Caroline Helwick

When GIST patients develop resistance to imatinib (Gleevec), second-line sunitinib (Sutent) has been shown to achieve a response rate of 7% and a median progression-free survival of 6.2 months. When patients progress on sunitinib, however, therapeutic options have been limited.

Pilot studies presented at the 2007 San Antonio Breast Cancer Symposium have found robust activity for the multi-targeted tyrosine kinase inhibitor sunitinib (Sutent) when given with docetaxel (Taxotere) (abstract 6079) or paclitaxel (abstract 6078) as first-line treatment for patients with advanced breast cancer.

The use of neoadjuvant chemotherapy in resectable esophageal cancer was bolstered by the results of two trials presented at the 2008 Gastrointestinal Cancers Symposium.

An international team of researchers has developed a predictive model that accurately estimates which breast cancer patients may relapse after neoadjuvant endocrine therapy, Matthew Ellis, MD, PhD, said at the 2007 San Antonio Breast Cancer Symposium (abstract 62).

A phase II study found improvements in recurrence-free and overall survival with adjuvant imatinib (Gleevec) in high-risk GIST patients, compared with historical controls, Ronald P. DeMatteo, MD, reported at the 2008 Gastrointestinal Cancers Symposium (abstract 8).

Optical tomography with ultrasound localization has the potential to monitor tumor vascular changes during neoadjuvant chemotherapy, according to a pilot study in which the modality was able to distinguish between responders and nonresponders, and even between complete and partial pathologic responses.

Digital tomosynthesis appears to be more sensitive than digital mammography for detecting breast cancer in a clinical setting, Debra M. Ikeda, MD, of Stanford University, reported at the 2007 San Antonio Breast Cancer Symposium (abstract 46).

About one-third of metastatic breast cancer patients with HER2 overexpression develop metastases to the brain, compared with 5% to 20% of the general metastatic breast cancer population, according to findings from a large observational study in newly diagnosed HER2-positive breast cancer.

A serum marker, colon-cancer-specific antigen-2 (CCSA-2), detects nearly 97% of colorectal cancers and can differentiate between advanced adenomatous polyps and less ominous ones, according to investigators from Johns Hopkins and the University of Pittsburgh who have collaborated on research in this area.

Four-year follow-up of the French/Belgian PACS-04 trial in early breast cancer found a trend toward benefit with sequential trastuzumab (Herceptin) in the first 18 months but, somewhat surprisingly, no difference in disease-free survival at 4 years. Marc Spielmann, MD, of the Institute Gustave Roussy, Villejuif, France, reported the findings at the 2007 San Antonio Breast Cancer Symposium (abstract 72).

A team of European investigators is taking a novel immunotherapeutic approach to advanced gastrointestinal tract tumors using the "trifunctional antibody" catumaxomab.

Do oncologists treat their patients with colon cancer the same as they would treat themselves? Usually. A survey presented at the 2008 Gastrointestinal Cancers Symposium probed the secret world of oncologists' personal preferences (abstract 444).

Accurate detection of micrometastases in the lymph nodes of colorectal cancer patients appears possible with an emerging quantitative RT-PCR assay being developed by DiagnoCure Oncology Laboratories (West Chester, Pennsylvania), according to an interview with investigators at the 2008 Gastrointestinal Cancers Symposium. Data from a large prospective NIH-sponsored trial are expected to be reported at ASCO 2008.

Survival and staging in colon cancer are related to the number of lymph nodes containing metastasis. But according to several reports from the 2008 Gastrointestinal Cancers Symposium, there may be a better way to determine prognosis. The “index of metastasis,” also called the “lymph node ratio,” may be a more accurate predictor of cancer-related survival than the number of positive nodes, according to investigators who presented data at the meeting.

In unselected patients, results with the anti-epidermal growth factor receptor (EGFR) antibody panitumumab (Vectibix) in metastatic colorectal cancer patients were disappointing. However, patients with wild-type KRAS tumor status did benefit from panitumumab, according to several studies reported at the recent 2008 Gastrointestinal Cancers Symposium.

The HER2-positive breast cancer population appears to be a heterogeneous group with a wide variation in response to trastuzumab (Herceptin). Higher levels of HER2 expression as well as HER2:HER2 dimerization were independently correlated with high response rates and longer time to progression in a study reported at the 2007 San Antonio Breast Cancer Symposium (abstract 2007).

The 21-gene recurrence score assay (Oncotype DX) was applied to early breast cancer patients with hormone-receptor and axillary lymph node positivity in two studies reported at the 2007 San Antonio Breast Cancer Symposium. Their findings suggest that the recurrence score can identify subsets most likely to benefit from chemotherapy.

When colorectal cancer metastasizes to the liver, hepatic resection can offer a survival benefit and even a "cure" in a fraction of patients. Five-year overall survival in some recent series approaches 60%. But the role of neoadjuvant chemotherapy in this group of patients has not been well established

As first-line treatment for metastatic breast cancer in HER2-positive patients, trastuzumab (Herceptin) can be given as a single agent, followed by docetaxel (Taxotere) upon progression, without compromising time to recurrence and providing a better toxicity profile

If therapeutic agents are documented to be more effective than standard therapies in the advanced breast cancer setting, they will also be effective in the adjuvant setting. This renders randomized phase III adjuvant trials unnecessary in many cases, and means that undue delays in moving new agents up-front are costing lives

Preliminary survival data are encouraging for the triple-drug combination of trastuzumab (Herceptin), docetaxel (Taxotere), and capecitabine (Xeloda) as first-line therapy for locally advanced or metastatic breast cancer

Overall survival after pancreatic resection can be markedly improved with adjuvant chemoradiation therapy, according to investigative groups who presented encouraging data on two different regimens at the 2008 Gastrointestinal Cancers Symposium.

Preliminary findings from the I-SPY trial of neoadjuvant chemotherapy are a testament to the complexity and heterogeneity of locally advanced tumors and validate the concept that “biology should dictate the ‘what’ and the ‘how’ of treatment,” according to Laura Esserman, MD, Director of the Breast Cancer Center and Professor of Surgery and Radiation at the University of California, San Francisco School of Medicine.

More data have emerged to suggest that MRI is more sensitive than mammography, though less specific, in screening women at high risk for breast cancer occurrence. Moreover, annual screening picks up a high number of ductal carcinomas in situ (DCIS), but also identifies tumors that are already large at diagnosis among BRCA1 mutation carriers.

A median follow-up of 100 months has shown continued benefit for anastrozole (Arimidex) as compared with tamoxifen in a study of postmenopausal women with hormone receptor-positive tumors.

The HER network is robust, complex, redundant, and adaptable. It provides proliferation and survival signals to a subset of breast tumors.

The combination of capecitabine (Xeloda) and ixabepilone (Ixempra) appears to be robust in patients with the triple-negative breast cancer phenotype. In heavily pretreated metastatic breast cancer patients, the regimen yielded an overall response rate of 27% and median progression-free survival of 4.1 months, according to a subset analysis of 187 patients from a larger randomized phase III trial of capecitabine with and without ixabepilone.

Anthracyclines are widely used in the adjuvant treatment of breast cancer, but this practice is being questioned as emerging data show benefits to be restricted to certain subsets of patients.

After breast-conserving surgery, a shorter radiotherapy regimen using accelerated hypofractionated whole-breast irradiation (AHWBI) is as effective and cosmetically acceptable as standard whole-breast irradiation (SWBI), according to the 12-year follow-up of a study by the Ontario Clinical Oncology Group.

Compared with standard treatment with doxorubicin/cyclophosphamide (AC), four cycles of docetaxel (Taxotere) plus cyclophosphamide (TC) improved both disease-free and overall survival in the extended follow-up and analysis of US Oncology Adjuvant Trial 9735.