“The cancer drug eribulin, originally developed from sea sponges, could give women with advanced triple negative breast cancer an average of five extra months of life, according to research presented at the National Cancer Research Institute (NCRI) Cancer Conference in Liverpool.
“Researchers led by Professor Chris Twelves, based at the University of Leeds and Leeds Teaching Hospitals NHS Trust, looked at two major clinical trials of more than 1,800 women with breast cancer that had started to spread to other parts of the body. The phase III trials – the final stage of testing before deciding whether a drug can be prescribed to patients – compared the survival of women treated with eribulin* to those given standard treatment.
“The two studies showed an overall improvement in survival of more than two months for women treated with eribulin**. The most significant improvement was seen in women with the advanced triple negative form of breast cancer, where there are limited treatment options; these women’s survival improved by nearly five months. There was also a survival boost of more than two months for women with the HER2 negative form of breast cancer***.
“Cancer spreading to other organs – called metastasis – is responsible for around 90 per cent of all cancer deaths. And, when patients with breast cancer are diagnosed after the disease has started to spread, 10-year survival is around one in 10, compared to nearly nine in 10 for those diagnosed at the earliest stage.
“Study author, Professor Chris Twelves, said: ‘Our results show a substantial improvement in survival for women with metastatic triple negative breast cancer, and a more modest, but significant, benefit for those with HER2 negative breast cancers.’
“ ‘Eribulin has previously been offered to women who’ve already been through several lines of chemotherapy. But the European Union has recently approved eribulin for patients who have received less treatment for their breast cancer, which means we hope to give more patients another treatment option in the not-too-distant future.’ “
“A large collaborative study provides new evidence that African-American women may be able to significantly reduce their risk of developing aggressive forms of breast cancer by breastfeeding. The study, published online ahead of print in the Journal of the National Cancer Institute, is based on a collaborative research effort led by researchers at Roswell Park Cancer Institute (RPCI), Boston University’s Slone Epidemiology Center and the University of North Carolina Lineberger Cancer Center.
“African-American women have a disproportionately high incidence of two aggressive forms of the disease: estrogen-receptor-negative (ER-negative) and triple-negative breast cancer, in which tumor cells test negative for three key hormone receptors. Earlier studies have shown a connection between the number of times a woman has given birth, or parity, and increased risk of ER-negative tumors, and that breastfeeding reduced risk of these aggressive breast cancers, but this large new study provides the most conclusive evidence to date of these connections.
“Researchers from the three institutions formed the AMBER Consortium, or African American Breast Cancer Epidemiology and Risk Consortium, by combining four epidemiologic studies with large numbers of African-American participants: the Black Women’s Health Study (BWHS), Multiethnic Cohort Study (MEC), Carolina Breast Cancer Study (CBCS) and Women’s Circle of Health Study (WCHS).”
“Women who have had children (parous women) appear to have an increased risk of developing estrogen receptor-negative breast cancer, the subtype that carries a higher mortality rate and is more common in women of African ancestry. A similar relationship was found for triple-negative breast cancer. However, the association between childbearing and increased risk of estrogen receptor-negative and triple-negative breast cancer was largely confined to the women who had never breastfed. These findings, published in the Journal of the National Cancer Institute, suggest that low rates of breastfeeding in African American women may contribute to their higher incidence of the more aggressive and difficult-to-treat subtypes of breast cancer.
“Researchers from Boston University’s Slone Epidemiology Center (SEC) collaborated with the Roswell Park Cancer Institute of Buffalo, NY and the University of North Carolina Lineberger Cancer Center to form a consortium to study the determinants of breast cancer subtypes in African American women. They combined data on breast cancer cases and controls from four large studies, including the Boston University Black Women’s Health Study. The combined analyses included 3,698 African American women with breast cancer, including 1,252 with the estrogen receptor-negative subtype.
“They found that parous women had a 33 percent higher chance of developing estrogen receptor negative breast cancer than women who had never given birth. Women who had four or more births and had never breastfed any of their babies had a 68 percent higher chance of developing this type of cancer compared with women who had only one birth and had breastfed that baby. By contrast, parous women who had four or more births had a slightly decreased risk of estrogen receptor-positive breast cancer, regardless of whether or not they had breastfed.”
“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.
Editor’s note: It can be useful for oncologists to be able to predict how well a particular treatment might work for a particular cancer patient. This article describes new research that points to a potential new way of predicting whether people with triple-negative breast cancer might benefit from chemotherapy after tumor-removal surgery to prevent the cancer from returning (“adjuvant chemotherapy”). The scientists found that measuring stromal lymphocytic infiltration — the amount of certain immune system cells found in so-called “stromal” cells adjacent to the tumor — could potentially be used to predict the outcome of adjuvant chemotherapy. Specifically, the greater the degree of stromal lymphocytic infiltration, the lower the risk of recurrence or death.
“Stromal lymphocytic infiltration significantly and independently predicted outcomes in patients with triple-negative breast cancer treated with adjuvant chemotherapy, according to an analysis of data from two randomized phase 3 trials.
“Sylvia Adams, MD, assistant professor of medicine at New York University Cancer Institute, and colleagues evaluated 506 tumors for density of tumor-infiltrating lymphocytes (TILs) in intraepithelial and stromal compartments. The tumors were randomly selected from the ECOG E2197 and E1199 trials based on availability of sections…
“Median follow-up was 10.6 years. Researchers found that higher stromal TILs scores were associated with a better overall prognosis. Specifically, every 10% increase in stromal TILs correlated with a 19% decreased risk for death (P=.01), an 18% decreased risk for distant recurrence (P=.04), and a 14% decreased risk for recurrence or death (P=.02).”
“The authors compare the clinical outcome and sites of relapse of TNBC in BRCA1 mutation carriers and non–carriers who received adjuvant chemotherapy. Results suggest that BRCA1 mutation carriers with TNBC had similar survival rates and sites of recurrence to non–carriers after treatment with conventional chemotherapy.”
Editor’s note: This article describes a breast cancer study that compared patients with BRCA1 mutations to patients without BRCA1 mutations. It was found that, after conventional chemotherapy, BRCA1-positive patients with triple-negative breast cancer had similar survival rates and sites of recurrence to BRCA1-negative patients.
“New research raises the prospect that some cancer patients with aggressive tumors may benefit from a class of anti-inflammatory drugs used to treat rheumatoid arthritis.
“Studying triple-negative breast cancer, researchers at Washington University School of Medicine in St. Louis found that some aggressive tumors rely on an antiviral pathway that appears to drive inflammation, widely recognized for roles in cancer, rheumatoid arthritis and other inflammatory diseases.
“The tumors that activate this particular antiviral pathway always have dysfunctional forms of the proteins p53 and ARF, both encoded by genes known for being highly mutated in various cancers. The investigators found that the two genes compensate for each other. If both are mutated, the tumors that form are more aggressive than if only one of these genes is lost.
“When both genes are lost and the antiviral pathway is activated, patients may benefit from a class of anti-inflammatory drugs called JAK inhibitors, currently prescribed for rheumatoid arthritis.”
Editor’s note: Recent research shows that drugs known as JAK inhibitors, often prescribed for arthritis, might also help fight certain types of breast cancer. Specifically, JAK inhibitors might benefit patients with triple-negative breast cancer whose tumors have mutated forms of the proteins p53 and ARF. The researchers are working with specialists to identify patients with those mutations who might benefit from JAK inhibitors.
“Basilea Pharmaceutica Ltd. (SIX: BSLN) reports today that it initiated a phase 2a study with its investigational oncology drug BAL101553. The study is designed to further characterize safety and tolerability, and to obtain efficacy data in adult patients with advanced or recurrent solid tumors who have failed standard therapy or for whom no effective standard therapy is available. Tumor types were selected based on clinical observations in the phase 1 study and a detailed analysis of potential patient stratification biomarkers across tumor indications. The study will also continue the extensive biomarker testing initiated in Phase 1, to further evaluate dose and patient populations most likely to respond.”
Editor’s note: A drug company is starting a clinical trial to test a new cancer drug called BAL101553 in volunteer patients. The trial is enrolling people with advanced or recurrent solid tumors, including people with colorectal cancer, gastric cancer or cancers of the gastro-esophageal junction, non-small cell lung cancer (NSCLC), ovarian cancer (or primary peritoneal), pancreatic cancer (including ampullary), and triple-negative breast cancer. Specifically, the trial is open to patients who have tried a standard treatment without benefitting or who, for whatever reason, have no effective standard treatment available to them. BAL101553 has already shown promise for some patients in a phase I trial. The new trial will continue to examine the safety and effectiveness of the drug, and it will also test patients’ tumors for specific biomarker molecules to see if patients with certain biomarkers are more likely to benefit.