Tamoxifen Linked to Reduced Contralateral Breast Cancer Risk

Excerpt:

“Use of tamoxifen and aromatase inhibitors during and after breast cancer treatment were found to reduce the risk of contralateral breast cancer in a community healthcare setting, according to a study published in JAMA Oncology.

“The authors of the real-world retrospective study found that among estrogen receptor (ER)-positive breast cancer patients who survived at least 5 years, tamoxifen use for 4 years or more prevented an estimated three contralateral breast cancer cases for every 100 women by year 10. This absolute risk reduction is consistent with prior results from tamoxifen clinical trials, according to study authors led by Gretchen L. Gierach, PhD, MPH, of the division of cancer epidemiology and genetics at the National Cancer Institute.”

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Results of Two Practice-Changing Breast Cancer Trials Upheld

Excerpt:

“Results of two pivotal breast cancer trials reported at the 2016 ASCO Annual Meeting confirmed the practice-changing findings that resulted from earlier findings.

“The phase III PALOMA-2 trial confirmed results from the smaller, open-label phase II PALOMA-1 trial that led to the U.S. Food and Drug Administration (FDA) approval of the cyclin-dependent kinase 4/6 inhibitor palbociclib (Ibrance). The drug was approved in combination with letrozole for the first-line treatment of metastatic disease.

“ ‘These data represent the longest front-line improvement in median progression-free survival seen to date in women with advanced estrogen receptor (ER)-positive breast cancer,’ said Dennis Slamon, MD, Director of Clinical/Translational Research and Professor of Medicine at the University of California, Los Angeles, and Director of the Revlon/UCLA Women’s Cancer Research Program.”

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Oncotype Dx Gene Test Has a Big Impact on Oncologists' Chemo Recommendations

Excerpt:

“The 21-gene Recurrence Score (RS) assay significantly influenced clinicians’ decisions to recommend breast cancer patients for adjuvant chemotherapy, analysis of a population-based dataset showed.

“Used to predict disease recurrence and benefit of chemotherapy in estrogen receptor-positive, lymph node-negative early-stage breast cancer (EBC), the assay had the strongest association with recommendation for chemotherapy, with an adjusted odds ratio (aOR) of 83 for high assay scores and 12 for intermediate scores, both relative to low scores.

“Test use was significantly associated with younger age, white race, academic centers, private insurance, and pT2/pN0(i+) grade 2 to 3 disease, Peter Kabos, MD, of the University of Denver, Aurora, CO, and colleagues reported online in the Journal of Clinical Oncology.”

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FDA Approves New Indication for FASLODEX® (Fulvestrant)

“AstraZeneca today announced that the US Food and Drug Administration (FDA) has approved a new indication expanding the use of FASLODEX® (fulvestrant) to include use in combination with palbociclib. The combination use is for the treatment of women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced or metastatic breast cancer (MBC) whose cancer has progressed after endocrine therapy. FASLODEX has been approved since 2002 as a monotherapy for the treatment of postmenopausal women with HR+ MBC whose cancer has progressed following antiestrogen therapy.

“Estrogen receptor (ER) positive breast cancer is the most common subtype of breast cancer and one of the key drivers of disease progression for this subtype is through the ER. Laboratory studies show that FASLODEX directly targets the ER by blocking and degrading the ER, helping to inhibit tumor growth.”


ASCO Recommends Ovarian Suppression for ER-Positive Breast Cancer

“An American Society of Clinical Oncology (ASCO) expert panel issued an updated guideline recommending that higher-risk premenopausal women with estrogen receptor (ER)-positive breast cancer receive ovarian suppression in addition to adjuvant endocrine therapy. Lower-risk patients, however, should not receive ovarian suppression.

“ ‘In the past year, randomized trials with robust methodological designs have analyzed the effect of ovarian suppression among premenopausal women with ER-positive breast cancers treated with tamoxifen,’ wrote the panel, led by ASCO expert Harold J. Burstein, MD, PhD, of Dana-Farber Cancer Institute in Boston. In the past, studies of this therapy have suffered from problems such as selection criteria confounding.

“The guideline update is based on four randomized controlled trials. These include the Eastern Cooperative Oncology Group 3193 (E-3193) trial, the Suppression of Ovarian Function Trial (SOFT), the Tamoxifen and Exemestane Trial (TEXT), and the Austrian Breast Cancer Study Group (ABCSG)-12 trial. Overall, the studies did not find a significant difference with regard to overall survival between tamoxifen alone, tamoxifen plus ovarian suppression, or aromatase inhibitors (AIs) plus ovarian suppression. The guideline update was published in the Journal of Clinical Oncology.”


New Image Analytics May Offer Quick Guidance for Breast Cancer Treatment

“For women with the most common type of breast cancer, a new way to analyze magnetic resonance images (MRI) data appears to reliably distinguish between patients who would need only hormonal treatment and those who also need chemotherapy, researchers from Case Western Reserve University report.

“The analysis may provide women diagnosed with estrogen positive-receptor (ER-positive)  answers far faster than current tests and, due to its expected low cost, open the door to this kind of testing worldwide.

“The research is published in the journal Nature Scientific Reports.”


Resistance Mutations: Next in ER+ Metastatic Breast Cancer?

“Estrogen receptor (ER) mutations can be easily detected in the plasma of patients with metastatic breast cancer and may hold the key to targeted treatments for women with endocrine-resistant disease, according to new analysis of patients in the BOLERO-2 trial.

” ‘Patients who had mutations had a shorter median survival than those who did not…and patients with different mutations might have different responses to therapies,’ Sarat Chandarlapaty, MD, PhD, a breast medical oncologist from Memorial Sloan Kettering Cancer Center in New York reported at the San Antonio Breast Cancer Symposium.

“BOLERO-2 enrolled postmenopausal women with metastatic, endocrine-resistant, ER-positive breast cancer and changed the standard of care in this setting, as reported by Medscape Medical News.”


One-Two Punch of Palbociclib, Paclitaxel Shows Promise against Advanced Breast Cancer

“Combining the new breast cancer drug palbociclib with paclitaxel (Taxol) shrank tumors in nearly half of patient with estrogen-receptor (ER) positive breast cancer, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The results will be presented Saturday at the 2015 San Antonio Breast Cancer Symposium. A second study provides new clues to how breast cancer develops resistance to the palbociclib, a common occurrence among many patients who take the drug.

” ‘Results of the first study found that palbociclib and paclitaxel can be safely combined on an alternating dosing schedule,’ said Angela DeMichele, MD, MSCE, the Alan and Jill Miller Associate Professor in Breast Cancer Excellence in Penn’s Abramson Cancer Center, and senior author on the study. ‘The high response rate we saw suggests this combination may hold benefits for patients over paclitaxel alone. Based on these results, a larger clinical trial to determine the benefits is warranted.’ “


Guideline: Limit Biomarker Testing in Metastatic Breast Ca

“HER2 and hormone-receptor status should form the basis for biomarker testing in metastatic breast cancer, according to a new clinical practice guideline from the American Society of Clinical Oncology (ASCO).

“All patients with accessible metastases should have biopsies to determine disease status. Retesting of HER2, estrogen receptor, and progesterone status should be offered, although data are insufficient to know whether a change in therapy based on the markers’ status will affect outcomes.

“In the case of discordant findings from biopsies of primary tumors and metastases, the marker status of the metastasis should take precedence with respect to treatment decisions, Catherine Van Poznak, MD, of the University of Michigan in Ann Arbor, and colleagues advised in a statement published online in the Journal of Clinical Oncology. Tests for carcinoembryonic antigen (CEA), cancer antigen (CA) 15-3 and CA 27-29 may be used adjunctively but not by themselves.”