San Antonio Breast Cancer Symposium (SABCS)

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).

Breast cancer patients with isolated tumor cells or micrometastases in sentinel nodes do not have poorer disease-free or overall survival than their counterparts with negative sentinel nodes, researchers reported at the SABCS (abstract 52).

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.

Some breast cancer patients with positive sentinel lymph nodes have factors associated with a low probability of having any other positive nodes and may therefore be able to safely skip completion axillary dissection, new data show.

Two new genomic assays may provide prognostic and predictive information for individual patients with breast cancer, thereby helping to guide treatment decisions, according to data from a pair of studies presented at SABCS.

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.

Women with breast cancer who take adjuvant tamoxifen for 10 years have a lower risk of recurrence than their counterparts who take it for 5 years, although the difference is thus far small, according to early results of the ATLAS (Adjuvant Tamoxifen, Longer Against Shorter) trial presented at SABCS (abstract 48).

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.

When used as adjuvant therapy for node-positive breast cancer, the combination of high-dose chemotherapy (HDC) and stem cell transplantation modestly improves relapse-free survival relative to standard-dose chemotherapy (SDC). But it offers at best minimal benefit in terms of overall survival, according to a meta-analysis presented at SABCS.

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.

Middle-aged women today are about half as likely as their counterparts 25 years ago to die from breast cancer, thanks in large part to the collective effects of modern therapies, according to new data reported at SABCS. Results of the 2005-2006 update of the worldwide overview presented by Richard Peto, PhD, on behalf of the Early Breast Cancer Trialists’ Collaborative Group were based on data from roughly 350,000 women and 400 randomized trials.

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.