Metastatic Breast Cancer News from the 2011 San Antonio Breast Cancer Symposium

Today we'll continue to cover headlines from the 2011 San Antonio Breast Cancer Symposium, with a focus on six studies relevant to women with metastatic breast cancer.

Links may be found on the treatment pages of our LATESTBreastCancer.com website.

Omnitarg for HER2 positive metastatic breast cancer

The phase III Omnitarg (pertuzumab) study, known as CLEOPATRA (CLinical Evaluation Of Pertuzumab and TRAstuzumab), was big news. Reuters, Medical News Today, The New York Times and Los Angeles Times all ran stories. The study was published in the New England Journal of Medicine on December 7. (Link to full text.)

In the study, 808 women with HER2 positive metastatic breast cancer were randomly assigned to receive Herceptin (trastuzumab) and Taxotere (docetaxel) either with or without Omnitarg.

For the Omnitarg group, median progression-free survival, meaning the amount of time the cancer remains stable, was 18.5 months compared to 12.4 months for the Herceptin/Taxotere only group.

Although it's too early to confirm overall survival data, preliminary results show 69 deaths among the 402 women treated with Omnitarg compared to 96 deaths among the 406 women who did not receive Omnitarg.

Genentech and its parent company, Roche, have applied for permission to market Omnitarg in the US and Europe as first-line treatment for HER2 positive metastatic breast cancer.

Avastin for HER2 positive metastatic breast cancer

After the recent FDA decision to pull approval of Avastin for metastatic patients, there has been interest in identifying subsets of patients who may benefit from Avastin.

The phase III study (AVEREL) of Avastin (bevacizumab) in HER2 positive metastatic patients was similar in design to the Omnitarg study. 208 women were treated with Herceptin and Taxotere alone. 216 also received Avastin. The New York Times, Los Angeles Times and US News and World Report/HealthDay covered the study.

For the Avastin group, progression-free survival was 16.5 months, compared to 13.7 months for the 208 in the Herceptin/Taxotere only group.

But some question whether small benefits in progression-free survival are important.

According to the New York Times, "there was absolutely no difference in how long the women lived." Genentech has decided not to apply for FDA approval for HER2 positive breast cancer. A company representative noted, "Our bottom line is we do not believe that the difference in P.F.S. is of a sufficient magnitude that it is likely to gain regulatory approval."

Future research will attempt to identify the subset of patients who benefit from Avastin. As Dr. Gabriel Hortobagyi from MD Anderson noted in Los Angeles Times,

"I have no doubt that Avastin is a very powerful drug for some patients. . . The problem with Avastin is we don’t have a biomarker to help us identify the sub-group."

Afinitor for hormone-receptor positive metastatic breast cancer

A study (BOLERO-2) of Afinitor (everolimus) involving 704 women with hormone-receptor positive breast cancer which progressed on prior hormone therapy was covered by The New York Times, Los Angeles Times and Medical News Today. The study was published in The New England Journal of Medicine on December 7. (Link to full text.)

For women who took Afinitor plus the aromatase inhibitor Aromasin (exemestane), median progression-free survival was 7.4 months, compared to 3.2 months for women who took Aromasin alone.

However, the New York Times (Dec. 7) noted that because all women had already failed to benefit from hormone therapy, "perhaps it is not surprising that the control arm did not do that well on exemestane alone."

But, the trial researchers said that doctors often prescribe Aromasin in practice when other hormone therapies fail.

Medical News Today quoted Dr. Hortobagyi, a study coauthor, to say, "These findings may establish a new standard of care for advanced breast cancer."

Faslodex for hormone-receptor positive metastatic breast cancer

A phase III trial (SWOG S0226) of Faslodex (fulvestrant) plus Arimidex (anastrozole) for women with hormone-receptor positive metastatic breast cancer was covered by the Medical News Today on December 9.

In the study, 707 postmenopausal women were assigned to receive Arimidex plus Faslodex or Arimidex alone. Compared to the Arimidex alone arm, the Faslodex arm experienced longer median overall survival (47.7 months vs. 41.3 months) and longer progression-free survival (15 months vs. 13.5 months).

Both Arimidex and Faslodex are already used to treat breast cancer, though not in comination. The lead study coordinator noted that "these patients have not had a new treatment that gave them an overall survival benefit in more than a decade."

Entinostat for hormone-receptor positive metastatic breast cancer

A small phase II study (ENCORE 301) of entinostat for locally recurrent or metatstatic breast cancer was covered in a PR Newswire press release and the New York Times (Dec. 7)

In the study, 130 patients were treated with Aromasin (exemestane) alone or Aromasin plus entinostat. The median overall survival for the entinostat group was 26.9 months, compared to 19.8 months in the Aromasin alone group. Progression-free survival was also better with entinostat (4.3 months vs. 2.3 months.)

A randomized phase III study is anticipated to begin enrollment in the first half of 2012.

Abraxane as first-line treatment for metastatic breast cancer

A phase II study comparing Abraxane (nab-paclitaxel) to Taxotere (docetaxel) as first-line therapy for metastatic breast cancer was covered by Medical News Today on December 12.

In the study, 300 women who received no prior chemotherapy for metastatic disease were divided into four groups. Three groups received different doses of Abraxane. The fourth group received Taxotere.

The best median overall survival was achieved by the group that received 150 mg of Abraxane twice weekly (33.8 months.) The other two Abraxane dose schedules achieved median overall survival of 22.2 months and 27.7 months. For the Taxotere group, median overall survival was 26.6 months.

Progression-free survival was also better for the Abraxane 150mg/twice weekly group at 14.6 months, compared to 7.5 months and 10.9 months for the other Abraxane doses and 7.8 months for the Taxotere group.


We'll continue to follow research developments for women with metastatic breast cancer. We add links to media stories and journal abstracts to our website, LATESTBreastCancer.com everyday. The latest news and research may be explored anytime by clicking the Treatments tab.

BRCA Mutation Breast Cancer News: The 2011 San Antonio Breast Cancer Symposium and Beyond

Last week there were several headlines from the 2011 San Antonio Breast Cancer Symposium. Today, we'll share the stories relevant to women with BRCA 1/2 gene mutations and some recent studies not presented at the Symposium.

Links may be found on the BRCA 1/2 Gene Testing (General) page of our LATESTBreastCancer.com website.

The risk of cancer in the other breast

It is understood that women with BRCA mutations have a higher risk of developing breast cancer, but how do they do once diagnosed with breast cancer?

A study from the Netherlands found that women with breast cancer who carry a BRCA 1 or BRCA 2 gene mutation have a higher risk of developing cancer in the opposite breast than non-carriers. Medical News Today and MSN/HealthDay covered the Symposium presentation.

The study followed 5,061 women with cancer in one breast for about 8 years. 211 women carried a BRCA 1 or BRCA 2 gene mutation. For women with a BRCA mutation, the 10-year risk of developing cancer in the opposite breast was 17.6 percent, compared to a 6 percent risk for non-carriers.

Age at diagnosis affected risk. For BRCA carriers first diagnosed before the age of 40, the 10-year risk was 26 percent. For those diagnosed between 40 and 50, the risk was 11.6 percent.

Triple-negative status also mattered. Triple-negative BRCA carriers had a 10-year risk of 18.9 percent, compared to 11.2 percent for BRCA carriers who were not triple-negative.

In her blog from the Symposium, Dr. Susan Love noted,

Of note, most of the women in this study had not had their ovaries out, which decreases the risk of second cancers significantly (70%). The study also found that both chemotherapy and hormonal therapy for the first cancer seemed to reduce the chance of getting a second cancer in the other breast. In this era of bilateral mastectomies, it was a good reminder that the risk to the other breast is not the same in everyone.

The risk of metastasis and death

Not all BRCA news this month came from the conference. A December Reuters piece discussed a recent Journal of Clinical Oncology (Dec. 5) study which compared survival differences among BRCA 1 mutation carriers, BRCA 2 carriers and non-carriers with breast cancer. Over 3,000 women were included. 90 had BRCA 1 mutations and 70 had BRCA 2 mutations.

The study found no difference in risk of metastasis and death between non-carriers and those with BRCA 1 mutations.

On the other hand, women with BRCA 2 mutations had a significantly higher risk of metastasis and breast cancer death. This may be explained by the fact that BRCA 2 carriers had worse tumors at diagnosis. When compared to women with similar age, tumor stage, nodal status and hormone receptor status, there was no difference in risk.

For BRCA 2 carriers, risk of death could be reduced with standard breast cancer treatment. For BRCA 2 carriers who did not receive chemotherapy, the risk of death increased over 300 percent. According to the lead study author, quoted in Reuters Health, "A lot of these women with genetic predisposition may develop tumors that have poor characteristics. . . But if they get standard treatment available they seem to do OK."

The risk of cancer at an earlier age

One study presented at the Symposium asked if the source of a BRCA 1/2 mutation, from the carrier's father or mother, affected breast cancer risk. US News and World Report/HealthDay covered the study on December 8.

Interestingly, for women with BRCA 1 mutations, those who inherited it from their mother were on average 45 at diagnosis. Those with BRCA 1 mutations from their fathers were on average 38.

For women with maternal BRCA 2 mutations, the average age at diagnosis was 50, compared to 41 for those with paternal BRCA 2 mutations.

The lead researcher noted that if confirmed in larger studies, "doctors might think about watching and waiting in young women" with maternal BRCA mutations and "being more aggresive" in young women with paternal mutations.

The risk of cancer for non-carriers from a family of BRCA carriers

What about women who do not carry a BRCA mutation, but come from a family of carriers? Are they at increased risk?

A Journal of Clinical Oncology study from Stanford studied 3,047 families with this question in mind. 160 families had BRCA 1 mutations. 132 had BRCA 2 mutations. Reuters discussed the results on October 31.

The study found "no evidence of increased breast cancer risk" for non-carriers from BRCA families compared to women with first-degree relatives from non-BRCA families. The authors concluded, "These results support the practice of advising noncarriers that they do not have any increase in breast cancer risk attributable to the family-specific BRCA1 or BRCA2 mutation."

These are only the latest research developments for BRCA mutation carriers. At LATESTBreastCancer.com, we follow breast cancer news and research daily. We add links to our website, sorted by treatment type. You may explore any time by clicking the Treatments tab.

Tomorrow's blog will highlight the latest news from the San Antonio Breast Cancer Symposium for women with metastatic breast cancer. Please stay tuned.

Zometa for Early-Stage Breast Cancer: Hormones May Matter

Can Zometa (zoledronic acid) prevent recurrence in women with early-stage breast cancer? Today we'll share the latest news and research. Links may be found on the Zometa (zoledronic acid) page of our website.

A new role for Zometa

Zometa is a bisphosphonate often prescribed to prevent bone loss in women taking aromatase inhibitors for breast cancer. It's also used to treat bone metastases in women with stage IV breast cancer.

Recent studies suggest Zometa may also prevent recurrence in women with early-stage breast cancer, but the results have been inconsistent. A new study in the New England Journal of Medicine suggests the key may lie in the hormonal status of the patient.

June: Zometa benefits premenopausal women on Zoladex and hormone therapy

A June 3 study in The Lancet Oncology evaluated Zometa in premenopausal women with hormone-receptor positive, stage I or II breast cancer, who were taking Zoladex (goserelin) for ovarian supression. (Drugs.com covered the study on June 3.)

About half of the 1,803 women took Zometa plus tamoxifen or Arimidex (anastrozole). The rest took tamoxifen or Arimidex alone.

At about 5 years follow-up, more than 2 years after completion of treatment with Zometa, 8% (76/900) of the Zometa group experienced a recurrence, compared to 12% (110/903) of the tamoxifen or Arimidex alone group. There was no significant difference in overall survival. (30 deaths out of 900 women taking Zometa, 43 out of 903 not taking Zometa.)

The authors concluded that the addition of Zometa "improved disease-free survival in the patients taking anastrozole or tamoxifen." They added, "These data show persistent benefits with zoledronic acid and support its addition to adjuvant endocrine therapy in premenopausal patients with early-stage breast cancer."

September: Zometa may only benefit postmenopausal women

In a September 25 New England Journal of Medicine study, about half of the 3,360 women with early-stage breast cancer were treated with Zometa plus standard chemo and hormone therapy. The rest received standard therapy alone. Patients varied in age, menopausal and hormone-receptor status.

In contrast to the Lancet study, at 5 years follow-up, the New England Journal of Medicine study found "no improvement" in disease-free survival for women with early-stage breast cancer taking Zometa. The authors concluded that their findings, "do not support the routine use of zoledronic acid as adjuvant therapy in unselected patients with early-stage breast cancer."

However, when the study participants were evaluated by subgroup, Zometa seemed to benefit postmenopausal women. (Reuters and Medical News Today covered this aspect of the study on September 25.) Zometa improved both disease-free survival (recurrence) rates and overall survival (death) rates for the group who had undergone menopause more than 5 years earlier.

The authors concluded, "For postmenopausal women, the use of bisphosphonates remains appropriate for the prevention of treatment-induced bone loss and osteoporosis and might have beneficial effects on disease outcomes. The optimum schedule, duration, and type of bisphosphonate therapy remain unknown."

Hormonal status may be the key

How do we reconcile these two studies? One found a benefit for premenopausal patients, the other did not. The answer may lie in the hormonal status of the patients.

The New England Journal of Medicine study noted that from a hormonal perspective, the postmenopausal patients in its study were similar to the premenopausal patients in the Lancet study who were treated with Zoladex for ovarian suppression. Both groups "had low levels of reproductive hormones at study entry." The authors suggest that Zometa "operates differently according to menopausal status."

Finally, the authors note that even though chemotherapy may induce menopause in young women, complete ovarian suppression may take "many months." They conclude, "Further investigation into the possible interaction between zoledronic acid and reproductive hormones is required."

At LATESTBreastCancer.com, we'll continue to follow developments in research on Zometa for breast cancer. We'll keep you posted.

The Latest Research on Breast Reconstruction after Mastectomy

Today we'll share the latest news and research on breast reconstruction after mastectomy. Topics include the reconstruction decision, the safety of silicone and a study on two-stage implants. Links to the news items and studies below may be found on the breast implant (with expander, two-stage) page of our website.

The decision to pursue reconstruction

Women facing breast cancer have many decisions to make about treatment. If a mastectomy is selected, additional decisions about breast reconstruction are required.

Reconstruction is not for everyone. According to a September 23 article in The Atlantic, women consider many factors such as cost, convenience and lifestyle. For women who decide against reconstruction, a variety of removable prosthetic breasts are available.

For those who choose reconstruction, there are many options, including saline and silicone implants and tissue grafting procedures such as TRAM flap, DIEP free flap and Gluteal free flap procedures.

Unfortunately, not everyone may be aware of their options. The Atlantic story noted that "the data suggest that only three in seven women get the chance to learn about reconstruction before they begin cancer treatment."

Moreover, uninsured women may never be informed of their reconstruction options. In a recent study, 52% of the 54 uninsured women "knew nothing about breast reconstruction." After learning about their options, the percentage who chose reconstruction rose from 47 to 76 percent (link).

FDA update on the safety of silicone implants

For those who choose silicone breast implants, there have been some concerns about safety. Back in June, the FDA issued an Update on the Safety of Silicone Gel-Filled Breast Implants. It was big news at the time, with the Los Angeles Times, The Washington Post, MedPage Today and Medical News Today covering the story.

Essentially, the FDA reviewed the latest studies and concluded that "silicone gel-filled breast implants have a reasonable assurance of safety and effectiveness when used as labeled." It found "no apparent association" between the implants and breast cancer, connective tissue disease or infertility.
Importantly, the FDA noted that 40 to 70 percent of breast reconstruction patients will need an additional surgery to modify, remove or replace the implant within the first 8 to 10 years. It recommended lifetime monitoring with periodic MRIs to detect asymptomatic ruptures.

The latest study on two-stage breast reconstruction

Breast implant reconstruction may be implemented in one or two stages. With one-stage, the implants are inserted immediately after the mastectomy. With two-stage, tissue expanders are inserted after the mastectomy, and replaced with permanent implant sometime later.

The latest study on two-stage breast reconstruction was published online in the American Cancer Society journal Cancer on September 14.

The study followed 151 women with stage II or III breast cancer for about 7 years. All received a skin-sparing mastectomy and axillary lymph node dissection with the placement of a tissue expander. All were treated with chemotherapy. About 4 weeks after chemo, tissue expanders were replaced with saline or silicone permanent implants. 8 weeks after the completion of chemo, post-mastectomy radiation was initiated.

At 7 years, local and regional control was 100%. Two women experienced chest-wall recurrence, but after 7 years. 29 patients experienced a distant metastasis. The 7-year distant metastasis-free survival rate was 81% and overall survival rate was 93%.

At 7 years, 29% underwent permanent implant removal or replacement (17.1% removal and 13.3% replacement.) The authors noted that it is "important" to consider this rate in the "context of the longevity of implants." They note,

"Breast prostheses are not permanent devices and may require revision over the life course of patients, even in women who receive implants primarily for augmentation purposes."

The study was unable to identify any factors, including implant type, which predicted a risk of implant replacement or removal.

The authors noted several limitations to their study. First, surgeries to modify the implants due to complications were not considered, but could be important as they they can "impact cost and quality of life." Also, the women in the study were treated at a single cancer center, Memorial Sloan-Kettering. The results "may not be generalizable to other populations at large."

At LATESTBreastCancer.com, we'll continue to follow the research in the field of breast reconstruction. Developments will be added to our website and database and highlighted here. Please stay tuned.

Breast Cancer News Weekly Wrap-Up (Sept. 12 to 18)

Today we'll wrap-up last week's breast cancer news. Topics include hot flashes, fatigue, mammography and environmental BPAs. Links to the news and research below may be found on the treatment pages of the LATESTBreastCancer.com website.

Effexor and Catapres effective for hot flashes

Some breast cancer treatments may induce menopause and cause unpleasant side effects such as hot flashes. A September 12 study in the Journal of Clinical Oncology compared Effexor (venlafaxine) to Catapres (clonidine) to a placebo for the treatment of hot flashes in breast cancer patients.

Both Effexor and Catapres were found to be effective in the management of hot flashes. Effexor resulted in a more immediate reduction in hot flashes, but at week 12, hot flashes were lower in the Catapres group. Reports of nausea, constipation and appetite loss were higher in the Effexor group.

A September 12 Family Practice News report on the study included a commentary which noted that the small size of the study was its "main weakness." In the end, only 35 patients took Effexor, 28 Catapres and 17 the placebo. A larger study would be needed to "reliably identify suspected differences between the study arms." Also, the study authors noted that the duration of the study may have been too short to adequately assess side effects.

Nonetheless, in the Family Practice News story, study authors said the "more rapid reduction in hot flashes suggests that venlafaxine is to be preferred over clonidine." They advised 37.5 mg daily in the first week, increasing to 75 mg "if greater efficacy is desired."

Fatigue after treatment associated with pain and depression

Last week EurekAlert! and the UPI covered a study from Spain on fatigue in breast cancer survivors. The study found that patients most affected by fatigue also suffered "episodes of depression, body image deterioration, neck and shoulder pain, and limited arm movement, possibly due to the surgical intervention," such as breast conserving surgery (lumpectomy) and mastectomy.

The lead author noted that these findings should "motivate" patient support programs to provide resources to improve psychological states and pain to improve fatigue.

Higher mammography rates associated with higher mastectomy rates

One of the goals of screening mammography is to detect breast cancer earlier to allow more women to undergo breast conserving surgery (lumpectomy) instead of mastectomy. A recent study in Norway found the opposite to be true.

The study compared breast surgery rates before and after the implementation of a breast screening program and rates between those invited for screening and those not. Screening was associated with an increase in all breast surgery (lumpectomy plus mastectomy) and an increase in mastectomy rates.

A September 13 story in US News and World Report/HealthDay noted that the study did not investigate why mastectomy rates climbed. Possible reasons include overdiagnosis (detecting and treating tumors that might never have posed a risk), poor access to radiation centers (making mastectomy a safer option), improved breast reconstruction techniques (making mastectomy a less "dreadful" choice) and patient decision to undergo more aggressive treatment due to recurrence fears.

BPA may interfere with tamoxifen

There may be another reason to avoid bisphenol-A (BPA). BPAs, which are used to make plastics, have been associated with a variety of health concerns. According to recent study in cells, BPA may not only increase the risk of developing breast cancer, may also interfere with tamoxifen therapy. (Link to the study.)

On September 13, the San Francisco Chronicle covered the study. In the lab, when non-cancerous cells from high-risk patients were exposed to BPA, they started to behave like cancer cells. When these BPA-exposed cells were exposed to tamoxifen, they continued to grow. "The study found that healthy cells exposed to BPA and methylparaben started figuring out ways to bypass drugs like tamoxifen."

Avoiding BPA may not be easy. According to Dr. William Goodson, lead study author, ""It's used so much. We kind of swim in it." Still, efforts to ban BPAs are underway. A current bill (AB1319) on the governor's desk would ban BPA in sippy cups and baby bottles in California.

At LATESTBreastCancer.com, we'll continue to follow the latest breast cancer news and research. You may access links to news articles, medical journal abstracts and FDA information on every breast cancer test and treatment option on our website anytime.

Breast Cancer News for BRCA 1/2 Mutation Carriers

BRCA 1/2 gene mutation carriers have been in the news lately. Today we'll share the latest headlines and the studies behind them.

ABC News: "Women Develop BRCA-Related Cancer Earlier Than Their Moms, Study Says"

This was the big story of the week. ABC News, US News and World Report, the Los Angeles Times and Medical News Today all ran stories. (Links may be found on the BRCAnalysis page of our website. From the home page, click the "Treatments" tab and search for "BRCAnalysis" in the box on the top right.)
The headlines stemmed from an MD Anderson study published in Cancer on September 12. According to the study, breast and ovarian cancers appear to be diagnosed at earlier ages in later generations. A statistical model revealed that for BRCA mutation carriers, breast cancer would be diagnosed almost 8 years earlier than in the generation before.

Currently, BRCA mutation carriers are advised to start screening by 25. In the Los Angeles Times, the authors said their findings may support earlier screenings for future generations.

Medical News Today: "BRCA1 Gene Mutation Associated With Neoadjuvant Chemotherapy"

Another BRCA study from MD Anderson made news this month. This one revealed some good news for BRCA 1 carriers.

Last week, Medical News Today and US News and World Report covered a Journal of Clinical Oncology study which found that carriers of the BRCA 1 mutation had a better response to chemotherapy before surgery, known as neoadjuvant chemotherapy.

In the study, 46% of the BRCA 1 carriers achieved a pathological complete response (pCR), meaning the tumor disappeared in response to treatment. Only 13% of the BRCA 2 carriers and 22% of the non-BRCA carriers achieved pCR.

However, after about 3 years, BRCA status made no significant difference in survival. But, BRCA 1 carriers who achieved a pCR had better 5 year relapse-free and overall survival rates than BRCA 1 carriers who did not.

In the media stories, lead author, Dr. Banu Arun noted,

"This new insight tempts us to speculate that the presence of the BRCA1 mutation determines how some women will respond to neoadjuvant chemotherapy. However, we need future prospective studies with larger cohorts and longer-term follow up to validate these findings and determine optimum treatment."

Next week, we'll share the latest breast cancer news and research on hot flashes and fatigue after treatment. Until then, you may explore all the latest news and research on any breast cancer test or treatment option at our LATESTBreastCancer.com website anytime.

Herceptin for Small, Early-Stage Breast Cancer: Does Tumor Size Matter?

When it comes to Herceptin for HER2 positive breast cancer, does tumor size matter? What if the tumor is very small? Should Herceptin still be considered? Today we'll share the latest research on Herceptin (trastuzumab) for women with small, node-negative, HER2 positive breast cancer.

Clinical Breast Cancer: HER2 positive breast cancer has a higher risk of recurrence than other breast cancers

A July 15 Clinical Breast Cancer study from MD Anderson compared the risk of recurrence for women with different breast cancer subtypes. All of the women had small (less than 2cm), node-negative breast cancer. None were treated with chemotherapy or Herceptin.

The study found that women with HER2 positive breast cancer had a greater risk of recurrence than women with hormone-receptor positive breast cancer. Triple-negative breast cancer also had a greater risk than hormone-receptor positive breast cancer, but the difference was not as high as with the HER2 group.

Cancer (6/16): Herceptin plus chemotherapy beneficial for tumors 2cm or less

A June 16 study in Cancer from the Memorial Sloan-Kettering Cancer Center compared recurrence rates for women treated with and without Herceptin plus chemotherapy for small (2cm or less), node-negative, HER2 positive breast cancer. Based on their comparison, the authors concluded, "Women with small, node-negative, HER2+ primary breast cancers likely derive significant benefit from adjuvant trastuzumab with chemotherapy."

Cancer (9/1): Herceptin reduces recurrence after lumpectomy for tumors 5cm or less

A September 1 study in Cancer from the Memorial Sloan-Kettering Cancer Center compared localregional recurrence rates (LRR) for women treated with or without Herceptin after lumpectomy (breast conserving surgery) and radiation. All women had node-negative, HER2 positive breast cancer measuring 5cm or less.

According to the conclusion, "Even among women with lower risk breast cancer, the relatively high locoregional failure rates associated with positive HER2 status could be reduced markedly with adjuvant trastuzumab chemotherapy." Within 3 years, there was a 10% recurrence rate for women not treated with Herceptin compared to a 1% rate with Herceptin.

Internal Medicine News: Uncertainty for tumors less than 1cm

An August 16 Internal Medicine News article discussed the uncertainty about Herceptin for women with very small (less than 1cm), node-negative, HER2 positive breast cancer.

Although studies such as the July 15 Clinical Breast Cancer study above suggest a higher risk of recurrence for small, HER2 positive breast cancer, an American Society of Clinical Oncology (ASCO) presentation suggested that for women with very small tumors (1cm or less), the risk of recurrence may be so low that the benefit of Herceptin may not be worth the risk of cardiovascular disease.

Nonetheless, Dr. Gabriel Hortobagyi from MD Anderson was quoted to say he discusses Herceptin and chemotherapy with anyone with HER2 positive breast cancer, regardless of tumor size.


For more on Herceptin for HER2 positive breast cancer, including two-years worth of news, research and overviews, please visit the Hercetpin (trastuzumab) page of our website. From the home page of our site, click the "Treatments" tab and search for "Herceptin" in the box in the top right corner.

More Media Headlines from Breast Cancer Symposium 2011

This weekend, there were a few more headlines from the 2011 Breast Cancer Symposium in San Francisco. Topics include accelerated partial breast irradiation, neoadjuvant (before surgery) chemotherapy and NKTR-102, a drug in development for metastatic breast cancer.

HemOnc Today: "Control rates similar after partial irradiation across various subtypes in early-stage breast cancer"

On September 9, HemOncToday.com shared a study which found excellent 5-year local control rates among women with a variety of breast cancer molecular subtypes treated with accelerated partial breast irradiation (APBI). APBI reduces treatment time from over 6 weeks to just five days.

Until now, most trials of APBI included only women with more favorable cancer subtypes. Dr. Robert R. Kuske was quoted to say, "I'm very glad to see this study being published, which shows that even younger women with aggressive breast cancer may have a 5-day alternative to the 6.5 weeks." He hoped that "hesitant physicians will now open the floodgates and will put these patients onto clinical trials in these subtypes."

MD Anderson: "Chemotherapy is as Effective Before Breast Cancer Surgery as After"

A study from MD Anderson compared local-regional recurrence (LRR) rates of women treated with chemotherapy before and after breast conserving surgery (lumpectomy).

5 and 10-year LRR rates were "excellent" for both groups. When age and tumor characteristics were factored in, "survival rates were essentially the same for both groups of women."

Dr. Elizabeth Ann Mittendorf, lead study author concluded,

“This study shows that women appropriately selected for BCT, even some women with Stage 3 breast cancer, can have excellent rates of local-regional control,” Mittendorf said. “The most important thing is putting all the factors together to determine who can most benefit from this approach.”

Medical News Today: "Positive Results From Phase 2 Clinical Study Of NKTR-102 In Metastatic Breast Cancer Presented In Oral Session At The ASCO 2011 Symposium"

Nektar Therapeutics announced positive phase 2 study results of NKTR-102 for metastatic breast cancer. The study showed promising progression-free survival and overall survival, even for women with a poor prognosis or who have been "heavily pretreated" with anthracylines/taxanes and/or Xeloda (capecitabine).

NKTR-102 was also "very well-tolerated," with minimal alopecia (hair loss), neuropathy (nerve damage) and neutropenia (low white blood cell count). The most common grade-3 toxicity was diarrhea, which typically occured after 3 months of therapy.

A phase 3 trial known as BEACON (BrEAst Cancer Outcomes with NKTR-102) is expected to begin in December 2011.

Tomorrow we'll share the latest research radiation therapy for breast cancer. 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.

The New Breast Cancer News Blog

Variety is the spice of life. Over the next few weeks, we're going to experiment with some different approaches to our breast cancer news blog. We'd love your input.

What we do now

At LATESTBreastCancer.com, we read breast cancer research journals and news reports every day. We share what we learn in two ways.

The website

First, we add links to latest news and research to our database and website - LATESTBreastCancer.com. The links are sorted by breast cancer test or treatment option. You may explore the latest research on any option under the Treatments tab.

For example, the tamoxifen page of our website has links to medical journal abstracts, news reports, general descriptions and FDA information, all in reverse chronological order. Every time we find a new study on tamoxifen, a link is added to the page.

The blog

We use this blog to highlight some of the news and research we add to the website. Until now, the blog discussed the latest developments on an almost daily basis. It was akin to a daily newspaper. We are starting to wonder if this is the most efficient (or interesting) way to share the news.

What we plan to do over the next few weeks

Over the next few weeks, we are going to try a variety of formats for the news blog. We'll continue to highlight the latest developments. However, instead of a daily run-down of headlines, we'll sort the data to present it in a more meaningful way.

Future news blogs will be sorted by topic, such as complementary therapies or side-effects, and by patient, with blogs for the newly-diagnosed, triple-negative or metastatic patients.

Don't worry, we'll continue to share media headlines. Our plans include -

News Alerts - Important studies making headlines. Issues you may want to discuss with your doctor now.

Buzzworthy - A weekly round-up of studies that garnered media attention. (Note, the studies that generate headlines are not always clinically relevant now. Some interesting discoveries are made in biology labs or animal studies. These will not make a difference in humans for some time.)

We're also going to share research you may not hear from other sources. Topics will include -

Under the Radar - Important studies that did not make headlines, but may make a difference in your treatment decisions.

The Cutting Edge - News and research on fresh, new options, available now.

Up-and-Coming - News and research on options not currently available, but making progress in clinical trials.

How you can help

We want this news blog to be interesting and meaningful. To be our best, we need your input and feedback. As we experiment with new styles, please let us know what works and what doesn't. If there's something you'd like to see, we'd love to hear about it. If you miss the daily news update, we want to know that too.

To share your feedback, please leave a comment, send an email, make a comment on our Facebook page or send us a tweet (@ann_latestbc).

The new blog will start this week. We're looking forward to keeping you posted.

Breast Cancer News (8/18): Survival and Vitamin D, Exercise and CYP2D6 Variations

Recent studies suggest a worse prognosis for breast cancer patients with low blood levels of vitamin D. Do vitamin D supplements improve prognosis? A recent review asked that very question. Today, we'll also share the latest research on how CYP2D6 variations and exercise affect survival. As always, links to the studies below may be found on the treatment pages of the LATESTBreastCancer.com website.

Vitamin D supplementation for cancer patients

Should breast cancer patients take vitamin D supplements to improve prognosis? An August 11 review in The Oncologist evaluated 25 studies involving several cancers. For breast cancer, the two studies reviewed reached opposite conclusions about the prognostic importance of vitamin D. Three prostate cancer trials showed no survival benefit of vitamin D supplementation. The authors concluded that even though low vitamin D was associated with worse prognosis in some cancers, the "currently available evidence is insufficient to recommend vitD supplementation in cancer patients in clinical practice."

Does this mean that breast cancer patients should not take vitamin D? Not necessarily.

First, The Oncologist study reviewed only two breast cancer studies. Recent studies suggest that low serum vitamin D at diagnosis may be associated with a worse prognosis. An April 29 University of Rochester Medical Center study (under the News tab) linked low vitamin D with more aggressive tumors and a worse prognosis. A July 27 Breast Cancer Research study found that low serum vitamin D "may be associated with poorer overall survival and distant disease-free survival in postmenopausal breast cancer patients." These recent studies were likely not considered in The Oncologist review. (The Breast Cancer Research study also noted that the only two previous studies were inconclusive.)

Also, even though vitamin D supplementation is not yet proven to improve prognosis, recent studies suggest it may be beneficial for breast cancer patients to preserve bone mineral density (Annals of Oncology, April 2 and Breast Cancer Research and Treatment, March 8) and to reduce bone and joint pain associated with aromatase inhibitors (Breast Cancer Research and Treatment, June 21).

The bottom line is that breast cancer patients with low serum vitamin D should discuss vitamin D supplementation with their doctors.

CYP2D6 variations do not affect risk of recurrence

Variations in CYP2D6 genes affect how tamoxifen is metabolized. Some women metabolize tamoxifen well. Some do not. Do variations in CYP2D6 affect the risk of recurrence? According to a August 5 study in Cancer, no. Researchers from MD Anderson found that variations in CYP2D6 genes "had no significant effect" on the risk of recurrence in women with early breast cancer treated with adjuvant tamoxifen.

Exercise after breast cancer diagnosis may improve survival

Studies have associated exercise with improved quality of life, but can exercise affect breast cancer survival? An August 12 study in Breast Cancer Research and Treatment revealed that exercise after a breast cancer diagnosis may affect the regulation of tumor suppressor genes, which have "favorable impacts on survival outcomes of breast cancer patients."

Please check back tomorrow for more breast cancer research news from LATESTBreastCancer.com.

Breast Cancer News (8/16): A little something for everyone

Today's breast cancer news update has a little something for everyone. For women in treatment, there's a story on tamoxifen, an overview of DCIS treatment options and an update on a vaccine in development. For women who have completed treatment, there are stories on fatigue and post-trauma survival. Of general interest, there are pieces on the biology of cancer cells and breast cancer statistics in South Chicago.

BREAST CANCER NEWS FOR WOMEN IN TREATMENT

Tamoxifen affected by genetic mutations and anti-depressants

Yesterday, CBS News Miami published a story and video explaining why tamoxifen may not be effective in some women. Mutations in CYP2D6 genes and anti-depressants, such as Zoloft and Prozac, may interfere with tamoxifen metabolism. Interestingly, the story notes that a "hint" that tamoxifen may not be working is the absence of hot flashes.

An overview of DCIS treatment options

In a commentary, "Management of DCIS - A Work in Progress," cancernetwork.com reviewed the latest treatment options for DCIS. In addition to standard options such as breast conserving surgery (lumpectomy) or mastectomy, the article addresses prognostic factors and a future role for molecular markers, such as HER2 status.

Plans for phase III vaccine trial make progress

In a GlobeNewswire press release, RXi Pharmaceuticals announced progress in its plans for a phase III trial of its NeuVax vaccine to prevent recurrence in early-stage, node-positive breast cancer with low to intermediate HER2 expression. A principal investigator has been named, conditional site approvals have been received, an organization has been selected to manage international centers and manufacturing approvals have been submitted. The trial is expected to commence in the first half of 2012.

BREAST CANCER NEWS FOR WOMEN WHO HAVE COMPLETED TREATMENT

Stress and growth after the trauma of breast cancer

After the stress of breast cancer diagnosis and treatment, some women experience post-traumatic stress disorder (PTSD). BreastCancer.org provides an overview of symptoms and management suggestions.

Yesterday, an article in the Philadelphia Inquirer explored studies on "the positive side of trauma and grief." For some women, experiencing a trauma such as breast cancer results in personal growth. The "key quality" for post-traumatic growth appears to be "expressive flexibility," the ability to express or suppress emotions as necessary. Experts caution that it is "bad to expect growth." The last thing patients need is more pressure.

Biofield therapy to treat fatigue in breast cancer survivors

Breast cancer survivors often battle fatigue. HemOnc Today wrote about a recent study in Cancer on the complementary therapy known as biofield healing. Basically, a biofield is believed to be the energy or aura that surrounds a person. In the study, biofield healing and mock healing both significantly reduced fatigue compared to wait-list controls. Only biofield therapy made a significant difference in cortisol slope. Because both biofield and mock therapy improved fatigue, the results may be partially due to "nonspecific factors," such as scheduled rest, touch and clinical intervention. However, because biofield healing had a greater effect on general and mental fatigue, the authors note that further study is warranted.

BREAST CANCER NEWS OF GENERAL INTEREST

How breast cancer cells evade natural killer cells

In a healthy immune system, natural killer (NK) cells exhibit anti-tumor activity. In breast cancer, tumor cells and the surrounding microenvironment develop the ability to escape NK cell antitumor immunity. The biological process is explained in a GEN: Genetic Engineering & Biotechnology News story on a recent study in The Journal of Clinical Investigation.

Breast cancer mortality rates in South Chicago

Yesterday, a story in the Chicago Sun Times revealed that Chicago's south and southwest side neighborhoods are the "unhealthiest in the city." Those areas had the highest breast cancer mortality rates and few breast health services. Neighborhoods in the north and northwest have more breast health resources and the lowest breast cancer mortality rates. Dr. Bechara Choucair, Chicago's commissioner of health, noted that black women are less likely to get breast cancer, but more likely to die from it. He said the focus "needs to be on making sure black women have more access to mammography, better quality mammography and more timely treatment."

Please check back tomorrow for more breast cancer news highlights from LATESTBreastCancer.com.

Breast Cancer News (8/15): 3D Mammography, Risk and Vision Side Effects

What's new in breast cancer news? This weekend, 3D mammography and a study on risk made headlines. From the research world, there were studies on the vision side effects of treatment and the use of breast cancer social media to identify treatment side effects. As always, links to the studies and stories below may be found on the treatment pages of the LATESTBreastCancer.com website.

Is 3D mammography a breakthrough in breast cancer?

On August 14, The Boston Globe asked if 3D mammography, which earned FDA approval in February, and is now available in at least 9 states, is really a breast cancer breakthrough. The comprehensive story addressed the history of the mammography debate, the benefits of 3D mammography in terms of sensitivity and specificity, the risk of increased radiation exposure and the financial cost. It noted that definitive research on overall survival is years away, meaning that 3D mammography may be outdated by the time we know if it improves breast cancer survival.

Aromatase and breast cancer risk

Researchers continue to explore the factors which increase a woman's risk of breast cancer. On August 12, Cancer Research UK covered a Cancer Research study which linked the overproduction of aromatase in breast tissue to breast cancer risk. Although it was an early animal study, the results suggest that aromatase inhibitors, such as Arimidex (anastrazole), may be "a better choice for cancer prevention in postmenopausal women" than tamoxifen. A Cancer Research UK study of Arimidex for breast cancer prevention in postmenopausal women at risk, called IBIS-II, is already underway.

How does breast cancer treatment affect vision and eye health?

A review in Current Eye Research analyzed how treatment for early breast cancer affects vision and eye health. Chemotherapy, hormonal therapy and drugs for side-effects were included. According to the review, Taxotere (docetaxel) can cause epiphora, an overflow of tears onto the face, due to duct narrowing. Tamoxifen can cause cataracts, affect the optic nerve, and alter the perceived color of flashed light. Arimidex may lead to vision reduction, and bisphosphonates for bone loss may cause inflammation within the eye. The authors note that doctors should be aware of these types of side effects and suggest avenues for future research.

What can researchers learn from breast cancer social media?

Finally, an interesting study in the Journal of Biomedical Informatics suggests that researchers monitor breast cancer online social media to learn more about breast cancer treatment side effects. The authors note that medical message boards contain a large number of posts, where patients share "opinions and experiences that would be potentially useful to clinicians and researchers." The authors monitored message boards for information on the side effects of tamoxifen, Arimidex, Aromasin and Femara. 75 to 80% of the side effects discussed were documented on the drug labels. Some side effects were "previously unidentified." The authors conclude that breast cancer chat rooms and message boards become a source of "medical hypothesis generation."

Please check back tomorrow for more breast cancer news and research updates from LATESTBreastCancer.com.

Breast Cancer News (8/11): Cardiotoxicity

Breast cancer treatment side effects are in the news again. Earlier this week, we shared the recent research on nausea and thromboembolic events. Today we'll review the latest studies on cardiotoxicity, the heart damage caused by some breast cancer treatments. As always, the news stories and studies discussed below may be found on the treatment pages of the LATESTBreastCancer.com website.

Herceptin-induced cardiotoxicity in elderly patients

The big story was a small study from Spain in the Annals of Oncology which assessed the cardiotoxicity of Herceptin (trastuzumab) in women older than 70. Twelve of the 45 women in the study developed Herceptin-related cardiotoxicity. According to Medical News Today, "Earlier clinical trials in younger, healthier women revealed a slightly lesser rate."

Cardiotoxicity was more prevalent in women with cardiovascular risk factors. It developed in 33% of the women with cardiac disease and 33.3% of the women with diabetes. By contrast, only 9.1% of those without cardiac disease and 6.1% of those without diabetes developed heart damage.

The cardiotoxicity induced by Herceptin was reversible in most. According to US News and World Report, "When the women with heart problems stopped taking Herceptin, all but one recovered fully and five were able to re-start treatment with the drug."

In conclusion, Dr. Cesar Serrano, who conducted the study, was quoted in Medical News Today, "We think that it is reasonable to refer elderly breast cancer patients to a cardiologist if one or more cardiovascular risk factors are present before or during treatment with trastuzumab. Moreover, a closer surveillance of early symptoms and cardiac function is highly recommended."

Exercise and Adriamycin-related cardiotoxicity

Can aerobic exercise prevent or reduce the heart damage associated with
Adriamycin (doxorubicin)? Researchers from the NASA Johnson Space Center asked that very question in a review in Circulation, a journal of the American Heart Association. To lay the preliminary groundwork, the authors reviewed the molecular mechanisms of chemotherapy-induced cardiotoxicity and the effects of exercise on heart tissue. Their early findings "have implications for future research regarding the application and effectiveness of exercise and doxorubicin treatment in humans."

Sutent and the risk of congestive heart failure

Sutent (sunitinib) is approved for renal cell carcinoma and gastrointestinal stromal tumors, and is in clinical trials for breast cancer. A Journal of Clinical Oncology review of phase II and phase III trials found Sutent to be associated with an increased risk of congestive heart failure in cancer patients.

A story and video from TheDoctorsChannel.com provides more detail. The review included 16 studies of renal cell carcinoma and other cancers, involving almost 7,000 patients. Patients treated with Sutent had about a 3-fold higher relative risk of developing high-grade congestive heart failure. The authors concluded that "clinicians need to be aware of the risk of CHF with sunitinib treatment to provide early intervention and balance therapeutic benefit with this potentially life-threatening adverse effect."

Tomorrow, we'll review the latest breast cancer research on another treatment side effect - insomnia. Please stay tuned.

Breast Cancer News (8/10): Exercise, Avastin and Soy

In today's breast cancer news update, we'll share the latest media headlines on exercise, Avastin and soy. As always, links to the news stories discussed below may be found on the treatment pages of the LATESTBreastCancer.com website.

The New York Times: "The Benefits of Exercise After Cancer"

Yesterday, The New York Times shared a recent report on the benefits of exercise during and after cancer treatment. In the report, "The importance of physical activity for people living with and beyond cancer:
A concise evidence review," Macmillan Cancer Support (UK) reviewed 60 studies on exercise during and after cancer treatment. Exercise was found to reduce the risk of breast-cancer mortality and recurrence. It also improved physical function, fatigue, well-being, body composition and bone health. For women with advanced breast cancer receiving chemotherapy, exercise affected quality of life and fatigue. The Macmillan Cancer Support webpage is full of additional information on physical activity for cancer patients and healthcare providers.

Bloomberg: "Roche Seeks ‘Middle Ground’ in U.S. Appeal of Avastin Breast Cancer Ruling"

The Avastin (bevacizumab) regulatory saga continues. According to a story in Bloomberg, Roche has appealed the recent FDA withdrawal of approval of Avastin for metastatic breast cancer with a "middle ground proposal." Roche asked the FDA to allow patients with advanced, aggressive cancer with few treatment options to use Avastin with Taxol (paclitaxel). The proposal includes an offer to provide doctors with a "risk-evaluation strategy" and additional information on Avastin effectiveness and risks. Roche also plans a 480 patient follow-up trial. Trial failure would trigger an "immediate voluntary withdrawal of Avastin for breast cancer." The trial is to include a test of a protein biomarker (VEGF-A) to identify patients who may benefit from Avastin.

The Los Angeles Times: "Study indicates soy won't fight bone loss after menopause"

After breast cancer treatment, some women turn to natural remedies, such as soy, for menopausal symptoms such as hot flashes and bone loss. According to a story in yesterday's Los Angeles Times, a recent study in the Archives of Internal Medicine has found that soy tablets do not reduce bone loss in post-menopausal women. Further, the women who took soy experienced more hot flashes and constipation. The women in the study were not breast cancer survivors, but the effects of soy on menopausal symptoms should still apply.

Please check back tomorrow for more breast cancer news and research updates from LATESTBreastCancer.com.

Breast Cancer News (8/9): Platinol, anemia drugs and the risk of thromboembolic events

A thromboembolic event (TEE) is an event (blood clot in the lungs (pulmonary embolism), deep-vein thrombosis (DVT) or stoke (blood clot in brain)) related to a blood clot loose in the blood stream. According to a recent Anticancer Research study, for patients with advanced breast cancer a TEE is associated with a worse prognosis, although a causal relationship is not yet clear. Today we'll look at recent studies which have linked breast cancer drugs (Platinol chemotherapy and Procrit, Epogen, Aranesp for anemia) to thromboembolic events.

"Unacceptable" rate of thromboembolic events in patients treated with Platinol

An August study in the Journal of Clinical Oncology found an "unacceptable incidence" of thromboembolic events in patients treated with Platinol (cisplatin) based chemotherapy. According to the story and video on TheDoctorsChannel.com, "nearly 1 in 5" (18.1%) have a TEE during treatment or within a month of ending it. Age, patient performance status and presence of a central venous catheter were associated with a higher risk of TEE. Until a "more applicable predictive model is available," the authors suggest that all patients on Platinol-based chemotherapy be considered for "thrombophrophylaxis, unless there is a contraindication." Both the study and news story may be found on the Platinol page of the LATESTBreastCancer.com website.

Drugs to treat anemeia associated with thromboembolic events

Erythropoietin-stimulating agents (ESAs) treat anemia by stimulating bone marrow to produce red blood cells. Back in February, a study in Cancer evaluated the risk of thromboembolic events in patients older than 65 with metastatic breast cancer treated with chemotherapy and ESAs, such as Epogen (epoetin alfa), Procrit (epoetin alfa) and Aranesp (darbepoetin alfa). In this group, TEEs were found to be a "common event" and caution was recommended.

Interestingly, an August 1 study in the Journal of Clinical Oncology found "widespread variablity" in the prescription of ESAs for patients older than 65 on chemotherapy. Some doctors under use and some overuse ESAs. The use and duration of ESA prescriptions varied with doctor experience, specialty and gender. The authors concluded, "Policies to discourage inappropriate use of cancer therapies are needed."

At LATESTBreastCancer.com, we'll continue to highlight studies on breast cancer drug side effects, including thromboembolic events. Please stay tuned.

Breast Cancer News (8/8): Aloxi for nausea

Nausea and vomiting are perhaps the most unpleasant potential side-effects of chemotherapy to treat breast cancer. This year, several studies have shown Aloxi (palonosetron) to be effective in the prevention of chemotherapy-induced nausea and vomiting for breast cancer patients. All of the studies discussed today may be found on the Aloxi page of the LATESTBreastCancer.com website.

Single dose of Aloxi plus dexamethasone for moderately emetogenic chemotherapy

A May 2011 study in the Italian journal Tumori examined the effectiveness of Aloxi to control nausea and vomiting associated with moderately emetogenic chemotherapy, meaning chemotherapy with a moderate risk of vomiting. A single IV administration of Aloxi (.25 mg) plus dexamethasone (8 mg) before the administration of chemotherapy adequately controlled nausea and vomiting "during the entire period of emetic risk."

Aloxi plus dexamethasone for repeated cycles of Platinol, AC or EC chemotherapy

An August 2011 Japanese phase III study in Supportive Care in Cancer tested Aloxi with repeated cycles of Platinol (highly emetogenic), Adriamycin/Cytoxan (AC) and Ellence/Cytoxan (EC) chemotherapy combinations. Aloxi (.75 mg) was administered 30 minutes prior to chemotherapy. Dexamethasone was administered on days 1 through 3. The authors found an "extraordinary safety profile and maintenance of efficacy . . . throughout repeated chemotherapy cycles."

Two studies show Aloxi to be superior to other, similar drugs

Biologically, Aloxi is a 5-hydroxytryptamine receptor antagonist (5-HT(3) RA). It blocks the action of seratonin at 5-HT(3) receptors in the central nervous system and gastrointestinal tract. Other 5-HT(3) RAs are available for the supression of nausea and vomiting. Two recent studies found Aloxi to be superior to other 5-HT(3) RAs.

A May study in Supportive Care in Cancer compared Aloxi to other 5-HT(3) RAs in breast cancer patients treated with Cytoxan based chemotherapy and lung cancer patients on Paraplatin (carboplatin) or Platinol (cisplatin). The patients on Aloxi had a "significantly lower risk" of nausea and vomiting associated with hospital admission compared to those treated with other 5-HT(3) RAs.

Similarly, a June 2011 study in Expert Reviews of Pharmacoeconomics & Outcomes Research compared different 5-HT RAs in combination with aprepitant/fosaprepitant and dexamethasone for highly emetogenic chemotherapy. Patients on Aloxi had a lower risk of uncontrolled nausea and vomiting events than patients on other 5-HT(3) RAs.

At LATESTBreastCancer.com, we'll continue to add the latest news and research on medications to treat side effects to our database and website. Please stay tuned.

Breast Cancer News (8/4): Is it safe to delay treatment?

After a breast cancer diagnosis, there's a natural sense of urgency to start treatment immediately. How long is it safe to wait? Today, we'll look at three recent studies on treatment delays for women with early, node-negative breast cancer.

Short delays before surgery not associated with significant changes in tumor size

In April, an MD Anderson study in the Annals of Surgery evaluated whether delays before breast cancer surgery affected tumor size for 818 clinically node-negative women. The median time from imaging to surgery was 21 days. The median difference in tumor size from mammogram to surgery was 0 cm, and from ultrasound to surgery was .1 cm. The researchers concluded, "Modest time intervals from imaging to surgery are not significantly associated with change in tumor size; thus, patients may undergo preoperative work-up without experiencing significant disease progression."

Senior researcher Dr. Funda Meric-Bernstam told Reuters Health, "Clearly, rapid treatment is desireable. However, taking a few weeks to coordinate care is safe. It's very unlikely there will be tumor progression."

Two studies on delays between surgery and radiation

Also in April, a study in Clinical Breast Cancer evaluated how delays between breast conserving surgery and the start of radiation affect local recurrence rates. 387 women with node-negative, early breast cancer were divided into four groups based on how long after surgery radiotherapy started - less than 60 days after surgery, 61 to 120, 121 to 180 and more than 180 days later. Five years later, "a delay in administering radiotherapy after breast-conserving surgery was not associated with an increased risk of local relapse." The authors did, however, acknowledge conflicting results from other published studies and noted that "a larger evaluation of this issue is warranted."

A Korean study in the May/June issue of Tumori evaluated the local recurrence rates for two groups of women with node-negative breast cancer treated with breast conserving surgery. The first group started radiation therapy within 6 weeks of surgery. The second group started more than six weeks after surgery. The eight-year "local control," meaning no local recurrence, rates were 94.5% in the less than six week group and 92.7% in the more than six week group. For women less than 40 years old, starting radiotherapy within six weeks of surgery was associated with "a higher local control rate." There was no statistically significant difference for older women. Also, the interval between surgery and radiation "had no impact on overall and distant metastasis-free survival." The authors concluded, "Early radiotherapy within 6 weeks of breast-conserving surgery is associated with increased local control in patients with node-negative breast cancer not undergoing chemotherapy."

The topic for today's blog was inspired by a recent Twitter chat where a breast cancer survivor advised the newly diagnosed not to rush to treatment, but to take time to explore options and seek second opinions. Twitter can be another valuable resource for breast cancer patients and survivors. Currently, a group of survivors, patients and medical professionals participate in a weekly chat under the #bcsm (breast cancer social media) hashtag. Conversations take place on Mondays at 9pm Eastern/6pm Pacific time. Recent topics have included "Advice for the Newly Diagnosed," and "How Breast Cancer Affects Families." To learn more, search for #bcsm on Twitter. I tweet under the name @ann_latestbc. I hope to see you there.

At LATESTBreastCancer.com, we'll continue to add breast cancer research on delays in treatment to our website and database. The studies discussed today can be found on the radiation and breast conserving surgery pages of our website.

Breast Cancer News (8/3): Mammography, Hercpetin and the NCCN Guide for Patients

Today in breast cancer news, we'll highlight a study on the radiation damage caused by screening mammography, two studies on the neoadjuvant (before surgery) use of Herceptin and the new patient-friendly guidelines from the National Comprehensive Cancer Network (NCCN).

DNA damage from screening mammography

Once concern in the screening mammography debate is the exposure to radiation. A July 29 study in the International Journal of Radiation Biology assessed mammography induced DNA damage, in the form of double-strand breaks, in cells of women with high and low risk of breast cancer. DNA double-strand breaks were induced by mammography in all patients, and the effects were "exacerbated" in high-risk patients. The researchers concluded, "These findings may lead us to re-evaluate the number of views performed in screening using a single view (oblique) in women whose mammographic benefit has not properly been proved such as the 40-49 and HR [high risk] patients."

Neoadjuvant use of Herceptin

Herceptin (trastuzumab) is used to treat HER2 positive breast cancer. This week, two studies addressed the use of Herceptin in the neoadjuvant setting, to shrink tumors before surgery.

A July 25 study in the Journal of Clinical Oncology found that the neoadjuvant combination of Herceptin plus chemotherapy resulted in a high rate of pathological complete response (pCR), "defined as no residual invasive tumor in breast and lymphatic tissue." Women with pCR who continued Herceptin after surgery had "an improved long-term outcome." On the other hand, patients "without a pCR had an increased risk for relapse and death."

A July 25 review of five trials (515 patients) in Breast (Edinburgh, Scotland) found the addition of Herceptin to chemotherapy in the "neoadjuvant setting improves the probability of achieving higher pCR with no additional toxicity."

NCCN Guidelines for Breast Cancer Patients

For doctors, the NCCN publishes Clinical Practice Guidelines in Oncology, which outline a recommended standard of care for the treatment of cancer. This week, the NCCN released a patient-friendly version for breast cancer called the NCCN Guidelines for Patients. It's a terrific starting point for the newly diagnosed, covering breast cancer development, detection, staging, and standard-of-care treatment options by type. It even addresses side effects, complementary therapy and caregiver issues.

Our website, LATESTBreastCancer.com, is an additional resource for breast cancer patients. Patients may explore the latest news and research on the standard-of-care treatment options mentioned in the NCCN Guidelines and up-and-coming tests and treatment options in development. In addition, subscribers may personalize their research to their pathology reports to see the test and treatment options applicable to them.

Breast Cancer News (8/2): Vitamin D and Exercise

There's more to breast cancer care than surgery, radiation and drugs. Complementary therapies and lifestyle choices can affect risk, recovery and quality of life. It's an aspect of prevention and care that women can control. Today we'll look at the latest breast cancer research on vitamin D and exercise.

Vitamin D for breast cancer side effects, risk and prognosis

The vitamin D page of the LATESTBreastCancer.com website is full of links to news and research on breast cancer side effects, risk and prognosis. Today, we'll discuss the most recent studies.

Vitamin D for aromatase inhibitor muscle and joint pain

A June 21 study in Breast Cancer Research and Treatment found that high doses of vitamin D reduced the muscle and joint pain associated with aromatase inhibitor therapy. On July 26, Washington University in St. Louis released a detailed written news story and video about the study.

Does exposure to solar vitamin D decrease breast cancer risk?

Recent studies on vitamin D from sun exposure and breast cancer risk are contradictory. On one hand, a June 6 study in the American Journal of Epidemiology determined that exposure to solar vitamin D during adolescence resulted in a lower risk of breast cancer. A June 28 article on the UK National Health Service Choices website provides a detailed analysis of the study.

On the other end of the spectrum, (no pun intended), the findings of a July 23 study in the European Journal of Cancer "contradict that vitamin D production through extensive sun exposure has any protective effect on internal cancer but emphasise the increased risk for skin cancer." In that study, the risk of breast and other internal cancers was calculated for Swedish women with basal cell carcinoma (BCC), which is typically associated with extensive sun exposure. The authors found that women with BCC had an increased risk of other forms of cancer, including breast cancer, prior to the BCC diagnosis.

Why are study results inconsistent? The answer may be that people are genetically different. Much as tamoxifen only treats hormone receptor positive breast cancer, vitamin D may only reduce risk in those with specific genetic characteristics. A June 21 study in Cancer Epidemiology, Biomarkers & Prevention evaluated whether genetic variations might explain why vitamin D is associated with breast cancer risk reduction in some but not others. The study concluded, "Variation in vitamin D-related genotypes may help to explain inconsistent results from previous epidemiologic studies and may lead to targeted prevention strategies."

Serum vitamin D levels and breast cancer prognosis

Recent studies suggest that low serum (blood) levels of vitamin D at diagnosis may be associated with a worse prognosis.

A July 26 Breast Cancer Research study found that low concentrations of serum vitamin D before the start of chemotherapy "may be associated with poorer overall survival and distant disease-free survival in postmenopausal breast cancer patients." In the study, 1,295 German postmenopausal breast cancer patients were followed a median of 5.8 years after diagnosis.

Back on April 29, US News and World Report covered a similar study which was presented at the annual meeting of the American Society of Breast Surgeons. In that study, "[r]esearchers from the University of Rochester Medical Center found an association between low vitamin D levels (less than 32 milligrams per milliliter of blood) and poor scores on every major biological marker used to predict a breast cancer patient's outcome."

Exercise and breast cancer side effects and survival

Exercise to reduce side effects

Most of the links on the exercise page of our website associate exercise with the reduction of breast cancer treatment side effects for survivors.

A recent Evidence-Based Complementary and Alternative Medicine study found that core stability exercise and massage reduced "fatigue, tension and depression and improved vigor and muscle strength" for breast cancer survivors.

A July 11 study in Medicine and Science in Sports and Exercise concluded that resistance training alone improved physical self esteem, which is based on conditioning, attractiveness and strength. Aerobic exercise improved physical conditioning. However, a combination aerobic and resistance program did not improve physical self esteem any greater than single modality programs.

Additional studies on exercise and breast cancer side effects were discussed in the July 7 issue of our blog.

Exercise to improve survival

We know there is evidence that exercise can improve quality of life for survivors, but does exercise after diagnosis affect breast cancer survival? The findings of a July 27 study in Cancer Prevention Research "suggest that exercise after breast cancer diagnosis may improve overall and disease-free survival." This is an exciting area of research that we will be sure to follow.

Please check back tomorrow for more breast cancer research news highlights. Until then, please check our website for the latest news and research on other breast cancer complementary therapies and lifestyle options.