San Antonio Breast Cancer Symposium (SABCS)

For women with triple-negative breast cancer, BRCA mutations can be a boon: These patients have a significantly lower risk of relapse than their counterparts who do not carry BRCA mutations, according to a study out of Houston’s M.D. Anderson Cancer Center. SABCS 2010 will feature an education session on the clinical utility of genetic testing for inherited predisposition to breast cancer.

For women with hereditary breast cancer, deciding on the best treatment option can be challenging. Three specialists, including medical oncologist Susan M. Domchek, MD, discuss the different approaches to managing breast cancer patients with a family history of BRCA mutations. Dr. Domchek will give a talk at SABCS 2010 on the management of women with a significant predisposition to breast cancer.

ASCO recently released updated guidelines on the use of adjuvant endocrine therapy in hormone-receptor-positive breast cancer. While the guidelines focus on all postmenopausal women, those who are age 75 and older require special consideration. Unfortunately, meaningful data to help healthcare providers make treatment decisions for these patients are scarce, according to Peter Ravdin, MD, PhD, an executive committee member and scientific program planning member of SABCS 2010.

The targeted combination of lapatinib (Tykerb) plus trastuzumab (Herceptin) led to a median overall survival of 14 months in women with refractory metastatic breast cancer, according to an updated analysis of the phase III EGF104900 trial. A bonus: The majority of toxicities were low-grade.

Despite a better dose loading schedule and compelling preclinical data, the combination of fulvestrant and anastrozole did not demonstrate any advantage in first relapse of hormone receptor-positive breast cancer, according to first results from the FACT trial.

Researchers in Taiwan and China found that alternating mammography and ultrasound led to a higher cancer detection rate in women aged 40-49. Meanwhile in the UK, a group from West Midlands Research Collaborative have made a case for starting screening at age 40 in certain ethnic groups. Finally, German investigators assessed the value of semi-annual ultrasound exams in high-risk women.

The RIBBON-2 trial met its primary endpoint to prolong progression-free survival, making the bevacizumab-chemotherapy combination a new treatment option, said principal investigator Adam Brufsky, MD. The trial continued the evaluation of bevacizumab plus chemotherapy to treat metastatic breast cancer after previous treatment failures.

Along with many other health issues, obese breast cancer patients face a particularly grim prognosis, with an amplified risk of recurrence and an increased risk of dying of the disease, according to results from a long-term, large-scale study in a Danish population. The researchers also noted that a larger body habitus negatively impacted treatment results.

Denosumab prevented more events, was better tolerated, and was more convenient for breast cancer patients with skeletal metastasis, according to results from a randomized double-blind trial that matched the RANK ligand inhibitor against zoledronic acid.

Exemestane alone and exemestane following tamoxifen, are equally appropriate treatment options, according to results from TEAM, the first trial prospectively powered to test the superiority of five years of aromatase inhibitors compared with a specific sequential strategy in postmenopausal women with endocrine-sensitive breast cancer.

Results from the CONFIRM trial found that a higher dose of fulvestrant was significantly more effective than a lower dose but did not lead to more toxicity, reported Angelo DiLeo, MD, who added “we anticipate that the 500-mg regimen will become the established dose for fulvestrant.”

SAN ANTONIO-Options for breast cancer prevention range from “noninvasive” lifestyle changes (diet, nutrition, exercise) to more radical surgical approaches. During an SABCS 2009 educational session, Judy Garber, MD, from Boston’s Dana-Farber Cancer Institute, outlined some of the advances in chemoprevention of ER-negative/HER2-positive breast cancers.

SAN ANTONIO-Investigators from Breast International Group 1-98 study and the Intergroup Exemestane Study updated their respective trial results at SABCS 2009. From the BIG 1-98 data, letrozole continued to show survival advantage, while exemestane offered protective benefits, based on IES study results.

Eidtmann H et al: The effect of zoledronic acid on aromatase inhibitor associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozole: 36 months follow-up of ZO-FAST (abstract 44).

Patients with operable triple-negative breast cancer are at increased risk for recurrence if their tumor has higher levels of a protein-encoding gene implicated in migration, proliferation, and other cellular processes, reported Joseph A. Sparano, MD, from the Eastern Cooperative Oncology Group.

Lapatinib (Tykerb) plus letrozole (Femara) may delay disease progression in metastatic breast cancer patients, according to an international phase III trial. Patients who benefited from the protocol were those who overexpressed the HER2/neu protein and the epidermal growth factor receptor and were also hormone receptor-positive.

Neoadjuvant therapy that includes trastuzumab (Herceptin) prolongs event-free survival and has an acceptable safety profile in women with HER2-positive locally advanced breast cancer, based on results from the largest trial testing such therapy in this setting.

Expression of the microtubule-binding protein Tau is not a reliable means of selecting breast cancer patients for adjuvant paclitaxel chemotherapy, investigators from Houston’s M.D. Anderson Cancer Center stated, adding that while Tau expression does predict survival, it does so in an unexpected way.

Data presented by the ATAC Trialists’ Group extends the value of the Oncotype DX Recurrence Score in assessing risk of distant recurrence in breast cancer patients receiving an aromatase inhibitor.

The cure for cancer lies in the biology of circulating and disseminating tumor cells that, unfortunately, evade detection and treatment very easily, according to one of the world’s leaders in the field. In a plenary lecture, Klaus Pantel, MD, described the properties and clinical relevance of the cells that eventually cause metastatic relapse but remain elusive at primary diagnosis.

The concept of bisphosphonates as anticancer agents took a leap forward this week thanks to results from the AZURE trial. Investigators from the UK reported that patients receiving zoledronic acid along with neoadjuvant chemotherapy experienced a doubling in complete pathological response.

Oncology NEWS International guest editor Dr. Andrew D. Seidman recommends SABCS 2008 lectures on modern molecular science, molecular profiling, and the American Association of Cancer Research distinguished lectureship in breast cancer research.

Insight into the molecular workings of HER2-positive breast cancer has paved the way for targeted agents that are showing great promise in clinical trials, according to a presentation at SABCS 2008. José Baselga, MD, from Barcelona, offers a primer on pertuzumab, trastuzumab-DM1, heat shock protein 90, and other agents that will provide “tremendous opportunity” in HER2-positive cancer treatment.

Emerging knowledge about breast cancer biology must be integrated into clinical trials in order to personalize treatment in patients with early breast cancer. Two speakers at an educational session on clinical trial design discussed our advancing understanding of basic science and the ways in which that can change and refine the design of clinical trials.

Estrogen-receptor–positive advanced breast cancer patients who have become resistant to endocrine therapies can derive clinical benefit from 6-mg daily doses of estradiol, according to a phase II study conducted at Washington University in St. Louis.

Combining endocrine therapy with signal transduction inhibition is an effective means of overcoming endocrine resistance in at least some populations of patients with breast cancer. Stephen R.D. Johnston, MA, PhD, director of clinical research and development at the Royal Marsden Hospital in London, discussed the data on this emerging strategy during an SABCS plenary lecture.

Aromatase inhibitors were associated with greater reductions in the risk of breast cancer recurrence in comparison with tamoxifen, according to a meta-analysis involving nearly 20,000 hormone receptor-positive early breast cancer patients.

Women with breast cancer who have isolated tumor cells or micrometastases in their sentinel lymph nodes are at increased risk for recurrence, even if their cancer otherwise has favorable features. Adjuvant systemic therapy, however, can attenuate that elevated risk, according to the findings of a major Dutch study.

The combination of nab-paclitaxel (Abraxane) and bevacizumab (Avastin) eradicates highly aggressive metastatic breast cancer in a preclinical model, Sophia Ran, PhD, reported at the SABCS (abstract 74).

Investigational agent denosumab is safe and efficacious for attenuating bone loss among women taking adjuvant aromatase inhibitors for breast cancer, according to a phase III randomized double-blind placebo-controlled trial reported at SABCS (abstract 47).