2018 Treatment Algorithm for Metastatic HER2-Positive Breast Cancer
How should clinicians position anti-HER2 agents and also incorporate endocrine therapies in the treatment of metastatic HER2-positive breast cancer? At the 2018 Miami Breast Cancer Conference, this question was explored by Sunil Verma, MD, Medical Director of the Tom Baker Cancer Center and...
mTOR Inhibitor Plus Endocrine Therapy in Postmenopausal Women With Advanced ER-Positive, HER2-Negative Breast Cancer
In the phase II BOLERO-4 trial reported in JAMA Oncology, Royce et al found that the combination of the mTOR inhibitor everolimus (Afinitor) and endocrine therapy was active in first-line treatment of postmenopausal women with advanced estrogen receptor (ER)-positive, human epidermal growth factor...
Expert Point of View: Timothy Gilligan, MD, MSc
“IN THE PAST, patients were often told to rest and reduce their physical activity during treatment, but we now know that exercise is both safe and beneficial,” said Timothy Gilligan, MD, MSc, moderator of a presscast where these results were presented prior to the Cancer Survivorship Symposium....
Four Years Posttreatment, Exercise Improves Physical Activity Levels, Reduces Fatigue in Patients With Breast and Colon Cancers
IN PATIENTS WITH breast and colon cancers, a physical exercise intervention conducted during adjuvant chemotherapy improved total physical activity levels 4 years after treatment, with a trend toward less fatigue, according to a follow-up study from the randomized multicenter PACT study, presented...
Cardiovascular Risk Factors, Cardiac Events, and Survival in Patients With Breast Cancer Enrolled in SWOG Clinical Trials
In a study reported in the Journal of Clinical Oncology, Hershman et al found that each additional baseline cardiovascular disease risk factor was associated with increased risk for cardiac events and death among Medicare patients who had been enrolled in SWOG trials in breast cancer. Study...
How Will ctDNA Assays Aid in Managing Breast Cancer?
CIRCULATING TUMOR DNA (ctDNA) assays are now commercially available for use in lung cancer and melanoma, where they can identify the presence of specific mutations that drive treatment selection. In breast cancer, ctDNA remains more of a research tool, but this is poised to change. At the 2018...
Potent Anti-HER2 Agents on the Horizon
THANKS TO the efficacy of five approved anti-HER2 agents, patients with HER2-positive breast cancer have overall survival numbers that are as good as, or better than, their HER2-negative counterparts. With the next generation of anti-HER2 therapies in clinical trials, these outcomes may become even ...
EBCC-11: Mastectomy and Axillary Dissection and Neoadjuvant Targeted Treatment in HER2-Positive Breast Cancer
Extensive surgery involving mastectomy and removal of several lymph nodes may be safely avoided for more women with some types of breast cancer if they receive targeted drugs before surgery, according to research presented at the 11th European Breast Cancer Conference (EBCC-11) (Abstract 19). The...
Extended Duration of Aromatase Inhibitors Need Not Be Very Long
At the 2017 San Antonio Breast Cancer Symposium (SABCS), Michael Gnant, MD, FACS, of the Medical University of Vienna presented the 9-year median follow-up of a trial looking at the length of extended aromatase inhibitor therapy. At least four other recently presented or published trials have...
Acupuncture for Joint Pain Associated With Aromatase Inhibition
Although aromatase inhibitors are highly effective as adjuvant therapy in metastatic breast cancer and for prevention of breast cancer, the side effects can be difficult to tolerate and often lead to discontinuation of therapy. A phase III randomized trial has found that acupuncture may relieve...
EBCC-11: Women Report Fewer Side Effects With Partial or Reduced Breast Radiotherapy vs Standard WBRT
The average number of moderate or marked side effects reported by patients with breast cancer is lower if they are treated with radiotherapy to part of the breast or a reduced dose to the whole breast, rather than with standard whole breast radiotherapy (WBRT), according to new findings presented...
EBCC-11: MINDACT Trial: Patients With Early Breast Cancer and Risk of Locoregional Recurrence
Women with small, low-grade, well-defined breast tumors and a genetic profile that shows they are at low risk of the cancer metastasizing have only a 1.4% risk of locoregional recurrence within 5 years, according to new results from a large randomized trial of nearly 7,000 patients. This low risk...
EBCC-11: Sentinel Lymph Node Biopsy in Triple-Negative and HER2-Positive Breast Cancers
Sentinel lymph node biopsies may be safely avoided for some women, according to research presented at the 11th European Breast Cancer Conference (EBCC-11). Two new studies show that women with either triple-negative or HER2-positive types of breast cancer, whose cancers respond well to chemotherapy ...
EBCC-11: Double Mastectomy in BRCA1 and BRCA2 Carriers
Healthy women who carry a breast cancer–causing mutation in the BRCA1 gene not only reduce their risk of developing the disease but also their chances of dying from it if they have both breasts removed, according to new research presented at the 11th European Breast Cancer Conference...
EBCC-11: DCIS Less Likely to Recur in Patients Who Are Postmenopausal, ER-Positive
Patients with ductal carcinoma in situ (DCIS) are less likely to have recurrent disease if they are postmenopausal or if their tumor is estrogen receptor (ER)-positive, according to research presented at the 11th European Breast Cancer Conference (EBCC-11) (Abstract 215). DCIS accounts for about...
EBCC-11: Risk of a Second Breast Cancer Can Be Better Quantified in Patients With a BRCA Mutation
The risk of a second breast cancer in patients with high-risk BRCA gene mutations can be more precisely predicted by testing for several other genetic variants, each of which are known to have a small impact on breast cancer risk, according to new research presented at the 11th European Breast...
Anthony D. Elias, MD, on Triple-Negative Breast Cancer: Treatment Update
Anthony D. Elias, MD, of the University of Colorado Cancer Center, reviews promising experimental treatments, as well as PARP inhibitor therapy in TNBC, including the implications of newly approved olaparib for gBRCA-mutant breast cancer.
William J. Gradishar, MD, on Hormone-Sensitive Breast Cancer: Treatment Update
William J. Gradishar, MD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discusses recent evidence on the efficacy, safety, and utility of HER2-targeted treatments in the adjuvant setting for early-stage and advanced breast cancers.
When Is Active Surveillance Appropriate in the Treatment of DCIS?
In 2017, more than 63,000 women in the United States were diagnosed with in situ breast cancer. The overwhelming majority of those women, about 83%, were diagnosed with ductal carcinoma in situ (DCIS), a condition characterized by the presence of abnormal cells confined to the breast milk ducts;...
Breast Cancer Care in U.S. Territories Seems to Lag Behind Care in Continental United States
OLDER WOMEN residing in U.S. territories are less likely to receive recommended or timely care for breast cancer compared with similar women residing in the continental United States, according to Yale researchers, whose findings were published in Health Affairs.1 “Inferior breast cancer care in...
Clinically Indicated Genetic Counseling After Breast Cancer Diagnosis
In a study reported in the Journal of Clinical Oncology, Katz et al found that less than half of patients with clinical indications received formal genetic counseling after breast cancer diagnosis. Study Details The study involved surveys of 5,080 patients aged 20 to 79 years diagnosed with early ...
TAILORx Trial Results Aid in Assessing the Effect of Chemotherapy in Women With Early-Stage Breast Cancer
On March 15, Genomic Health, Inc, was informed by the ECOG-ACRIN Cancer Research Group that the TAILORx trial, has achieved sufficient information to render a conclusion regarding the efficacy of chemotherapy in patients with early-stage breast cancer who have Oncotype DX recurrence score...
ASTRO Issues New Clinical Guideline for Whole-Breast Radiation Therapy
The American Society for Radiation Oncology (ASTRO) has issued a new clinical guideline for the use of whole-breast radiation therapy for breast cancer that expands the population of patients recommended to receive hypofractionated treatment. The guideline was published by Smith et al in...
Effect of High-Deductible Insurance Enrollment on Breast Cancer Diagnosis and Treatment
In a study reported in the Journal of Clinical Oncology, Wharam et al found that women who were switched from low-deductible to high-deductible insurance policies had delays in diagnostic workup, early breast cancer diagnosis, and initiation of chemotherapy compared with those maintained on...
AACR 2018: Acquired HER2 Mutations Confer Resistance to Hormone Therapy in ER-Positive Metastatic Breast Cancer
Mutations in HER2 were found to confer resistance to hormone therapy in some estrogen receptor (ER)-positive metastatic breast cancer cases, and resistance could be reversed by dual treatment with the hormone therapy fulvestrant (Faslodex) and the HER2 kinase inhibitor neratinib (Nerlynx),...
FDA Approves Abemaciclib as Initial Therapy for Hormone Receptor–Positive, HER2-Negative Metastatic Breast Cancer
On February 26, the U.S. Food and Drug Administration (FDA) approved abemaciclib (Verzenio) in combination with an aromatase inhibitor as initial endocrine-based therapy for postmenopausal women with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer. MONARCH 3 Approval...
Mentorship From a Past ASCO President and Others Steers a Career to Academic Research
Breast cancer specialist Stacy L. Moulder, MD, was born and reared in Brookhaven, Mississippi, a small town southwest of the state capital of Jackson. “I was always interested in math and science, and I had a wonderful biology teacher in high school. It was when the advanced placement courses...
Breast Cancer Screening Guidelines May Lead to Delayed Diagnosis in Nonwhite Women
The current guidelines for mammographic breast cancer screening, which are based on data from primarily white populations, may lead to delayed diagnosis in nonwhite women, according to a report published by Stapleton et al in JAMA Surgery. A team of Massachusetts General Hospital (MGH)...
Effect of Postmastectomy Radiation Therapy in Node-Positive Breast Cancer
In an analysis of data from the Breast International Group (BIG) 02-98 trial reported in the International Journal of Radiation Oncology*Biology*Physics, Zeidan et al found that postmastectomy radiation therapy (PMRT) vs no PMRT was associated with significantly reduced risk of locoregional...
EXPERT POINT OF VIEW: Aditya Bardia, MD
ADITYA BARDIA, MD, Director of Precision Medicine at the Center for Breast Cancer, Massachusetts General Hospital, Harvard Medical School, Boston, said: “This large, well-powered trial that included 181 centers and more than 2,600 patients unfortunately failed to show that celecoxib improved...
No Evidence of Celecoxib Benefit Reported in Patients With Early Breast Cancer
TWO YEARS of treatment with celecoxib had no observed effect on 5-year outcomes of patients with early breast cancer in the large REACT trial presented at the 2017 San Antonio Breast Cancer Symposium.1 “There was no overall benefit observed in disease-free survival or overall survival for...
Selected Abstracts From the San Antonio Breast Cancer Symposium
EACH YEAR, The ASCO Post asks Jame Abraham, MD, FACP, Director of the Breast Oncology Program at Taussig Cancer Institute and Co-Director of the Cleveland Clinic Comprehensive Breast Cancer Program, to give his picks for the most important research presented at the San Antonio Breast Cancer...
PIK3CA Mutation and Prognosis in Early-Stage Breast Cancer
In a study reported in the Journal of Clinical Oncology, Zardavas et al found that the prognostic effect of PIK3CA mutation in early breast cancer was reduced after adjustment for other prognostic factors. Study Details The study involved analysis of individual patient data from a pooled...
Neoadjuvant Therapy in Triple-Negative Breast Cancer
In a phase III trial (BrighTNess) reported in The Lancet Oncology, Loibl et al found that the addition of the PARP inhibitor veliparib to carboplatin and paclitaxel in neoadjuvant therapy did not increase pathologic complete response rate in women with triple-negative breast cancer. Study Details ...
Upfront Adjuvant Aromatase Inhibitor Therapy vs Aromatase Inhibitors After Tamoxifen in Hormone Receptor–Positive Early Breast Cancer
An Italian phase III trial (FATA-GIM3) has shown no difference in disease-free survival with 5 years of upfront adjuvant aromatase inhibitor therapy vs 2 years of tamoxifen followed by 3 years of aromatase inhibitor therapy in women with hormone receptor–positive early breast cancer. The...
FDA Authorizes Direct-to-Consumer Test That Reports Three Mutations in the BRCA1/BRCA2 Breast Cancer Genes
Today, the U.S. Food and Drug Administration (FDA) authorized the Personal Genome Service Genetic Health Risk (GHR) Report for BRCA1/BRCA2 (Selected Variants). It is the first direct-to-consumer (DTC) test to report on three specific BRCA1/BRCA2 breast cancer gene mutations that are most common in...
Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors
In a Danish study reported in the Journal of the National Cancer Institute, Zachariae et al found that an Internet-delivered cognitive-behavioral therapy intervention improved insomnia among breast cancer survivors. Study Details In the study, 255 patients from a national sample of Danish breast...
Conqueror in Action: Katherine Reeder-Hayes, MD, Takes on Breast Cancer
When a cutting-edge cancer tool becomes available, marginalized populations such as African Americans and older patients often have less access to it than other populations. This is problematic, especially when those with limited access are those who could benefit the most. As a result, public...
Adjuvant Chemotherapy for ER-Negative and ER-Positive Isolated Locoregional Recurrence of Breast Cancer
As reported in the Journal of Clinical Oncology by Wapnir et al, the final analysis of the phase III CALOR trial showed benefit of adjuvant chemotherapy in estrogen receptor (ER)–negative but not ER-positive isolated locoregional recurrence of breast cancer. Study Details In this open-label ...
Experiences With Radiation Therapy Better Than Expected for Most Patients With Breast Cancer
A new study reveals that many patients with breast cancer have misconceptions and fears about radiation therapy, but their actual experiences with this treatment modality are better than they expected. In the study published by Shaverdian et al in Cancer, most patients agreed that their initial...
FDA Approves Abemaciclib as Initial Therapy for Hormone Receptor–Positive, HER2-Negative Metastatic Breast Cancer
On February 26, the U.S. Food and Drug Administration (FDA) approved abemaciclib (Verzenio) in combination with an aromatase inhibitor as initial endocrine-based therapy for postmenopausal women with hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)-negative advanced...
Addition of Metronomic Chemotherapy to Dual Anti-HER2 Treatment in Older Patients With Metastatic Breast Cancer
In the phase II EORTC 75111-10114 trial reported in The Lancet Oncology, Wildiers et al found that the addition of metronomic oral cyclophosphamide to pertuzumab (Perjeta) and trastuzumab (Herceptin) improved progression-free survival in elderly or frail women with HER2-positive metastatic breast...
Serum Bone Biomarkers in Early Breast Cancer and Risk of Bone Metastasis
In a study reported in the Journal of the National Cancer Institute, Brown et al found that the serum bone biomarkers P1NP, CTX, and 1-CTP showed good prognostic ability for bone metastasis in patients in the phase III AZURE (BIG01/04) trial of adjuvant zoledronic acid in early breast cancer....
Family History Increases Breast Cancer Risk, Even in Women Aged 65 and Older
A family history of breast cancer continues to significantly increase chances of developing invasive breast tumors in women aged 65 years and older, according to research published by Braithwaite et al in JAMA Internal Medicine. The findings could impact mammography screening decisions later in...
Electra D. Paskett, PhD, on Breast Cancer and Arm Mobility: Clinical Trial Results
Electra D. Paskett, PhD, of The Ohio State University Comprehensive Cancer Center, discusses study findings on whether exercise helps women with breast cancer regain arm mobility after lymph node surgery (Abstract 123).
Huntsman Cancer Institute to Use National Cancer Institute Grant for Breast Cancer Trial Center
Huntsman Cancer Institute at the University of Utah has been awarded a $2.4 million 2-year grant from the National Cancer Institute to help continue its research in breast cancer. Alana Welm, PhD, and Bryan Welm, PhD, investigators at Huntsman Cancer Institute, along with Michael Lewis, PhD, a...
Ovarian Function Suppression During and After Chemotherapy Valid for Some Patients With Early Breast Cancer
Temporary ovarian suppression during chemotherapy as a means of preserving ovarian function and fertility in young women with early breast cancer is controversial. An eagerly awaited meta-analysis including individual patient data from five randomized controlled trials found that the use of...
Perioperative Aromatase Inhibitors: No Effect on Recurrence, but Ki67 Level Important
Updated analysis from the United Kingdom’s POETIC trial found no evidence that perioperative aromatase inhibitor therapy slows or prevents time to recurrence of breast cancer. However, the study did show that tumor Ki67 levels after 2 weeks of perioperative aromatase inhibitor therapy are...
SABCS Highlights Focus on Predicting Residual Tumor Burden, Therapy-Related Arm Morbidity, Lifestyle and Cancer Risk
We have covered many of the important presentations from the 2017 San Antonio Breast Cancer Symposium in the pages of The ASCO Post and in our online Evening News. Here are summaries of additional noteworthy studies presented at the meeting. We hope you will find them of interest. Predicting...
New International Practice Guidelines for Using CYP2D6 Genotype to Guide Antiestrogen Treatment in Breast Cancer
An international group of clinicians and scientists representing the Clinical Pharmacogenetics Implementation Consortium (CPIC) published the first-ever clinical practice guidelines for using CYP2D6 genotype to guide tamoxifen therapy. Their research was published by Goetz et al in Clinical...
