Does Sequential vs Concurrent Treatment Change Outcomes in HER2+ Breast Cancer?


“Outcomes for patients with HER2-positive breast cancer did not differ when treated with sequential chemotherapy plus trastuzumab compared with a concurrent approach, according to a new phase III trial.

” ‘The effectiveness of trastuzumab with chemotherapy in the neoadjuvant setting is evident; however, the cardiac safety of trastuzumab combined with anthracyclines has been questioned,’ wrote study authors led by Kelly K. Hunt, MD, of the University of Texas MD Anderson Cancer Center in Houston.”

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Scalp-Cooling Device Cuts Hair Loss in Breast Cancer Patients Undergoing Chemotherapy


“While nothing easy or simple comes from a cancer diagnosis, one of the most traumatic experiences for breast cancer patients, particularly for women, is hair loss. Dr. Julie Nangia, assistant professor in the Lester and Sue Smith Breast Center within the NCI-designated Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine, sees this all too frequently when treating her patients.

” ‘Hair loss takes a tremendous toll on the patient’s body image, and they no longer have the anonymity of hiding the disease; everyone can see that they’re sick,’ said Nangia. ‘Patients and physicians have been hoping and searching for methods or therapies to prevent or reduce hair loss due to chemotherapy, but the options have been very limited due to the complexity of both the disease and the treatment.’

“Nangia may have found the answer in research presented at the 2016 San Antonio Breast Cancer Symposium, which details the results of a study using a scalp cooling cap to reduce hair loss in breast cancer patients undergoing taxane or anthracycline chemotherapy.”

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Use of Anthracyclines Plus Taxanes Found to be Beneficial in Early, HER2-Negative Breast Cancer


“Treatment with anthracyclines was proven to be beneficial for patients with high-risk, HER2-negative, early-stage breast cancer, according to a joint analysis of the “ABC” trials presented at the 2016 ASCO Annual Meeting.

“The analysis, which included more than 4000 patients, demonstrated that docetaxel plus cyclophosphamide (TC) was significantly inferior to various taxane-plus-anthracycline-based (TaxAC) chemotherapy regimens.

“ ‘Statistical noninferiority of the non-anthracycline regimen could not be demonstrated,’ said lead investigator Joanne Lorraine Blum, MD, PhD, medical oncologist with Texas Oncology at the Baylor-Sammons Cancer Center in Dallas. ‘In terms of the study’s primary endpoint, invasive disease-free survival, TC x 6 was significantly inferior to TaxAC.’ ”

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Anthracyclines Negatively Impact Brain Function

“Cancer survivors treated with anthracycline-based chemotherapies exhibited poorer performance of certain cognitive skills compared with survivors who received no chemotherapy or other classes of chemotherapies, according to the results of a study published in JAMA Oncology.

“While the study of 62 primary breast cancer survivors is retrospective and small, the results suggest that further studies are needed to understand how the neurologic effects of anthracycline-based chemotherapy agents may be minimized.

“Shelli R. Kesler, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and Douglas W. Blayney, MD, of the Stanford University School of Medicine in Stanford, California, analyzed both cognitive function and resting state functional magnetic resonance brain imaging data from breast cancer survivors who were treated, on average, 2.1 years prior to undergoing the assessments. The patients were all assessed at Stanford University.”

Rolapitant Reduced Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Moderately Emetogenic Chemotherapy or Anthracycline/Cyclophosphamide

“In a phase III study reported in The Lancet Oncology, Schwartzberg et al found that the addition of rolapitant to serotonin (5-HT3) receptor antagonist and dexamethasone treatment significantly improved complete response rates in prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy or anthracycline and cyclophosphamide regimens.

“In this double-blind trial, patients from 170 sites in 23 countries were randomly assigned between March 2012 and September 2013 to receive oral rolapitant 180 mg or placebo 1 to 2 hours before the administration of moderately emetogenic chemotherapy. All patients received oral granisetron 2 mg and oral dexamethasone 20 mg on day 1 (except for those receiving taxanes, who received dexamethasone according to the package insert) and granisetron 2 mg on days 2 and 3. Treatment was given for up to six cycles, with a minimum of 14 days…

“The investigators concluded: ‘Rolapitant in combination with a 5-HT3 receptor antagonist and dexamethasone is well tolerated and shows superiority over active control for the prevention of chemotherapy-induced nausea and vomiting during the 5-day (0–120 h) at-risk period after administration of moderately emetogenic chemotherapy or regimens containing an anthracycline and cyclophosphamide.’ “

Age, BMI Tied to Chemo-Related Heart Damage in BrCa Patients

“Age and body mass index (BMI) were found to be independent predictors of anthracycline-related diastolic dysfunction in an analytical prospective cohort study of breast cancer patients undergoing treatment with broad-spectrum anthracycline chemotherapy, researchers said.

“Overall, the incidence of diastolic dysfunction during follow-up was 57% and persisted up to 12 months later in 73% of patients, reported Jose M. Serrano, MD, of the Hospital Universitario de Fuenlabrada, Servicio de Cardiologıa, Madrid, Spain, and colleagues in The Oncologist.

“Diastolic dysfunction is an important predictor of all-cause mortality and plays an essential role in the pathophysiology of other cardiac diseases, they noted.

” ‘We confirmed in our study the association of age with the development of diastolic dysfunction, with an odds ratio of 1.12 (95% CI: 1.03-1.19) in the regression model,’ said Serrano.”

A Breast Cancer Tumor's Immune Signature Could Predict Response to Neoadjuvant Therapy

“In a study reported in the Journal of Clinical Oncology, Denkert et al found that increased tumor-infiltrating lymphocytes and the presence of lymphocyte-predominant breast cancer were associated with increased rates of pathologic complete response in patients receiving neoadjuvant anthracycline-taxane treatment with or without carboplatin. Higher rates were observed with carboplatin, with treatment interactions being significant among all patients and among those with HER2-positive disease but not among those with triple-negative disease. mRNA profiles for immune-related genes also distinguished pathologic complete response rates.

“The study involved 580 tumors from patients in the GeparSixto trial, which assessed the effects on pathologic complete response rates of adding carboplatin to neoadjuvant anthracycline plus taxane treatment. The current analysis assessed the effects on pathologic complete response of tumor-infiltrating lymphocyte levels, the presence of lymphocyte–predominant disease, and levels of immune-activating (CXCL9, CCL5, CD8A, CD80, CXCL13, IGKC, CD21) and immunosuppressive genes (IDO1, PD-1, PD-L1, CTLA4, FOXP3).”

Common Chemotherapy Is Not Heart Toxic in Patients with BRCA1/2 Mutations

“Use of anthracycline-based chemotherapy, a common treatment for breast cancer, has negligible cardiac toxicity in women whose tumors have BRCA1/2 mutations—despite preclinical evidence that such treatment can damage the heart.

“The findings, to be presented at the 2014 San Antonio Breast Cancer Symposium (SABCS), represent a unique effort between cardiologists and oncologists at Georgetown Lombardi Comprehensive Cancer Center and MedStar Heart & Vascular Institute in Washington to answer a vital clinical question.

” ‘Our study was prompted by evidence from animal studies suggesting that mice with BRCA1/2 mutations in the heart were susceptible to heart damage—treatment with anthracyclines led to reduced cardiac function and heart failure much more frequently in these mice than in those without these mutations,’ says the study’s principal investigator, Ana Barac, MD, PhD, an assistant professor of medicine at Georgetown University School of Medicine and director of the cardio-oncology program at MedStar Heart & Vascular Institute.”