Breast Cancer Specialist Reports Advance in Treatment of Triple-Negative Breast Cancer

“Because of its rapid growth rate, many women with triple-negative breast cancer receive chemotherapy to try to shrink it before undergoing surgery. With the standard treatment, the cancer is eliminated from the breast and lymph nodes in the armpit before surgery in about one third of women. This is referred to as a pathologic complete response (pCR). In patients who achieve pCR, the cancer is much less likely to come back, spread to other parts of the body, and cause the patient’s death than if the cancer survives the chemotherapy.

“Sikov and his collaborators studied the addition of other drugs – carboplatin and/or bevacizumab – to the standard treatment regimen to see if they could increase response rates. More than 440 women from cancer centers across the country enrolled in this randomized clinical trial.

” ‘Adding either of these medications significantly increased the percentage of women who achieved a pCR with the preoperative treatment. We hope that this means fewer women will relapse and die of their cancer, though the study is not large enough to prove this conclusively. Of the two agents we studied, we are more encouraged by the results from the addition of carboplatin, since it was associated with fewer and less concerning additional side effects than bevacizumab,’ Sikov explains.”

Editor’s note: This article describes the results of a clinical trial—a research study with volunteer patients.


Response to Neoadjuvant Therapy Could Help Determine Whether Radiation is Needed

The gist: Depending on how well their neoadjuvant therapy works, some breast cancer patients might benefit from extra treatment with radiation after surgery. A large study looked at the records of 11,995 women treated for stage I, II, or III breast cancer. After neoadjuvant therapy, some women had no more signs of an invasive tumor and no cancer in their lymph nodes. Other patients still had residual cancer. The researchers found that patients whose cancer disappeared before surgery had a lower risk of return of their cancer (recurrence). Doctors could use this information by recommending radiation to patients who still have residual cancer after neoadjuvant treatment. 

“An analysis of data from 12 large clinical trials found that the cancer’s pathologic response to neoadjuvant chemotherapy and tumor subtype are strong predictors of locoregional breast cancer recurrence. According to the researchers, the study showed that these two predictors may be more informative than the tumor stage at diagnosis, which is commonly used in current practice, for evaluating locoregional breast cancer recurrence risk. The findings of this study, the largest of its kind to date, were presented yesterday at a presscast in advance of the 2014 Breast Cancer Symposium (Abstract 61).

“Neoadjuvant and adjuvant chemotherapy provide equivalent survival benefits, but more women typically undergo adjuvant therapy. An important advantage of receiving chemotherapy before surgery is that it can shrink and even eradicate the tumor in the breast and axillary lymph nodes, potentially reducing the need for mastectomy, lymph node removal, and radiation therapy after surgery.

“ ‘We’re finding that receiving neoadjuvant chemotherapy is not only a good option for treating breast cancer and preventing future recurrence in other parts of the body, but it also provides important information on the risk for logocregional recurrence,’ said lead study author Eleftherios Mamounas, MD, MPH, FACS, Medical Director of the Comprehensive Breast Program at the UF Health Cancer Center in Orlando, Florida, and Professor of Surgery at the University of Central Florida. ‘This can potentially help to better identify patients at higher risk for recurrence who may benefit from the addition of radiotherapy and those at low risk who may not need it.’ ”


Neoadjuvant Chemotherapy Reduces Postoperative Morbidity in Women With Breast Cancer Undergoing Mastectomy

Editor’s note: Cancer patients sometimes take neoadjuvant therapy—a treatment given before the main treatment to reduce the risk of the cancer returning later (recurrence). In a recent study, researchers looked at the effects of neoadjuvant chemotherapy for breast cancer patients before mastectomy. They measured morbidity, which they defined as a list of various conditions including surgical site infection, pneumonia, and sepsis. The researchers found that neoadjuvant chemotherapy reduced the risk of these conditions.

“In a study reported in JAMA Surgery, Abt et al found that neoadjuvant chemotherapy is safe in women with breast cancer undergoing mastectomy with or without immediate breast reconstruction. Neoadjuvant chemotherapy was an independent predictor of reduced 30-day postoperative morbidity in women undergoing mastectomy without breast reconstruction and in those undergoing immediate tissue expander breast reconstruction…

“The study included women in the American College of Surgeons National Surgical Quality Improvement Program database undergoing mastectomy with or without immediate breast reconstruction from January 2005 through December 2011. Rates of 30-day overall, systemic, and surgical postoperative morbidity were compared between women who did and did not receive neoadjuvant chemotherapy.

“Postoperative morbidity was defined as superficial and deep incisional surgical site infection, organ space surgical site infection, wound dehiscence, pneumonia, unplanned intubation, pulmonary embolism, > 48 hours of ventilatory assistance, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke or cerebrovascular accident, coma > 24 hours, cardiac arrest, myocardial infarction, bleeding requiring transfusion, prosthesis or flap failure, deep vein thrombosis requiring treatment, sepsis, septic shock, and return to the operating room within 30 days.”


ASCO: Chemotherapy Key Part of Curative Lung Cancer Therapies

“Cancer Network: Thank you for speaking with us today, Dr. Kris. First, can you tell us why this is an important topic for an education session? Is there a debate of the use of chemotherapy in treating lung cancer?

“Dr. Kris: I wouldn’t quite say that there is a debate, but there is an impression that the therapy of lung cancers has switched to targeted therapies or immune therapies. Looking at the ASCO abstracts this year that would be an easy conclusion to draw. But there is an indisputable fact that no matter what target you can identify in a patient’s tumor, be it PD-L1 or a BRAF mutation, at some point in a patient’s illness they will be receiving chemotherapy. As we look at entire care of people with lung cancer it is very important to remember that virtually every single one will receive chemotherapy, and that we need to pay attention to choosing the best chemotherapy. We also need to think about doing research in chemotherapy. Clearly, we can do a better job, and we need more research to find the best drugs. Also, we need to find a way to use them with our targeted therapies.”

Editor’s note: Targeted therapies and immunotherapies are all the rage now in cancer treatment. But there are still important roles for chemotherapy. This article gives a great overview of recent advancements in the use of chemotherapy in lung cancer treatment, and why we need further research to refine and improve the benefits of chemotherapy.


Neoadjuvant Chemotherapy Reduced Mortality in Upper Tract Urothelial Carcinoma

“Neoadjuvant chemotherapy following surgery extended 5-year survival rates in patients with urothelial carcinoma, according to results of a retrospective study.

“Researchers reported a 5-year survival rate of 80.2% among patients who received neoadjuvant chemotherapy vs. 57.6% for patients who underwent surgery without chemotherapy.”

Editor’s note: Neoadjuvant treatment is a first-step treatment given to shrink a tumor before surgery to remove it. Neoadjuvant treatment can be performed with a variety of methods, including radiation therapy and hormone therapy. In this case, chemotherapy was used as a neoadjuvant, and appeared to benefit patients.

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Meta-Analysis Shows Survival Benefit of Preoperative Chemotherapy in NSCLC

“In a systematic review and individual patient meta-analysis reported in The Lancet, the NSCLC Meta-analysis Collaborative Group found that neoadjuvant therapy for non–small cell lung cancer (NSCLC) was associated with a significant 13% reduction in risk of death. Significant benefits in recurrence-free survival and time to distant recurrence were also observed…

“Preoperative chemotherapy was associated with a 13% improvement in overall survival.

“Preoperative chemotherapy was associated with a 15% improvement in recurrence-free survival and a 31% improvement in time to distant recurrence.”

Editor’s Note: “neoadjuvant therapy” refers to chemotherapy given before tumor removal surgery in the hopes of improving the success of the surgery.