“Women with early-stage breast cancer may now receive a one-dose radiation treatment at the same time as lumpectomy surgery, eliminating the need to return to the hospital daily for up to six weeks for post surgical radiation treatments.
“The relatively new treatment option available at Rush, intraoperative radiation therapy (IORT), delivers one precise, concentrated dose of radiation to the tumor site immediately following surgical removal of the cancer.
“After the breast cancer is removed, a catheter-like device with a balloon at the tip is inserted into the lupectomy [sic] cavity. The balloon is inflated with saline and the radiation therapy source docks precisely into the catheter to deliver radiation to the breast tissue surrounding the cavity where the tumor was removed, while avoiding radiation to nearby organs. At the end of radiation treatment, the balloon is deflated and easily removed and the cavity is closed.”
Editor’s note: This article covers several new cancer drugs that are showing consistent promise in clinical trials with volunteer patients. One of the drugs, neratinib, may be an effective treatment for breast cancer patients who have taken trastuzumab but have become resistant to it.
“Evolution of HER-2–targeted therapy is one of the most fascinating stories in breast cancer treatment. Introduction of trastuzumab (Herceptin, Genentech) has dramatically changed the survival of patients with HER-2–positive breast cancer. However, a large number of trastuzumab-treated patients will develop resistance. Pertuzumab (Perjeta, Genentech) and ado-trastuzumab emtansine (Kadcyla, Genentech) were found to be effective in this subset of patients. Those patients who progress on multiple HER-2–targeted therapies still continue to have good performance status and will benefit from further treatment options.
“Neratinib (PB272, Puma Biotechnology) is an irreversible multikinase inhibitor. In preclinical and clinical studies, it has shown to reverse trastuzumab resistance. Some of the early phase 2 studies have shown very high response rate in patients with trastuzumab-naive metastatic breast cancer.”
“Key genetic variants may affect how cancer patients respond to radiation treatments, according to a study published this week in Nature Genetics. The research team, which included researchers at the Icahn School of Medicine at Mount Sinai, found that variations in the TANC1 gene are associated with a greater risk for radiation-driven side effects in prostate cancer patients, which include incontinence, impotence and diarrhea.
“The current results are based on a genome-wide association study, a type of study in which researchers examine numerous genetic variants to see if any of them are associated with a certain type of complication, which could sometimes emerge years after treatment was completed.
“ ‘Our findings, which were replicated in two additional patient groups, represent a significant step towards developing personalized treatment plans for prostate cancer patients,’ said Barry S. Rosenstein, PhD, Professor, Radiation Oncology, Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, the lead Mount Sinai investigator on the study. ‘Within five years, through the use of a predictive genomic test that will be created using the data obtained in the recent study, it may be possible to optimize treatment for a large number of cancer patients.’ ”
Editor’s note: When making treatment decisions, it can be very useful to know how a patient might respond to certain treatments. A recent study involving prostate cancer patients found genetic markers that were associated with a greater risk of side effects from radiation treatment. The finding could lead to the development of a genetic test to help doctors personalize treatment plans for prostate cancer patients.
“In the phase III Cancer and Leukemia Group B (CALGB) 40101/Alliance trial reported in the Journal of Clinical Oncology, Shulman et al found that noninferiority of adjuvant single-agent paclitaxel was not established vs doxorubicin/cyclophosphamide for relapse-free survival in women with operable breast cancer with 0 to 3 positive nodes. Paclitaxel was less toxic than doxorubicin/cyclophosphamide.”
Editor’s note: A recent study found that treatment with the drug paclitaxel was no better than a combination of doxorubicin and cyclophosphamide for breast cancer patients who had 0-3 positive axillary nodes (i.e. cancer cells were found in 0-3 lymph nodes; cancer cells in lymph nodes can be used to predict the risk of metastatic breast cancer).
“The authors compare the clinical outcome and sites of relapse of TNBC in BRCA1 mutation carriers and non–carriers who received adjuvant chemotherapy. Results suggest that BRCA1 mutation carriers with TNBC had similar survival rates and sites of recurrence to non–carriers after treatment with conventional chemotherapy.”
Editor’s note: This article describes a breast cancer study that compared patients with BRCA1 mutations to patients without BRCA1 mutations. It was found that, after conventional chemotherapy, BRCA1-positive patients with triple-negative breast cancer had similar survival rates and sites of recurrence to BRCA1-negative patients.
“Many caregivers of terminal cancer patients suffer depression and report regret and guilt from feeling they could have done more to eliminate side effects and relieve the pain. So researchers devised and tested an intervention that quickly integrates a cancer support team to guide caregivers and their patients through difficult end-of-life treatment and decisions.”
“Approximately 15% of patients with breast cancer have tumors that overexpress the HER2 protein and these patients can benefit from HER2-targeted therapies. The American Society of Clinical Oncology recently released a clinical practice guideline on systemic therapy for patients with advanced HER2-positive breast cancer, published in the Journal of Clinical Oncology. The rationale for the guideline is that several new agents have become available for treatment of metastatic HER2-positive breast cancer since the approval of trastuzumab (Herceptin).
“Up to half of all patients with HER2-positive metastatic breast cancer develop brain metastases over time. Recommendations for the management of brain metastases in patients with HER2-positive breast cancer are detailed in another recently released companion guideline.”
Editor’s note: Click through to the full article (arrow button to the right of the title) to see the recommendations.
“At a median follow-up of 8 years, patients receiving trastuzumab (Herceptin) sequentially after chemotherapy and radiotherapy in the Herceptin Adjuvant (HERA) trial had a low incidence of cardiac events and these were reversible in the vast majority of patients. This long-term assessment confirms and extends previous reports of cardiac safety.
“The three-arm HERA trial compared 2 years or 1 year of trastuzumab with observation in 5,102 patients with human epidermal growth factor receptor 2 (HER2)-positive early-stage breast cancer. ‘This is the first time that results of the 2-year trastuzumab arm have been reported, and the follow-up time has doubled,’ researchers reported in the Journal of Clinical Oncology.
“Eligible patients had a left-ventricular ejection fraction of at least 55% following neoadjuvant chemotherapy with or without radiotherapy and cardiac function was closely monitored. Cardiac adverse events leading to discontinuation of trastuzumab occurred in 9.4% of the 1,673 patients receiving 2 years of trastuzumab and 5.2% of the 1,682 patients receiving 1 year of trastuzumab.”
Editor’s note: This story discusses the results of a study that investigated the effects of the drug trastuzumab (brand name Herceptin) on cardiac health. The study involved 5,102 patients with HER2-positive, early-stage breast cancer. All of the patients had been previously treated. Patients were given trastuzumab as an adjuvant therapy—a treatment given after the main treatment to keep cancer from returning. Researchers found a low incidence of adverse cardiac events for the patients. However, they say that each patient should still have a cardiac assessment before and while taking trastuzumab to ensure that any problems are detected early.
“In a modest-sized lab at the Moores Cancer Center at the University of California, San Diego, scientists investigating how cancer cells develop resistance to drug treatments recently discovered something that surprised even the most seasoned members of the research team: A new generation of drugs that are currently among the most popular treatments for lung, breast and pancreatic cancers actually induce drug resistance and spur tumor growth.
“These popular cancer drugs, known as receptor tyrosine kinase inhibitors (RTKs), are actually making cancers stronger. That’s the bad news. The good news is that researchers believe they have found a way to eliminate that threat.
“Researchers found that two of the drugs — Erlotinib for lung cancer and Lapatinib for breast cancer — are effective for a while, but eventually stop killing cancer cells and begin prompting them to resist the drug and become more aggressive.
“ ‘We knew that cancer typically builds up a resistance to these and other drugs. But we did not know that these drugs actually induce tumor progression,’ said David Cheresh, Moores’ vice chair of pathology and the lead researcher on this study.”
Image: A breast cancer cell. London Research Institute EM Unit/Cancer Research UK