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 LATESTBreastCancer.com 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.

Breast Cancer News Weekly Wrap-Up (Aug. 28 to Sept. 1)

What's new in breast cancer news? Today we'll share the week's headlines and the studies behind them.

US News and World Report: "Some Older Breast Cancer Patients Can Skip Hormone Therapy: Study"

This headline sounds encouraging. For hormone receptor positive breast cancer, hormonal therapy is typically prescribed for five years and associated with unpleasant side effects. Who wouldn't want to skip it?

However, there is some fine print. (Links to the US News and World Report/HealthDay story, the underlying study and related Memo to the Media may be found on the Arimidex (anastrozole) page of our website.)

The August 31 Journal of the National Cancer Institute (JNCI) study evaluated mortality (death) rates for women in Denmark with early-stage, node-negative, hormone-receptor positive breast cancer. Women over 60, with small tumors (up to 10mm), who received no hormonal therapy or chemotherapy were not at an increased risk of death compared with women the same age in the general population.

In an accompanying editorial, the authors noted that even if there is no benefit in terms of mortality, hormonal therapy reduces the risk of recurrence in the same or opposite breast, and many "will continue to take it for that reason." (See the JNCI Memo to the Media under the News tab.)

For women in this subset, this study is another factor to be considered in the decision on whether to take hormonal therapy. According to the Memo to the Media, "patient preferences regarding risks and benefits play a critical role" in the decision. In US News and World Report, Dr. Jennifer Griggs, a study co-author, suggested a three month trial of hormone therapy to gauge side effects before deciding whether to continue.

Reuters: "New breast cancer gene may help predict risk"

The gene at issue, known as CHEK2, is not really new. The CHEK2 genetic test is available, but not generally offered. Instead, BRCA 1/2 genetic tests are typically used to assess hereditary risk. (More on the test and links to the study and story below may be found on the CHEK 2 gene testing page of our website.)

The August 29 Journal of Clinical Oncology study from Poland estimated breast cancer risk in women with CHEK2 mutations and family histories of breast cancer. Baseline lifetime risk was assumed to be 6%. Women with a CHEK2 mutation and no family history had an estimated lifetime risk of 20%. Risk increased with family history. A second-degree relative with breast cancer raised the risk to 28%, one first-degree relative to 34% and both a first- and second-degree relative to 44%.

An August 29 story in Reuters noted that the study may not be "ready for prime time yet." According to Reuters, Dr. James P. Evans, editor-in-chief of Genetics in Medicine, called the study a "nice start," but said it would be "premature" to recommend CHEK2 testing for everyone with a family history now. Dr. Diana Petitti, of Arizona State University in Phoenix, said the study is "an important breakthrough," but more research is needed, noting that "this is a field where replication is critical."

One of the concerns is that the Polish women in the study may be different than Americans. In America, the lifetime risk of breast cancer is about 12% (1 in 8). According to the study authors, that number is only about 6 percent in Poland.

ScienceDaily.com: "Breast Cancer Risk Drops When Diet Includes Walnuts, Researchers Find"

A recent study in Nutrition and Cancer found that walnut consumption reduced breast cancer risk in mice. Study leader Elaine Hardman, Ph.D was quoted in ScienceDaily.com to say, "The results of this study indicate that increased consumption of walnut could be part of a healthy diet and reduce risk for cancer in future generations." (Link on the the Fruits, Vegetables and Nuts page of our website.)

Animals studies such as this one are often interesting, but the applicability in humans has not yet been proven in human trials.

Toronto Sun: "Smoking after menopause could increase risk for breast cancer: Study"

This week, the Toronto Sun, US News and World Report/HealthDay and WebMD covered an August 10 study in The Journal of Endocrinology and Metabolism which found higher androgen and estrogen levels in smokers.

According to the study, because hormone levels dropped with smoking cessation, "hormone related disease risks could potentially be modified by changing smoking habits."

Next week, we'll share the latest research on soy for breast cancer survivors. Until then, all the latest news and research on any breast cancer test or treatment option may be found on the treatment pages of the LATESTBreastCancer.com website.

Breast Cancer News (8/24): Aromatase Inhibitors and Tamoxifen

Tamoxifen or aromatase inhibitors? It's a treatment decision for postmenopausal women with hormone-receptor positive breast cancer. Three recent studies compared tamoxifen to aromatase inhibitors in terms of survival, toxicity and tumor activity. Links to all studies and media coverage may be found on the Arimidex page of the LATESTBreastCancer.com website.

Adjuvant therapy: Aromatase inhibitor toxicity and overall survival

When used as adjuvant therapy to prevent recurrence, aromatase inhibitors (AIs) are associated with improvements in disease-free survival, but not overall survival. A review in the Journal of the National Cancer Institute, first published online July 8, examined whether differences in toxicity explain the difference in overall survival. Yesterday, Medical News Today and medpagetoday.com covered the results.

The review included 7 trials and 30,023 patients. Longer use of AIs was associated with increased odds of cardiovascular disease and bone fractures, but decreased odds of venous thrombosis and endometrial cancer. Five years of AIs was associated with an increase in the odds of death without breast cancer recurrence compared to 5 years of tamoxifen or 2-3 years of tamoxifen followed by AIs. However, the difference was not statistically significant.

The authors concluded that when used alone, "cumulative toxicity" of AIs may explain the lack of overall survival benefit despite improvement in disease-free survival. Switching from tamoxifen to AIs "reduces this toxicity and is likely the best balance between efficacy and toxicity."

Advanced breast cancer: Aromatase inhibitors vs. tamoxifen

A review in Clinical Breast Cancer, first published online July 7, compared aromatase inhibitors to tamoxifen as first-line therapy to treat advanced breast cancer. The review included 6 trials with 2,560 patients. Aromatase inhibitors had a significantly better overall response rate and clinical benefit. There was a trend towards improved overall survival, but it was not statistically significant. Toxicities did not differ significantly, except vaginal bleeding and thromboembolic events.

The authors concluded that AIs "appeared to be effective and feasible compared with tamoxifen as first-line hormonal therapy in postmenopausal women with advanced breast cancer." They noted that further, randomized, controlled trials are necessary.

PET scanning reveals differences in anti-estrogen activity

How effective is hormonal therapy in blocking estrogen activity?

A July 15 Clinical Cancer Research study used PET scanning to monitor how tumors in metastatic patients responded to tamoxifen, Faslodex (fulvestrant) and aromatase inhibitors such as Arimidex, Aromasin or Femara. This week, DOTMed News and Medical News Today covered the study.

Thirty women with metastatic breast cancer underwent PET scan imaging. Uptake of an estrogen-containing contrast agent was used to assess estrogen binding. A decline in uptake meant less estrogen binding. Tumor uptake "declined more markedly" with tamoxifen and Faslodex than with aromatase inhibitors. Tamoxifen was more effective than Fulvestrant in complete tumor blockade of estrogen.

The authors concluded that PET scanning "can assess" the pharmacodynamics (what a drug does to a body) and "give insight" into the activity of estrogen-receptor targeted agents. "Imaging revealed significant differences between agents," including differences in blockade.

Dr. Hannah Linden, a study author, was quoted in both media stories to say, "What we're suggesting in the paper . . . is if estrogen is incompletely blocked you're not getting a good outcome for the patient."

We'll continue to follow hormone therapy research. We review medical journal abstracts and media sources daily. All the latest news and research on any breast cancer test or treatment option may be found on the treatment pages of the LATESTBreastCancer.com website anytime.