EBCC-10 NEWS: Combination of Lapatinib and Trastuzumab Shrinks HER2 Positive Breast Cancer Significantly in 11 Days After Diagnosis

“Amsterdam, The Netherlands: Approximately a quarter of women with HER2 positive breast cancer, who were treated with a combination of the targeted drugs lapatinib and trastuzumab before surgery and chemotherapy, saw their tumours shrink significantly or even disappear, according to results from a clinical trial.

“Professor Nigel Bundred told the 10th European Breast Cancer Conference (EBCC-10) today (Thursday): ‘This has ground-breaking potential because it allows us to identify a group of patients who, within 11 days, have had their tumours disappear with anti-HER2 therapy alone and who potentially may not require subsequent chemotherapy. This offers the opportunity to tailor treatment for each individual woman.’

“Prof Bundred, who is Professor of Surgical Oncology at The University of Manchester and the University Hospital of South Manchester NHS Foundation Trust (UK), was presenting results from the UK EPHOS-B multi-centre, clinical trial, in which 257 women with newly-diagnosed, operable, HER2 positive disease were recruited between November 2010 and September 2015.”

Greater Suppression of Intraprostatic Androgens by Adding Abiraterone to LHRH Agonist in Patients With Prostate Cancer

The gist: Patients with intermediate- or high-risk prostate cancer who are prescribed treatment with leuprolide acetate before prostatectomy may benefit more if they also take abiraterone acetate (aka Zytiga).

“In a phase II study reported in the Journal of Clinical Oncology, Taplin et al found that the addition of neoadjuvant abiraterone acetate (Zytiga) to the luteinizing hormone–releasing hormone (LHRH) agonist leuprolide acetate resulted in greater suppression of intraprostatic androgens in patients with intermediate- or high-risk localized prostate cancer.

“In the study, 58 patients were randomly assigned to receive abiraterone plus leuprolide (n = 30) or leuprolide alone (n = 28) for 12 weeks followed by prostate biopsy. All patients then received 12 weeks of abiraterone plus leuprolide and underwent radical prostatectomy…

“The investigators concluded: ‘LHRH [agonist] plus [abiraterone acetate] treatment suppresses tissue androgens more effectively than LHRH [agonist] alone. Intensive intratumoral androgen suppression with LHRH [agonist] plus [abiraterone acetate] before prostatectomy for localized high-risk [prostate cancer] may reduce tumor burden.’ “

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.”

Continued Event-Free Survival Benefit of Neoadjuvant/Adjuvant Trastuzumab in HER2-Positive Locally Advanced Breast Cancer

The gist: A recent clinical trial found that the drug trastuzumab (Herceptin) improves survival and lowers the risk of recurrence for women with HER2-positive, locally advanced breast cancer. Patients in the trial received Herceptin as part of both neoadjuvant (before surgery) and adjuvant (after surgery) treatment. The researchers followed the patients for five years after treatment.

“As reported by Gianni et al in The Lancet Oncology, long-term follow-up of women with HER2-positive locally advanced breast cancer receiving neoadjuvant chemotherapy alone vs with neoadjuvant and adjuvant trastuzumab (Herceptin) in the phase III NOAH trial has shown continued event-free survival benefit of trastuzumab treatment and a strong association of event-free survival with pathologic complete response rate in trastuzumab recipients.

“In this open-label trial, 235 women with HER2-positive locally advanced or inflammatory breast cancer were randomly assigned to receive neoadjuvant chemotherapy alone (n = 118) or with 1 year of trastuzumab given concurrently with neoadjuvant chemotherapy and continued after surgery. (A parallel group with HER2-negative disease received neoadjuvant chemotherapy alone; outcomes in this group are not reported here.)”

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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Improved Survival Associated with Neoadjuvant Chemoradiation in Patients with Clinical Stage IIIA(N2) Non–Small-Cell Lung Cancer

Optimal management of clinical stage IIIAN2 non-small-cell lung cancer (NSCLC) is controversial. This study examines whether neoadjuvant chemoradiation plus surgery improves survival rates when compared with other recommended treatment strategies.