Slide Show: 2013 San Antonio Breast Cancer Symposium

Slide 1: Pathologic Complete Response Indicator of Improved Overall Survival for HER2-Positive Breast Cancer Patients Treated With Adjuvant Trastuzumab Plus Lapatinib and PaclitaxelResults from the large, randomized phase III NeoALTTO (Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimization) trial demonstrate that for women with HER2-positive breast cancer treated with trastuzumab, lapatinib, and paclitaxel as an adjuvant therapy, pathologic complete response (pCR) is an appropriate surrogate endpoint. After a median follow-up of 4 years, patients who had a pCR were 62% more likely to not have had cancer recurrence, second cancer development, or death.Source: Piccart-Gebhart M, Holmes AP, de Azambuja E, et al. The association between event-free survival and pathologic complete response to neoadjuvant lapatinib, trastuzumab or their combination in HER2-positive breast cancer. Survival follow-up analysis of the neoALTTO study. SABCS 2013; Abstract S1-01.Slide 2: Best Post-Surgery Treatment for HER2-Positive Breast Cancer May Be Docetaxel Plus Carboplatin and Trastuzumab-Results of the BETH StudyThe randomized phase III BETH (Bevacizumab With Trastuzumab Adjuvant Therapy in HER2-Positive Breast Cancer) trial shows that the combination of docetaxel, carboplatin, and trastuzumab is equally effective as the standard treatment of an anthracycline plus trastuzumab for HER2-positive breast cancer patients. The disease-free survival was 92% for both treatment arms after a follow-up of 38 months. Anthracycline treatment is associated with cardiac toxicities and long-term side effects that can include heart failure and leukemia. Longer-term follow-up to confirm the efficacy of the newer regimen continues.Source: Slamon DJ, Swain SM, Buyse M, et al. Primary results from BETH, a phase 3 controlled study of adjuvant chemotherapy and trastuzumab ± bevacizumab in patients with HER2-positive, node-positive or high risk node-negative breast cancer. SABCS 2013; Abstract S1-03.Slide 3: Women Over 65 With Estrogen Receptor-Positive Breast Cancer Treated With Hormone Therapy After Surgery Can Avoid RadiotherapyFor every 100 women with hormone-positive breast cancer that are treated with radiotherapy, one will recur with or without radiotherapy and four will have their recurrence prevented, but 95 will undergo radiotherapy that is unnecessary. These are the results of the international phase III PRIME (Postoperative Radiotherapy In Minimum-Risk Elderly) II study that includes 1,000 patients. At 5 years, there was no significant difference in overall survival between patients who received radiotherapy and those who did not (regional recurrence of 0.5% and 0.8%, respectively). Source: Kunkler IH, Williams LW, Jack W, et al. The PRIME II trial: Wide local excision and adjuvant hormonal therapy ± postoperative whole breast irradiation in women ≥ 65 years with early breast cancer managed by breast conservation. SABCS 2013; Abstract S2-01.Slide 4: Re-examination of Four Large Mammography Screening Studies Show Substantial Reduction in Breast Cancer Mortality With ScreeningFour large screening studies (US Preventive Services Task Force, European Screening Network, Nordic Cochrane, and UK Independent Breast Screening Review) previously showed a large range in the number of women that need to be screened in order to prevent a single breast cancer death. A new analysis of these studies shows their results to be more similar than previously thought. The new adjusted estimates are 64 to 257 screenings to prevent a breast cancer death.Source: Smith RA, Duffy S, Chen TH-H, et al. Disparities in the estimates of benefits and harms from mammography: Are the numbers really different? SABCS 2013; Abstract S1-10.Slide 5: Surgery and Radiotherapy May Not Benefit Metastatic Breast Cancer Patients Treated With ChemotherapyMetastatic breast cancer patients, who initially responded to chemotherapy, did not have a better overall survival if also treated with radiotherapy and surgery. This is among the first randomized trials to examine whether additional surgery and therapy benefits those women who initially present with metastatic breast cancer. Researchers randomized 350 women for a median follow-up of 17 months.Source: Badwe R, Parmar V, Hawaldar R, et al. Surgical removal of primary tumor and axillary lymph nodes in women with metastatic breast cancer at first presentation: A randomized controlled trial. SABCS 2013; Abstract S2-02.Slide 6: Adding Carboplatin to a Neoadjuvant Chemotherapy Regimen in Triple-Negative Breast Cancer Patients Boosts Pathologic Complete Response RatesA randomized phase II trial of 454 patients shows that adding both bevacizumab and carboplatin to a standard neoadjuvant chemotherapy backbone increases pathologic complete response (pCR) in patients with triple-negative breast cancer. In the neoadjuvant setting, pCR is associated with improved recurrence-free survival and overall survival. However, bevacizumab also increased high-grade adverse events, including post-surgery complications. The boost in pCR rates when bevacizumab was combined with carboplatin was additive but not synergistic. Patients in the study continue to be followed for long-term recurrence and survival rates.Source: Sikov WM, Berry DA, Perou CM, et al. Impact of the addition of carboplatin (Cb) and/or bevacizumab (B) to neoadjuvant weekly paclitaxel (P) followed by dose-dense AC on pathologic complete response (pCR) rates in triple-negative breast cancer (TNBC): CALGB 40603 (Alliance). SABCS 2013; Abstract S5-01.Slide 7: Anastrozole Reduces Risk of Breast Cancer by 53% in High-Risk WomenThe aromatase inhibitor anastrozole reduced the risk of a first breast cancer diagnosis by more than half in postmenopausal women at high risk, according to the results of the 3,864-patient International Breast Cancer Intervention Study (IBIS)-II trial. Women who took anastrozole had an incidence of breast cancer of 2% compared with 4% for those who took a placebo (P