The gist: Recent research shows that testing for BRCA1 and BRCA2 mutations might be useful for patients with triple-negative breast cancer, even if they have no family history of breast cancer.
“The high prevalence of deleterious mutations in predisposition genes in patients with triple-negative breast cancer unselected for family history suggests germline genetic testing for BRCA1 and BRCA2 mutations may be appropriate in this population, according to study results.
“However, further analyses of non-BRCA genes are needed to assess their utility in this setting, researchers wrote.
“Fergus J. Couch, PhD, of the department of laboratory medicine and pathology at Mayo Clinic in Rochester, Minn., and colleagues evaluated data from 1,824 women with triple-negative breast cancer who were enrolled on one of 12 studies. All women were unselected for family history of breast or ovarian cancer, and most were non-Hispanic white (97%). The median age of the population at diagnosis was 51 years (range, 22-93).”
The gist: In a recent clinical trial with locally advanced or metastatic breast cancer patients, women who took the drug eribulin did just as well as women who took capecitabine. The results were particularly strong for women with triple-negative breast cancer. All women in the trial had received previous treatment with anthracycline- or taxane-based chemotherapy. More research is planned to determine just how beneficial eribulin might be.
“An international research team, led by Dartmouth’s Peter A. Kaufman, MD, published findings in the Journal of Clinical Oncology demonstrating that, while not superior to capecitabine, eribulin is an active and well-tolerated therapy in women with metastatic breast cancer (MBC) receiving this therapy as a first, second, or third line chemotherapy regimen. Additionally, these patients had all been previously treated with both an anthracycline and a taxane in either the adjuvant or metastatic setting. This study is the first to address the use of eribulin early in the course of metastatic breast cancer, specifically either the first or second line setting.
” ‘Additionally, it is of great interest that subset analysis suggests that eribulin may be particularly active and effective in triple negative MBC, which is known to be an aggressive subset of breast cancer, and one associated unfortunately with a particularly poor prognosis overall,’ said Kaufman.
“Eribulin has been approved in numerous countries in the third line or latter setting for the treatment of MBC, and is increasingly widely used. It is the only chemotherapeutic agent shown to have a survival benefit for patients with MBC in the third line or latter chemotherapeutic setting. Given previous research findings, and now findings from this large international trial, there has been great interest from oncologists and other clinicians in the potential impact that eribulin might have earlier in the course of MBC.”
The gist: A new treatment that has shown promise in other types of cancer will soon be tested in triple negative breast cancer (TNBC) patients. The treatment, called IL-12 ImmunoPulse, delivers instructions for making a protein called IL-12 into a patient’s tumor. The patient’s cells then make IL-12, which boosts the immune system. A small pilot study will take place at Stanford University in California. It will test whether ImmunoPulse has promising effects on the immune system. If it is successful, researchers might try combining the treatment with drugs that are known to be more effective when the immune system is stimulated.
“OncoSec Medical Inc. (OTCQB: ONCS), a company developing DNA-based intratumoral cancer immunotherapies, plans to initiate a pilot study to assess IL-12 ImmunoPulse in patients with Triple Negative Breast Cancer (TNBC). The study will be conducted at Stanford University with Melinda L. Telli, MD, serving as lead investigator.
“This pilot study is designed to assess whether IL-12 ImmunoPulse increases TNBC tumor immunogenicity by driving a pro-inflammatory cascade of events that leads to increases in cytotoxic tumor-infiltrating lymphocytes (TILs). The presence and number of TILs is thought to be a key requirement for promoting the anti-tumor activity of antibodies like anti-PD-1/PD-L1. By driving cytotoxic immune cells into the tumor, IL-12 ImmunoPulse may be an ideal candidate to combine with checkpoint blockade therapies which reported some activity in TNBC.
“Worldwide, TNBC amounts to approximately 200,000 cases each year and accounts for approximately 20 percent of all breast cancer. It is most commonly diagnosed in younger women (less than 40 years) and is characterized by higher relapse rates when compared with estrogen receptor (ER)-positive breast cancers. TNBC is also associated with an increased risk of recurrence, both locally and in distant sites, including the lung and brain. Advanced TNBC remains a significant area of unmet medical need and there is no established standard-of-care. Treatment generally includes chemotherapy, with or without radiation and/or surgery. However, no treatment regimen has clearly demonstrated superiority.”
The gist: The U.S. Food and Drug Administration (FDA) has granted a “Fast-Track” designation to a new treatment for people with metastatic, triple-negative breast cancer who haven’t had success with their previous treatments. The treatment is called sacituzumab govitecan (aka IMMU-132). The Fast-Track designation means that the FDA will facilitate a faster approval process so that the treatment can soon be prescribed by oncologists in the U.S.
“The FDA today granted fast track status to sacituzumab govitecan, an antibody–drug conjugate in development for treatment of patients with triple-negative breast cancer who failed prior therapies for metastatic disease, according to the drug’s manufacturer.
“Sacituzumab govitecan (IMMU-132, Immunomedics) is formed by using the moderately-toxic SN-38 — the active metabolite of irinotecan (Camptosar; Pfizer), used to treat certain solid tumors — conjugated to an anti–TROP-2 antibody.
“The FDA’s Fast Track program is intended to facilitate the development and expedite the review of new drugs intended to treat serious conditions, as well as agents that would fill unmet medical needs.
“The FDA based its decision on the efficacy sacituzumab govitecan has shown in patients with advanced triple-negative breast cancer.
The gist: A drug called sacituzumab govitecan has shown promising results in a clinical trial in patients with metastatic triple-negative breast cancer (TNBC) who have taken previous treatments. In the trial, patients generally experienced a longer period of time without their cancer worsening when they took sacituzumab govitecan compared to when they took their last treatment for TNBC.
“Immunomedics, Inc., (Nasdaq:IMMU) today announced that sacituzumab govitecan, the Company’s novel investigational antibody-drug conjugate (ADC), continues to produce a partial response (PR) rate of 30% and a 70% clinical benefit rate (CBR), defined as PR and stable disease, in patients with metastatic triple-negative breast cancer (TNBC) who had been heavily pretreated. For patients with PR or stable disease longer than 6 months, the CBR was 40%. Significantly, PRs ranging from 30% to 70% tumor shrinkage as best response were reported. Responses are measured by computed tomography (CT) based on RECIST 1.1 criteria.
“Dr. Aditya Bardia of Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, presented the Phase 1/2 study at the San Antonio Breast Cancer Symposium in San Antonio, TX. Commenting on the results, Dr. Bardia stated, ‘TNBC patients in this late-stage setting have limited treatment options that are effective. We are quite encouraged with this experience with sacituzumab govitecan, especially the time-to-progression results, which showed that the duration of response for the responding patients was generally longer than their last prior therapy for TNBC.’ ”
“As the name implies, TNBC represents breast cancers that are negative for estrogen and progesterone receptors, as well as human epidermal growth factor receptor 2, or HER2. This type of breast cancer comprises about 15-20% of all invasive breast cancers and is more prevalent in young and African-American women. Despite the fact that initial responses with chemotherapy are high, TNBC characteristically has a high recurrence rate and is perhaps the most difficult type of breast cancer to treat successfully with current cytotoxic agents. According to a published report, the median survival for patients with metastatic triple-negative breast cancer is estimated to be 13 months. 1 Currently, there are no targeted treatments available for TNBC.”
The gist: A different treatment schedule after surgery might increase survival and time without cancer worsening for women with axillary node-negative or high-risk node-negative breast cancer. A clinical trial found that these women might benefit from taking the drug paclitaxel once per week or docetaxel once every three weeks, instead of paclitaxel once every three weeks. The same trial found that women with triple negative breast cancer (TNBC) also benefit from weekly paclitaxel. But docetaxel once every three weeks showed better results for women with ER-positive, HER2–negative breast cancer.
“Women with axillary node-negative or high-risk node-negative breast cancer achieved prolonged DFS and marginally improved OS when they received adjuvant paclitaxel every week or docetaxel every 3 weeks compared with paclitaxel every 3 weeks, according to phase 3 study results presented at the San Antonio Breast Cancer Symposium.
“Further, weekly paclitaxel extended DFS and OS in women with triple-negative breast cancer, whereas docetaxel administered every 3 weeks improved DFS in women with ER-positive, HER-2–negative disease.
“Joseph A. Sparano, MD, professor of medicine and women’s health at Albert Einstein College of Medicine, and colleagues evaluated various regimens in 4,954 women with axillary node-positive or high-risk node-negative breast cancer. Previously released results, based on a median 5.3 years of follow-up, showed those who received adjuvant weekly paclitaxel (HR=0.73; P=.0006) or docetaxel every 3 weeks (HR=0.77; P=.02) demonstrated longer DFS than women who received paclitaxel every 3 weeks.
“The current analysis occurred after a median 12.1 years of follow-up. The numbers of DFS events (1639 vs. 1048) and deaths (1283 vs. 686) in the current analysis vs. the previous report were substantially higher.”
The gist: A prostate cancer drug called Xtandi (aka enzalutamide) might also help treat women with advanced, androgen receptor-positive triple-negative breast cancer (TNBC). More research will need to be done to see whether Xtandi outperforms standard chemotherapy for these patients.
“Preliminary results from a Phase II trial of Astellas’ Xtandi (enzalutamide) show positive benefits for the prostate cancer drug when used as a single therapy to treat women with advanced androgen-receptor positive, triple-negative breast cancer.
“But Novartis’ bid to prove benefits for Afinitor (everolimus) as a first-line treatment for women with HER2-positive advanced breast cancer failed, after a Phase III trial found no benefit in this group of patients. [See more here.]
“The data from both studies were presented at the San Antonio Breast Cancer Symposium in Texas. The trial involving Xtandi is the largest to date in patients with androgen-receptor positive triple-negative breast cancer, and the first to report objective responses to a hormonal therapy.
“The study found that out of 26 women evaluated, 11 showed a clinically significant benefit after 16 weeks and 9 showed benefit after 24 weeks. More data is due in 2015 from a further 76 women enrolled in the study, but so far researchers have observed positive responses in one woman and partial positive responses in three more women in this group.”
The gist: Women with basal-like triple-negative breast cancer (TNBC) might benefit from adding either the drug bevacizumab (Avastin) or the drug carboplatin to their chemotherapy treatment before tumor-removal surgery (neoadjuvant chemotherapy). For non-basal-like TNBC patients, carboplatin shows similar benefit, but bevacizumab may actually worsen their treatment response.
“A study of women with triple-negative breast cancer (TNBC) has shown that women with the basal-like subtype of breast cancer had higher rates of pathologic complete response (pCR) with the addition of bevacizumab (Avastin) to neoadjuvant chemotherapy than did women with non–basal-like breast cancer. No difference in response was seen between the two subtypes for the addition of carboplatin.
“These results were part of a subtype analysis of the CALGB/Alliance 40603 study and were presented at the 2014 San Antonio Breast Cancer Symposium, held December 9–13 in San Antonio, Texas, by William M. Sikov, MD, associate director of clinical research for the program in women’s oncology at Women and Infants Hospital and associate professor of medicine at Alpert Medical School of Brown University in Providence, Rhode Island.
“Earlier this year, results of the initial study of 443 women published in the Journal of Clinical Oncology showed that the addition of carboplatin or bevacizumab to neoadjuvant chemotherapy in women with stage II to III TNBC increased rates of pCR. In the subtype analysis, Sikov and colleagues sought to identify subgroups of patients who were more or less likely to benefit from the addition of these therapies.
“In a clinical trial involving women with triple-negative breast cancer, patients who received the drugs carboplatin and/or bevacizumab in combination with standard chemotherapy prior to surgery were more likely to have their tumors disappear entirely from the breast, according to data presented by investigators during the 2014 San Antonio Breast Cancer Symposium.
“Although bevacizumab doesn’t reduce long-term rates of cancer recurrence, the results raise hopes that carboplatin can be an important part of the fight against triple-negative cancer, say the leaders of the study, which was organized by the Alliance for Clinical Trials in Oncology with extensive involvement of physician/scientists at Dana-Farber Cancer Institute.
“The investigators analyzed data from 360 patients with triple-negative breast cancer, the vast majority of whom had a form of the disease known as basal-like tumors. Triple-negative cancer, named for its cells’ lack of three key receptors, accounts for about 15-20 percent of all breast cancers and tends to be aggressive, but can often be treated successfully if caught early. Basal-like tumors are made up of cells that resemble the basal cells lining the milk ducts.
“In the trial, patients with triple-negative breast cancer were treated with ‘neoadjuvant” chemotherapy’ — which helps shrink tumors so they can be surgically removed — either alone or in combination with bevacizumab or carboplatin or both. (Bevacizumab prevents tumors from developing networks of blood vessels; carboplatin is a platinum-based chemotherapy agent.)”