Wednesday, October 26, 2011

Femara for Breast Cancer: October News and Research

October has been hopping with news and research about the aromatase inhibitor Femara (letrozole) for breast cancer. Today we'll share the five latest studies and the headlines about them. Links may be found on the Femara (letrozole) page of our website.

Femara more effective than tamoxifen

The big story this month was an October 21 study in The Lancet Oncology which compared 8 year recurrence and survival rates for postmenopausal women taking Femara, tamoxifen or a sequential combination of both for early-stage, hormone-receptor positive breast cancer. The study is known as the Breast International Group (BIG) 1-98 study. The New York Times, The Telegraph (UK), US News and World Report/HealthDay and Medical News Today all ran stories.

According to the study, Femara alone resulted in a reduction in breast cancer recurrence and death compared to tamoxifen alone. Sequential use of tamoxifen and Femara, in any order, did not improve outcome compared to Femara alone, "but might be useful strategies when considering an individual patient's risk of recurrence and treatment tolerability."

Femara improves response to chemotherapy before surgery

Not all of the October Femara studies made headlines. An October 16 study in Breast Cancer Research and Treatment evaluated the addition of Femara to chemotherapy before surgery for postmenopausal women with locally advanced breast cancer. For women with hormone-receptor positive breast cancer, the addition of Femara to chemotherapy improved clinical and pathological response rates with "acceptable toxicity" compared to chemotherapy alone.

Femara reduces bone mineral density

Not all Femara news this month was good. An October 14 Annals of Oncology study evaluated bone loss in women in the BIG 1-98 study discussed above. It found that Femara use was associated with a reduction in bone mineral density, whether used alone or in sequence with tamoxifen, when compared to the use of tamoxifen alone. In fact, the "sequential schedules were as detrimental for bone density" as taking Femara alone.

Zometa improves bone mineral density for women taking Femara

There may be a way to reduce the risk of bone loss associated with Femara. An October 10 study in the journal Cancer compared the immediate use of Zometa (zoledronic acid) with the delayed use in postmenopausal women with early breast cancer taking Femara for 5 years. The trial is known as Z-FAST. The Los Angeles Times and Medical News Today covered the study.

According to the study, taking Zometa (zoledronic acid) with Femara "upfront," from the beginning, "significantly and progressively" increases bone mineral density, compared with a delayed start of Zometa. The authors also found that "long-term coadministration of letrozole and zoledronic acid is well tolerated."

Another study evaluated the data from the Z-FAST trial. Whereas the October 10 Cancer study looked at bone mineral density at 5 years, an October 17 study in Clinical Breast Cancer evaluated the data at month 12. It also found that immediate use of Zometa prevented bone loss and increased bone mineral density, "regardless of BMD [bone mineral density] at baseline."

These are only the five most recent studies on Femara (letrozole) for breast cancer. For two years of news and research, plus overviews and FDA information, please check the Femara (letrozole) page of our website. From the home page, click the Treatments tab and search for 'Femara' in the search box on the top right of the page.

We'll continue to follow developments in breast cancer research. Links are added to our website daily and interesting findings are highlighted here. Please stay tuned.

Wednesday, October 19, 2011

Vitamin Use After Breast Cancer Diagnosis: Antioxidant Safety

Is it safe to take antioxidants during breast cancer treatment? According to a recent study in the journal Cancer, the answer may depend on the type of supplement and the dose.

The study

The study examined the association between antioxidant use and breast cancer recurrence and survival in 2,264 women with early-stage breast cancer. 81% took antioxidants after diagnosis, either individually or in multivitamin form. (Links to the study and Reuters and Indianapolis Star articles may be found on the multivitamin page of our website.)

Vitamin C and vitamin E

Taking single supplements of vitamin C or vitamin E six or seven times a week was associated with a lower risk of breast cancer recurrence. Vitamin E was also associated with a decreased risk of death from any cause.

However, the lead researcher noted that much of this benefit may be due to a "healthy user bias," meaning women who take supplements "tend to have healthier habits in general."

Carotenoids: Vitamin A, beta-carotene and lutein

On the other hand, "frequent use" of any combination of carotenoids, such as vitamin A, beta-carotene and lutein, was associated with an increased risk of death from breast cancer or any other cause. Of 89 women who took carotenoids six to seven days a week, 18 percent died of breast cancer, compared to less than 7% of women who did not.

Because these patients would also have a "healthy user bias," the lead researcher noted the findings on the increased risk of death "are even more striking."


The study findings did not pertain to multivitamin use, which "generally have more moderate doses of individual nutrients."

Notes of caution from the researchers

Heather Greenlee, lead researcher, told Reuters that the study "adds to the growing body of literature suggesting that dietary supplements containing high doses carotenoids may be harmful, and people should think twice before taking them."

At, we follow breast cancer news and research daily. We highlight interesting developments in this blog and add links to medical journal abstracts and news articles to the treatment pages of our website. We sort news and research by test, treatment option and complementary therapy. Our goal is to make internet research easy. We look forward to keeping you posted.

Wednesday, October 12, 2011

Herceptin Plus Chemotherapy for HER2 Positive Breast Cancer: The Latest Data in the Hunt for the Best Combination

Herceptin (trastuzumab) is the treatment of choice for women with HER2 positive breast cancer. By itself, it is associated with a risk of heart damage. What happens when it is combined with chemotherapy? Which drug combinations are best in terms of effectiveness and side-effects?

Today we'll share the two most recent studies on Herceptin in combination with chemotherapy. Both evaluated chemotherapy combinations with and without anthracyclines, such as Adriamycin and Ellence. Links may be found on the Herceptin (trastuzumab) page of our website.

TCH better than AC-T plus H as adjuvant therapy

An October 6 study in The New England Journal of Medicine evaluated the risks and benefits of Herceptin plus chemotherapy as adjuvant (after surgery) therapy for women with early-stage, HER2 positive breast cancer. The Los Angeles Times and US News and World Report/HealthDay covered the study.

The 3,222 women in the study were divided into three groups. One received Adriamycin (doxorubicin) and Cytoxan (cyclophosphamide) followed by Taxotere (docetaxel) (AC-T). One received AC-T plus 52 weeks of Herceptin (AC-T plus H). The last received Taxotere, Paraplatin (carbobplatin) and 52 weeks of Herceptin (TCH).

In terms of effectiveness, the AC-T plus H and TCH groups had similar disease-free and overall survival rates, and both were superior to the group that did not receive Herceptin.

In terms of side-effects, the AC-T plus H group experienced "significantly higher" rates of congestive heart failure and cardiac dysfunction than the TCH group. There were seven cases of leukemia in the AC-T plus H group and one in the TCH group.

The authors concluded that the addition of one year of Hercpetin significantly improved disease-free and overall survival. The risk-benefit ratio favored the TCH combination over AC-T plus H, "given its similar efficacy, fewer acute toxic effects, and lower risks of cardiotoxicity and leukemia."

PH-FECH better than TCH as neoadjuvant therapy

A September 27 study in Cancer evaluated Herceptin plus chemotherapy as neoadjuvant (before surgery) treatment. This time, TCH came out on the bottom.

The 300 HER2 positive women were treated with either Taxol (paclitaxel) and Herceptin followed by 5-FU, Ellence (epirubicin), Cytoxan and Herceptin (PH-FECH) or Taxotere, Paraplatin and Herceptin (TCH).

Patients in the PH-FECH group experienced a higher rate of pathological complete response (pCR), meaning tumor disappearance. They also had a lower risk of recurrence and death compared to the TCH group.

In terms of side-effects, there was "no significant difference" in heart damage. However, the authors noted that the women in the PH-FECH group had "fewer cardiac comorbidities at baseline," meaning they had a lower risk of heart damage when the study started.

The authors concluded that the type of neoadjuvant therapy is predictive of pCR rate. "Although TCH is active, PH-FECH shows a higher pCR rate and RFS [relapse-free survival] advantage."

At, we'll continue to monitor research on Herceptin plus chemotherapy. Today's studies are only the two most recent. For two-years worth of news and research, please visit the Herceptin page under the Treatments tab of our website.

Tuesday, October 4, 2011

Nausea and Vomiting after Chemotherapy for Breast Cancer: New ASCO Guidelines on Prevention

Nausea and vomiting are perhaps the most unpleasant potential side effects of chemotherapy for breast cancer. Last week the American Society of Clinical Oncology (ASCO) updated its practice guidelines for the prevention of nausea and vomiting. Today, we'll highlight the latest recommendations.

Links to the new guidelines published in the Journal of Clinical Oncology, a video about the update and a Los Angeles Times story on the start of preventative medication may be found on the Aloxi (palonosetron) page of our website.

Adriamycin/Cytoxan and Ellence/Cytoxan combinations have a high risk

The ASCO guidelines classify chemotherapy drugs and combinations according to the likelihood that they may cause nausea and vomiting. Individually, Adriamycin (doxorubicin), Ellence (epirubicin) and lower dose Cytoxan (cyclophosphamide) are considered to have a moderate risk of causing nausea and vomiting. Under the new guidelines, the Adriamycin/Cytoxan and Ellence/Cytoxan combinations are considered to have a high risk, meaning they are very likely to cause nausea and vomiting.

Three drug combination for chemotherapy with a high risk

For chemotherapy drugs with a high risk of causing nausea and vomiting, such as the combinations above, Platinol (cisplatin) and high dose Cytoxan, the guidelines recommend a three drug combination:
EMEND (aprepitant) or EMEND for Injection (fosaprepitant) . Because EMEND for Injection is administered for 1 day rather than 3, it may be preferable.


Aloxi (palonosetron). If Aloxi is not available, Kytril (granisetron) or Zofran (odansetron) may be substituted.


Two drug combination for chemotherapy with a moderate risk

For chemotherapy with a moderate risk of causing nausea and vomiting, such as Camptosar (irinotecan), Paraplatin (carboplatin) or Adriamycin, Ellence or low dose Cytoxan alone, the ASCO recommends a two drug combination of dexamethasone plus Aloxi. The report notes that there is "moderate evidence" suggesting that EMEND may add benefit.

One drug for chemotherapy with a low risk

For chemotherapy with a low risk of causing nausea and vomiting, such as Taxotere (docetaxel), 5-FU (fluorouracil), Gemzar (Gemcitabine), methotrexate, Torisel (temsirolimus) and Ixempra (ixabepilone), the ASCO recommends a single dose of dexamethasone.

According to an October 3 article in the Los Angeles Times, it's not unusual to start taking medication to prevent nausea before the start of chemo.

A September 26 What to Know guide from ASCO provides a patient-friendly summary of the ASCO guidelines, including a classification of chemotherapy drugs by risk of nausea and vomiting.

At, we'll continue to follow research on the prevention of nausea and vomiting related to chemotherapy for breast cancer. Any new developments will be added to the treatment pages of our website and highlighted here. Please stay tuned.