SABCS 2015: Mastectomy Plus Reconstruction Has Higher Complication Rates and Costs Than Lumpectomy Plus Radiation

“Among the various guideline-concordant local therapy options available for women with early-stage breast cancer in the United States, mastectomy plus reconstruction had the highest complication rates and complication-related costs for both younger women with private insurance and older women on Medicare and was the most expensive option for younger women, according to data presented at the 2015 San Antonio Breast Cancer Symposium, held December 8–12 in San Antonio, Texas (Abstract S3-07).

“ ‘Women with early-stage breast cancer have several local therapy options. Although there’s nuance as far as what treatment is best for which patient, there is a large group of patients for whom most, if not all, of these treatment options are considered guideline-appropriate,’ said Benjamin D. Smith, MD, Associate Professor and Research Director of the Breast Radiation Oncology Section in the Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center.”

Big Changes Coming in Treatment of Triple-Negative Breast Cancer

“The treatment paradigm for patients with triple-negative breast cancer is set to undergo a dramatic transformation, as standard chemotherapeutic approaches are perfected and novel antibody-drug conjugates are developed.

“The treatment paradigm for patients with triple-negative breast cancer (TNBC) is set to undergo a dramatic transformation, as standard chemotherapeutic approaches are perfected and novel antibody-drug conjugates (ADCs) are developed. Kimberly Blackwell addressed this topic at the 2015 Chemotherapy Foundation Symposium, a meeting of over 1,000 oncologists and oncology professionals in New York City in November.

“ ‘I think we will see significant improvements in triple-negative breast cancer within the next few years,’ said Blackwell, an oncologist at the Duke Cancer Institute. ‘There are two ADCs that I am fairly excited about that are in late stage development.’ “

Men Who Forgo Aggressive Treatment for Prostate Cancer Don't Receive Appropriate Monitoring

“An increasing number of men diagnosed with low-risk prostate cancer are opting for active surveillance – closely monitoring their cancer – rather than aggressive treatment to avoid the debilitating potential side effects of surgery and radiation, such as erectile and urinary dysfunction.

“However, a new study by UCLA researchers has found that less than 5 percent of men who chose to forgo aggressive treatment are being monitored as closely as they should be, putting them in danger of their cancer progressing or metastasizing without their knowledge.

“The study, published today in the peer-reviewed journal Cancer, examined the records of 37,687 men diagnosed with prostate cancer from 2004 to 2007 who were followed through 2009. They found that of the 3,656 men diagnosed with prostate cancer who did not undergo aggressive treatment, only 166 men, or 4.5 percent, were being monitored appropriately, said Dr. Karim Chamie, the study’s first author and an assistant professor of urology at UCLA.”

New Statistical Model May Help Predict Patients Most Likely to Benefit from Surgical Treatment for Mesothelioma

“A new statistical model may help predict which patients are most likely to receive life-extending benefits from surgical treatment for malignant pleural mesothelioma (MPM), according to an article in the September 2015 issue of The Annals of Thoracic Surgery.

“MPM is an aggressive cancer that affects the lining of the chest cavity (pleura). The main cause of mesothelioma is believed to be repeated exposure to asbestos, which is a naturally occurring group of minerals found in soil and rocks around the world. Asbestos was previously used to make fireproof materials, such as theater curtains, insulation, flooring, and workers’ gloves, and is still used in some products today. About 3,000 cases of mesothelioma are diagnosed in the US each year, with many more worldwide. There is frequently a lag time of twenty years or more between exposure to asbestos and the development of the disease.

“Currently, there is no cure for advanced stage mesothelioma, and the 5-year survival rate is only about 10%.”

New Blood Test for ROS1 Could Help People with Non-Small Cell Lung Cancer Make Personalized Treatment Decisions

The gist: A new blood test might help people with non-small cell lung cancer (NSCLC) make decisions about their treatment. Doctors often use molecular testing to look for tumor mutations that might affect which treatments they suggest to a patient. Molecular testing requires tumor cells, which are usually taken directly from the tumor in a biopsy. A new, less invasive molecular test for NSCLC just requires a blood sample. The test uses circulating tumor DNA, pieces of DNA released by tumor cells into the bloodstream. It looks for a mutation known as ROS1 gene rearrangement. Patients with this mutation might be able to take specific drugs that target the mutation to treat cancer.

“Biocept, Inc. (Nasdaq:BIOC), a molecular oncology diagnostics company specializing in biomarker analysis of circulating tumor DNA (ctDNA) and Circulating Tumor Cells (CTCs), today announced the launch of ROS1 testing on CTCs, which will help physicians identify which of their patients may be receptive to certain drugs for the treatment of non-small cell lung cancer.

“Biocept’s new blood test identifies chromosomal rearrangements of the gene encoding ROS1 proto-oncogene receptor tyrosine kinase (ROS1), thereby defining a distinct molecular subgroup of NSCLCs. Patients with ROS1-positive tumors may be receptive to a number of therapeutic options that inhibit this target.

“It can be difficult to obtain enough tissue material for molecular testing of biomarkers like ROS1 from lung cancer patients due to the small size of tissue biopsies. Occasionally, tissue biopsies are altogether impossible because of risks associated with a surgical procedure for these patients. Biocept’s ‘liquid biopsy’ offers a method of determining the crucial genomic status of a tumor using a simple blood test.”

Active Surveillance Safe for Favorable-Risk Prostate Cancer

“Active surveillance appeared safe and feasible for patients with favorable-risk prostate cancer, according to long-term follow-up of a prospective single-arm cohort study.

“Active surveillance has gained acceptance for patients with favorable-risk prostate cancer because it may reduce the risk for overtreatment of clinically insignificant disease, while still allowing for definitive therapy for patients whose risk appears to increase over time. However, long-term follow-up on this approach is lacking, according to background information provided by researchers.

“In the current study, Laurence Klotz, MD, FRCS(C), chief of the division of urology at Sunnybrook Health Sciences Centre and professor in the department of surgery at the University of Toronto, and colleagues reported long-term outcomes of a large cohort of men who underwent active surveillance.

“The study included 993 men (median age, 67.8 years; range, 41-89) with favorable- or intermediate-risk prostate cancer treated at a single academic health sciences center.”

Diagnostic Tool Oncotype DX Associated with Reduction in Chemotherapy Rates Post-Surgery in Younger Patients

The gist: New research shows interesting results for a test that’s used to determine whether early-stage breast cancer patients need chemotherapy after tumor-removal surgery. The test, called Oncotype DX, is linked with lower chemotherapy use in younger patients, but not in patients 66 years old or older. The test is used for patients with lymph node-negative, hormone receptor (HR)-positive and HER2-negative breast cancer. It looks at a patient’s tumor genes to determine how likely a return of cancer later on (recurrence) might be.

“In what’s believed to be one of the largest population-based studies of Oncotype DX ever conducted, researchers at The University of Texas MD Anderson Cancer Center have found that the commercial diagnostic tool, Oncotype DX, was associated with a decrease in chemotherapy use in younger patients, but not in those over 66 years of age.

“Mariana Chavez Mac Gregor, M.D., assistant professor, health services research and breast medical oncology, will present the findings at a poster session of the 2014 San Antonio Breast Cancer Symposium.

“Oncotype DX is a 21-gene assay used to help estimate the likelihood of recurrence in women with early-stage breast cancer and, thus, determine those who may or may not benefit from adjuvant chemotherapy. The National Comprehensive Cancer Network includes its use for women with lymph node-negative, hormone receptor (HR)-positive and HER2-negative disease…

” ‘In the younger group of breast cancer patients for whom the test is appropriate, and when used in this setting, we’re finding an important reduction in chemotherapy use. The contrast between older and younger patients’ results did surprise us. However, generally, older breast cancer patients receive much less chemotherapy because of their age and because they often have additional co-morbidities. Perhaps we will see that impact with time,’ said Chavez Mac Gregor.”

Breast Removal Rates Increasing for Early Cancers in U.S.

“More women in the U.S. are choosing to have their breasts removed for early cancers instead of breast-conserving procedures that deliver equal results, according to a new study.

“The researchers don’t suggest that either choice is wrong or right. But they point to a recent 34 percent rise in the likelihood a woman will opt for total breast removal as a trend that needs further study to make sure women are being well informed about their risks.

“ ‘We don’t know what’s going to be happening in the future, but it’s important for patients, providers and policymakers to know that this is our current trajectory,” said Dr. Kristy Kummerow, the study’s lead author from Vanderbilt University Medical Center in Nashville.

“The complete removal of the breast – known as mastectomy – was common before research in the 1980s found that lumpectomy, which is the removal of just the tumor, provides equal outcomes, especially for early cancers.

“Kummerow and her coauthors write in JAMA Surgery that rates of lumpectomy, or breast conserving therapy, rose over the years, but then began declining again.”

Metastatic Breast Cancer Therapy: Tried and True to What's New

The gist: A breast cancer expert outlines the complex decisions involved in treating metastatic breast cancer. She emphasizes the importance of tumor biopsy to guide treatment decisions.

“Oct. 13 was National Metastatic Breast Cancer Awareness Day. An estimated 170,000 Americans are currently living with metastatic breast cancer, and about 40,000 people die of this disease annually in the U.S. About 5% to 10% of patients initially present with metastases; however, most patients with metastatic disease have a recurrence of early-stage breast cancer.

“The median survival for metastatic breast cancer is approximately 18 to 24 months, but can vary from a few months to many years depending on the type of breast cancer. Treatment of advanced breast cancer is lifelong. The goals of therapy are to maintain quality of life, delay disease progression, and prolong survival.

“Breast cancer is a heterogeneous disease. The treatment paradigm is not a “one size fits all” approach. Before any treatment for metastatic disease, I obtain the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status on available tumor tissue, preferably a biopsy of the metastases. This drives my selection of therapy.”