Research Directions

Currently, one of the most challenging problems in oncology is to accurately predict whether neoplastic lesions detected by screening tests will progress. The focus on developing ever-more sensitive cancer screening tests has produced the clinical dilemma of overdiagnosis. Overdiagnosis occurs when ...

Breast Cancer

The Canadian National Breast Screening Trial Had So Many Flaws That Its Results Should Not Be Used to Guide Screening Recommendations

If a randomized, controlled trial of therapy for breast cancer was submitted for publication in which 1. The drug being tested was old and ineffective, and 2. prior to randomization, the women underwent a clinical breast examination and the study coordinators knew who had the largest cancers, and...

Breast Cancer

Flaws in CNBSS Are Vast, Impact on Screening Recommendations Is Nil

The recent report from the Canadian National Breast Screening Study (CNBSS)—published in BMJ and reviewed in this issue of The ASCO Post—concluded that annual mammography in women aged 40 to 59 does not result in a reduction in mortality from breast cancer beyond that of physical examination alone...

Breast Cancer

No Mortality Benefit of Mammography Screening in 25-Year Follow-up of Canadian National Breast Screening Study

As reported in BMJ by Anthony B. Miller, MD, Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, and colleagues, the 25-year follow-up of the Canadian National Breast Screening Study has shown no mortality benefit of annual mammography screening for breast cancer...

Breast Cancer

SSO-ASTRO Margin Guideline: Why Now and What Does It Mean?

Although breast-conserving therapy has been a standard practice for more than 20 years, controversy still exists over what constitutes the appropriate margin of normal breast tissue around a tumor that minimizes local recurrence while maintaining a good cosmetic outcome. Surveys of surgeons1 and...

Breast Cancer

SSO-ASTRO Consensus Guideline on Margins for Breast-Conserving Surgery in Stage I/II Invasive Breast Cancer

The Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) formed a multidisciplinary expert panel in 2013 to examine the relationship between surgical margin width and ipsilateral breast tumor recurrence and develop guidelines on margins for breast-conserving...

Breast Cancer

Exemestane to Reduce Invasive Breast Cancer Risk Has Small Negative Impact on Quality of Life

Detailed quality-of-life data from the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Mammary Prevention 3 (MAP.3) trial showed that exemestane given for the prevention of breast cancer “has limited negative impact on menopause-specific and health-related [quality of life] in...

Breast Cancer

LY2835219 Shows Strong Single-Agent Activity in Preliminary Study in Metastatic Breast Cancer

Inhibitors of cyclin-dependent kinase (CDK) 4/6 are getting attention as a novel approach for the treatment of breast cancer. At the 2014 American Association for Cancer Research (AACR) Annual Meeting, two presentations focused on these new agents. One was a phase II study of Pfizer’s compound...

Breast Cancer

PALOMA-1 Trial Finds Palbociclib/Letrozole Doubles Progression-Free Survival in Metastatic Breast Cancer

First-line treatment with the combination of palbociclib plus letrozole extended progression-free survival by approximately 50% in patients with metastatic estrogen receptor–positive, HER2-negative breast cancer, according to final results of the PALOMA-1 trial, a randomized phase II study...

Breast Cancer

ASCO Issues Two New Guidelines on Treating Patients With Advanced, HER2-Positive Breast Cancer

ASCO recently issued two clinical practice guidelines on treating women with advanced, HER2-positive breast cancer. The first guideline lists the appropriate systemic therapies for women newly diagnosed with advanced disease and those whose early-stage disease progressed to advanced cancer. The...

Breast Cancer

Adjuvant Chemotherapy Accelerates Pace of Physiologic Aging in Women Treated for Breast Cancer

“Adjuvant chemotherapy for breast cancer is gerontogenic,” accelerating the pace of physiologic aging, according to an analysis of blood and clinical data from 33 women with stage I to III breast cancer. “We have shown that cytotoxic chemotherapy potently induces the expression of markers of...

Breast Cancer

Epigenetic Reprogramming of HOXC10 Results in Endocrine Resistance in Breast Cancer

Resistance to aromatase inhibitors is a major problem in treatment of estrogen receptor (ER)-positive breast cancer. In a study reported in Science Translational Medicine, Pathiraja and colleagues found pervasive DNA hyper- and hypomethylation and enrichment for promoter hypermethylation of...

Breast Cancer
Colorectal Cancer
Lung Cancer
Pancreatic Cancer

ASCO Committee Defines Clinically Meaningful Goals for Clinical Trials in Pancreas, Breast, Lung, and Colorectal Cancers

The ASCO Cancer Research Committee recently convened four disease-specific working groups—in pancreas, breast, lung, and colon cancers—to “consider the design of future clinical trials that would produce results that are clinically meaningful to patients.” An ASCO perspective statement, reported in ...

Breast Cancer

Postmastectomy Radiotherapy Benefits Women With Breast Cancer That Has Spread to One to Three Lymph Nodes

In women with breast cancer who had between one and three positive lymph nodes, radiotherapy reduced the recurrence rate by 32% and the breast cancer death rate by 20%. Giving radiotherapy to these women led to nearly 12 fewer recurrences of breast cancer per 100 women after 10 years, and eight...

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