Understanding Breast Cancer Management and Treatment

This month ONCOLOGY presents a special desk reference on the treatment and management of women with breast cancer, including discussion about adjuvant treatment of early disease and first-line cytotoxic chemotherapy for metastatic breast cancer. The emergence of trastuzumab (Herceptin) as a component of therapy for women with HER2-positive disease is also reviewed along with recent data concerning the roles of novel molecular targeted agents bevacizumab (Avastin), sunitinib (Sutent), and lapatinib (Tykerb). A comprehensive look at some of the common side effects associated with breast cancer treatment is also included.

Understanding Breast Cancer Treatment

In "Systemic Treatment of Breast Cancer-Two Decades of Progress" guest editor Dr. Andrew Seidman highlights some of the landmark accomplishments in breast cancer treatment over the past 20 years, including the emergence of a new generation of aromatase inhibitors and new anthracyclines, the impact of the taxanes, and the development and role of the molecular agents in reaching specific cellular targets and pathways. Drs. Witherby and Muss provide a detailed discussion about the management of early breast cancer in older women and review the appropriate treatment of this population who have poorer outcomes when undertreated.

Aromatase Inhibitors, Bisphosphonates, and Side Effects

Aromatase inhibitors (AIs) are more effective than selective estrogen receptor modulators (SERMs) such as tamoxifen in preventing recurrence in estrogen receptor positive early breast cancer and are likely to replace SERMs as first-line adjuvant therapy for many patients. The AIs, however, are not without side effects and women receiving these agents are at greater risk for more osteoporotic fractures and greater bone mineral loss than women receiving tamoxifen. Drs. Edith Perez and Katherine Weilbaecher review the topic "Aromatase Inhibitors and Bone Loss" and the role of bisphosphonate therapy in some patients. Drs. Catherine Van Poznak and Cherry Estilo take a closer look at women receiving bisphosphonate therapy and review the incidence, prevention, and management of an associated risk factor, osteonecrosis of the jaw.

In "Second Opinion" medical editors Drs. David Crawford and Al Barqawi present the case of a 42-year-old premenopausal woman recently diagnosed with breast cancer. Their colleagues at the University of Colorado present a discussion concerning the history and second opinion consensus regarding this young woman's postoperative care after diagnosis of a solitary sternal lesion.

Finally, Dr. V. Craig Jordan provides his important perspective about the study of tamoxifen and raloxifene (Evista) in his "Closing Thoughts" essay "A STAR Is Born."

This special issue was designed to be read and kept as a resource on breast cancer management. For your convenience, the full contents of this issue are also available online at www.cancernetwork.com

-The Editors