Breaking Research News from sources other than Breastcancer.org
Comments
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Traveltext: Thank you so much for your message! I am aware of this program and am signed up to get information about it. Good to know that you have attended and found it worthwhile. I have not applied because it's so hard for me to arrrange for time off work. I gather that there is a while before the 2019 application deadline so I still hope I may be able to figure work related issues before the application deadline. Thank you so much for sharing this information. There may be others who will be interested to see this information and consider applying. We need all the advocacy leadership we can get!
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Inflammation Markers and Cognitive Performance in Breast Cancer Survivors 20 Years After Completion of Chemotherapy
- Breast Cancer Research This study investigated levels of blood cell–based inflammatory markers for approximately 20 years in 166 breast cancer survivors after receiving postsurgical radiotherapy and six cycles of adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy. The study further explored the relationship between these markers and global cognitive performance. Breast cancer survivors had a lower general cognitive factor and higher levels of inflammatory markers than did non-exposed individuals in the comparator group.The study authors conclude that additional prospective studies are needed to explore the relationship between inflammation and long-term cognitive sequelae in treated cancer survivors.
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TAILORx Trial
This study investigated the predictive value of the 21-gene Oncotype genomic expression profile to determine whether or not adjuvant chemotherapy improved outcomes when added to endocrine therapy in hormone receptor–positive early-stage breast cancer. Patients were stratified based on their 21-gene assay score; those with a recurrence score <11 received endocrine therapy only, and those with a score of ≥26 received both chemotherapy and endocrine therapy. These patients were randomized to either receive chemotherapy or not prior to endocrine therapy.
Outcomes were also excellent among patients with recurrence scores of 11 to 25, with an overall distance recurrence rate of 5%. There <1% difference for all endpoints whether or not the patient received chemotherapy, confirming the absence of benefit from adding chemotherapy in these patients with intermediate-risk recurrence scores who do perfectly well with endocrine therapy alone. Subgroup analysis suggested that patients younger than 50 years with high intermediate recurrence score (21–25) might benefit from chemotherapy added to endocrine therapy.
These results definitively support the use of the 21-gene assay to help make decisions regarding the need for chemotherapy in the large majority of patients with early-stage breast cancer who are hormone receptor–positive. At Long last, we can be confident that genomic expression profiling is not only prognostic for outcome in early-stage breast cancer, but also predictive. It should be used routinely to make treatment decisions.
https://www.practiceupdate.com/C/76799/56?elsca1=e...
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Trump Administration: Ease Scope of Practice Laws
Also takes aim at "certificate of need" regulations
3 Dec 2018
Easing scope-of-practice laws and streamlining graduate medical education (GME) funding would make U.S. healthcare more competitive and efficient, the Trump administration said Monday.... "easing the licensing pathway for highly qualified, foreign-trained doctors is one step that could be taken in the short run to expand the supply of medical practitioners..." The authors attack state "certificate of need" (CON) laws, which require healthcare providers to seek approval before opening certain types of facilities.
https://www.medpagetoday.com/publichealthpolicy/he...
https://www.hhs.gov/sites/default/files/Reforming-...
{Posted because this may impact the availability of care in our communities - at least in the long run.}
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Stromal Characteristics Are Adequate Prognosticators for Recurrence Risk in DCIS of the Breast
- European Journal of Surgical Oncology - Nov 2018 This study investigated the prognostic potential of stromal characteristics from 211 DCIS patients. High nuclear grade, myxoid stromal architecture, and moderate to extensive stromal inflammation were significantly associated with decreased recurrence-free survival, independent of radiotherapy.Based on these features, a combined risk score (CRS) was calculated, ranging from 0 to 3. A high CRS of 3 was associated with significantly shorter recurrence-free survival.We were able to validate our previously reported findings regarding the prognostic potential of myxoid periductal stroma in an independent DCIS patient cohort. A CRS based on nuclear grade, myxoid stromal architecture and stromal inflammation might facilitate discrimination of low risk from high risk patients. Consequently, the CRS may tailor adjuvant therapy. Future research should investigate whether radiotherapy can be safely omitted in patients with a low CRS.
https://www.ejso.com/article/S0748-7983(18)31996-6/fulltext0 -
2018 Top Stories in Oncology: The Rising Tide of Precision Medicine in Metastatic Breast Cancer
Written by Reshma L. Mahtani DO
"The concept of targeted therapies for the treatment of cancer started with the approval of tamoxifen for ER+ breast cancer. Since then, it has served as a catalyst for the development of a multitude of targeted therapies in various tumor types and has ushered in the era of precision medicine. This is an emerging approach that incorporates individual genomic alterations to develop a personalized treatment plan. This year marks a significant step forward in the quest for the development of personalized treatment approaches in metastatic breast cancer (MBC), given the approval of new therapies and the reporting of several key data sets...."
https://www.practiceupdate.com/C/76798/56?elsca1=e...
{Good op ed on advances in precision treatment of MBC. A quick overview of many highlights.}
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The 21-gene Oncotype predictive value is very good for most tumors. The testing was mostly done on the most common kinds of breast cancer. The rarer tumors do not necessarily respond the same to the testing. In mucinous breast cancer there was no survival difference across the RS groups suggesting that RS might not be prognostic in IMC.
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HER3-Targeting Antibody-Drug Conjugate Shows Encouraging Activity in Advanced Breast Cancer
U3-1402, an investigational antibody-drug conjugate targeting HER3, induced objective responses in more than 40% of heavily pretreated patients with HER3-expressing breast cancer.
Myelopreservation Possible With CDK4/6 Inhibitor Trilaciclib in TNBC
A longer duration of chemotherapy exposure was possible in patients with metastatic triple-negative breast cancer who received trilaciclib, an investigational CDK4/6 inhibitor, in addition to gemcitabine and carboplatin compared with GC alone.
Extended PFS Observed in Alpelisib Combo for PIK3CA-Mutant Breast Cancer
Additional analyses from the SOLAR-1 study showed that alpelisib, an investigational alpha-specific PI3K inhibitor, combined with fulvestrant extended progression-free survival compared with fulvestrant alone in patients with PIK3CA-mutant advanced breast cancer regardless of line of therapy or prior CDK4/6 inhibitor treatment.
PD-L1 Immune Cell Expression Critical to Atezolizumab Efficacy in TNBC
Improvements observed in progression-free survival and overall survival with the addition of first-line atezolizumab to nab-paclitaxel in patients with metastatic triple negative breast cancer or inoperable locally advanced TNBC are exclusive to those patients with PD-L1 expression ≥1% in immune cells.
Axillary Radiotherapy Alternative to Lymph Node Dissection in Early-Stage Breast Cancer
Axillary radiotherapy was associated with locoregional control comparable to that with axillary lymph node dissection in patients with early-stage breast cancer who had a positive sentinel lymph node biopsy.
Lower-Dose Tamoxifen Reduces Recurrence Risk, Toxicity Incidence in Breast Cancer
The use of low-dose tamoxifen was shown to significantly reduce the risk of new and recurrent disease following surgery in women diagnosed with breast intraepithelial neoplasia but it did not cause more serious adverse events compared with placebo.
CTC Counts Demonstrate Selection Value in Metastatic Breast Cancer
The use of circulating tumor cell counts demonstrated strong value for selecting endocrine therapy versus chemotherapy for patients with estrogen receptor–positive, HER2-negative metastatic breast cancer.
Accelerated PBI Not Equal to WBI in Ipsilateral Breast Tumor Recurrence
Accelerated partial breast irradiation following lumpectomy was marginally not found to be equivalent to whole breast irradiation to control ipsilateral breast tumor recurrence.
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CAR T-Cell Therapy Shows Early Potential in TNBC
Chimeric antigen receptor T cells targeting the tyrosine kinase receptor ROR1 can be transferred into breast cancer patients safely and the cells expand in vivo.
Venetoclax Has Impressive Activity in ER+ and BCL-2+ Breast Cancer
Combining the BCL-2 inhibitor venetoclax with endocrine therapy elicited notable activity with a tolerable safety profile in patients with estrogen receptor–positive and BCL-2–positive metastatic breast cancer.
Durvalumab/Olaparib Combo Is Active in BRCA-Mutated Metastatic Breast Cancer
The combination of olaparib and durvalumab in patients with HER2-negative metastatic breast cancer with germline BRCA mutations is well tolerated and has promising activity, especially in earlier settings.
Palbociclib Combo Active in HER2+ Breast Cancer
The combination of palbociclib and trastuzumab demonstrated safety and efficacy in patients with advanced estrogen receptor–positive/HER2-positive breast cancer.
Oxybutynin Decreases Hot Flashes, Improves Quality of Life in Breast Cancer Survivors
Oxybutynin helped to reduce the frequency and intensity of hot flashes among women who could not take hormone replacement therapy in survivorship.
Telephone-Based Lifestyle Interventions Improved Breast Cancer Outcomes
Early-stage breast cancer survivors who completed a telephone-based lifestyle intervention program lost weight and tended to have higher rates of disease-free survival.
Breast Cancer Surgery Choice May Affect Quality of Life in Younger Patients
Younger patients with breast cancer who underwent lumpectomy had better quality of life than women who had a mastectomy.
Exercise Helps Women Maintain Cardiovascular Function During Adjuvant Breast Cancer Treatment
Women who took part in a supervised exercise program during adjuvant treatment for breast cancer had better cardiovascular function than women who did not participate in the program.
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A blood test may be here or be much nearer to use than it was just months ago!
Detection and localization of surgically resectable cancers with a multi-analyte blood test
http://science.sciencemag.org/content/early/2018/01/17/science.aar3247
"Abstract
Earlier detection is key to reducing cancer deaths. Here we describe a blood test that can detect eight common cancer types through assessment of the levels of circulating proteins and mutations in cell-free DNA. We applied this test, called CancerSEEK, to 1,005 patients with non-metastatic, clinically detected cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung, or breast. CancerSEEK tests were positive in a median of 70% of the eight cancer types. The sensitivities ranged from 69% to 98% for the detection of five cancer types (ovary, liver, stomach, pancreas, and esophagus) for which there are no screening tests available for average-risk individuals. The specificity of CancerSEEK was > 99%: only 7 of 812 healthy controls scored positive. In addition, CancerSEEK localized the cancer to a small number of anatomic sites in a median of 83% of the patients."
--- in language a person whom is not a dr can understand on CNN
"The 10-minute test developed in Australia is yet to be used on humans, and large clinical trials are needed before it can be used on prospective patients. But the signs are positive.
Tests on more than 200 tissue and blood samples detected cancerous cells with 90% accuracy, the researchers said.
It's been used only to detect breast, prostate, bowel and lymphoma cancers, but they're confident the results can be replicated with other types of the disease."
https://www.cnn.com/2018/01/19/health/cancer-blood-test-study/index.html
""We were pleasantly surprised that we could detect the amount of cancers that we were able to detect," Papadopoulos said. "We were even more pleasantly surprised that not only we detected cancers, but with some degree of certainty, we were able to localize it to at least two sites as to where these cancers might be."The study had some limitations, including that the patients in the study already had been diagnosed with cancer, mostly based on symptoms. So patients in a real-life screening likely would have less advanced disease and might be more difficult to test.
Also, in a real-life scenario, even healthy patients who would be tested could have inflammatory or other diseases that could skew test results, which wasn't seen among the healthy patients in the study.
The researchers have moved forward with a follow-up, five-year study to further evaluate the blood test,"
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Study shows novel strategy to reduce breast cancer bone metastasis
https://www.news-medical.net/news/20181112/Study-s...0 -
Prophylaxis May Cut Cardiotoxicity Risk in HER+ Breast Cancer
Clear benefit for anthracycline treatment, not trastuzumab
The frequency of cardiotoxicity declined significantly with prophylactic antihypertensive medication for patients with early HER2-positive breast cancer treated with anthracycline-containing chemotherapy, but not trastuzumab (Herceptin), a randomized trial showed.
https://www.medpagetoday.com/meetingcoverage/sabcs...
https://www.medpagetoday.com/meetingcoverage/acc/7...
Primary Source
Journal of the American College of Cardiology
Source Reference: Avila MS, et al "Carvedilol for prevention of chemotherapy related cardiotoxicity" JACC 2018. DOI: 10.1016/j.jacc.2018.02.049.Secondary Source
American College of Cardiology
Source Reference: Guglin ME, et al "Lisinopril or carvedilol for prevention of trastuzumab induced cardiotoxicity" ACC 2018; Abstract 405-14.
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Patients Say Quality of Life Suffered With Mastectomy for Early Breast Cancer
Breast-conservation options were associated with better sexual, psychosocial outcomes
Women who opted for mastectomy rather than breast-conserving surgery for early breast cancer had worse quality of life regarding their psychosocial and sexual well-being, according to survey results reported here.
https://www.medpagetoday.com/meetingcoverage/sabcs...
Primary Source
San Antonio Breast Cancer Symposium
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End-of-life Surrogates Often Overconfident
Most are less prepared than they think to make necessary decisions
Patients' end-of-life surrogates are overly confident in their readiness to make crucial decisions for their loved ones, recent research found.
"Respecting Choices is an intensive program utilizing a specially trained facilitator to conduct conversations with patients and their surrogates. Because it requires the commitment of resources, it is probably best suited for patients with advanced illness and a high likelihood of needing a surrogate decision maker in the near future,"
https://www.medpagetoday.com/publichealthpolicy/ge...
Primary Source
JAMA Internal Medicine
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This seems to indicate that 17% of breast cancer patients will have a second (non BC) cancer diagnosis within 5 years. This is scary.....and seems awfully high to me. It was a large study, with over 87,000 participants.
https://www.practiceupdate.com/c/76907/2/1/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter&rid=MTMwMzczODQ4NTI3S0&lid=10332481
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KBeee: I think that is correct. I tend to think that the risk of recurrence and spread is downplayed (pink-washed?). I posted on another forum that I had been reading studies (a lot) and doing some mental math which stopped me in my tracks: the stats I was reading said that about 20% of women would be diagnosed stage IV de novo and that 30% with early stage breast cancer would become stage IV at some point. Those who progress to stage IV are front-loaded, that is, the risk is higher in the first 5 years following the early stage diagnosis. So 17% within 5 years does not surprise me at all. What did surprise me was if you add 20% diagnosed as stage IV de novo and 30% will eventually "convert," you are in the neighborhood of 50%. That seems high. And scary.
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I would imagine some people could have "cancer friendly" levels of metabolic disease? Or genetic mutations?
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Lumpie, do you have a link for the “ frontloading”?
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SABCS: Axillary RT as Good as Surgery in Breast Cancer
Radiation non-inferior to surgery after positive sentinel node
https://www.medpagetoday.com/meetingcoverage/sabcs...
The 10-year follow-up of the controversial AMAROS study appeared to confirm that irradiating the axilla after a positive sentinel node diagnosis is as good in preventing breast cancer recurrence as lymph node dissection, and reduced the risk of lymphedema by 50%, researchers reported here.
After 10 years, 7 of 744 women who underwent lymph node dissection experienced a recurrence in the axilla compared with 11 of 681 women who underwent radiotherapy (P=0.37), according to Emiel Rutgers, MD, PhD, of the Netherlands Cancer Institute in Amsterdam.
Primary Source
San Antonio Breast Cancer Symposium
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Rules Needed for Better Patient Record Access, Say Experts
It won't happen unless it's required
Making health data easier for patients to access and use won't happen nationwide until regulations require it, experts said here Wednesday.
"EMR [electronic medical record] vendors do respond to customers, but they [seem to] respond more efficiently to regulation and incentives,"
https://www.medpagetoday.com/practicemanagement/in...
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Originally I understood it to be cancers other than breast cancer (referring to the post I made earlier), but I dug in to the original study and they include breast cancer in that, so the number do indeed make sense. There is a big difference in individuals who have a first degree relative who's had cancer, which is frustrating that there is zero screening afterwards (and I have extensive family history).
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Hello, I saw this in our local TV news and I wanted to share it with all of you. I don't know if my MO submitted my stuff for genetic testing because I am the first woman in either side of my family to have BC and I guess that's why I found this article so interesting and valuable.
Breast cancer testing guidelines out of date, study says
https://www.news4jax.com/health/breast-cancer-testing-guidelines-out-of-date-study-says
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Marijen, Here is one graphic showing much higher recurrence at < 50 months.
https://openi.nlm.nih.gov/detailedresult.php?img=P...
I have looked at so many statistics and graphics over the years! In reviewing data, i found that many illustrate *survival* at intervals (including 5 years) which is slightly different from recurrence. I also pulled up the Predict tool on the NHS site. I couldn't recall whether it showed recurrence or survival stats. It shows survival. If I find others, I will post them.
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Thank you Lumpie. I guess this explains why the first five years are crucial. But you would think they would be screening us for metastasis at 24 months instead of just the mammograms. Correct?
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Interesting that the graph/risk for distant metastasis drops to a relatively low level from peak and stays low.
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I wonder if this also applies to the hormone positive tumors.
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More trouble with health insuranc
OBAMACARE, RIP
JUDGE DECLARES UNCONSTITUTIONAL WITHOUT TAX0 -
Marijen: in response to your 12/10 post, I think that they should be screening us ALL for metastasis periodically - or at least give us the choice. At present they just send us on our way and we generally don't get diagnosed until things are so far progressed that we are nearly dead, hence the extremely poor prognosis for stage IV patients. At the risk of sounding extremely jaded I could suggest that health systems don't particularly want to find mets early because it is so darned expensive to treat. And if we live a long time, that really gets expensive. In fairness, the other side of this argument is that 1) it would take a lot of screening to find a metastasis and 2) there is a lot of uncertainty around treating early mets. My response would be that 1) most of us would rather be screened than dead and 2) with practice, therapies will get better. I am hopeful that further research on CTC (circulating tumor cells) will allow blood tests to be an afordable means of monitoring for metastasis or recurrence. Then we may get some traction.
Gudrun: I think the graph included all types of tumors.
Marijen: No end to the healthcare "challenges." If there are coverage junkies out there watching the various proposals, there is a good summary of the various Democratic proposals here: https://www.vox.com/2018/12/13/18103087/democrats-...
and an interesting libertarian-leaning proposal here: https://niskanencenter.org/blog/ahca-catastrophic-... (aspects are intereesting but it achieves cost savings primarily through lifetime caps so that's a no-go.)
The Mods may have us move discussion of health insurance issues to another discussion strand. I haven't looked for one in a while, so if there is a good one, maybe someone will direct us to it - or we can search. Here's one: https://community.breastcancer.org/forum/113/topic...
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Thank you Lumpie! I wish I could summarize things the way you do. I did ask my BS for a CTC test. I brought him a study that said it can catch metastasis 11 months sooner than symptoms. He promised when I had surgery (which was delayed for 7 months because apparently I was in a study too), that he would draw the blood for the test. He lied. That never happened. I dumped him as quick as I could. Who needs a lying doctor?
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Lumpie, it's not so simple as scans and blood tests to screen for metastases. It really is up to patients to be aware of the symptoms and get tested immediately.
https://my.clevelandclinic.org/health/diseases/172...
Diagnosis
There is no one test to check for metastasis. Various tests will reveal different things. The tests that are done are determined by the type of primary cancer and/or any symptoms that need to be investigated.Blood tests
Routine blood tests such as liver enzymes may be elevated in the presence of liver metastasis. However, these blood tests are often normal, even in people with advanced disease.Tumor markers
Some cancers have specific blood tests that can be helpful in following the disease AFTER it has been diagnosed. If these levels rise, it can be an indication that the disease is active or progressing.Imaging
The results of these and other tests may not provide definitive information. The findings must be correlated with each other, the physical examination, symptoms, and in some cases biopsy.
Patients have to be very aware of the symptoms for advancing to Stage IV of this disease:
https://www.medicalnewstoday.com/articles/322462.p...As you say:
1) it would take a lot of screening to find a metastasis and 2) there is a lot of uncertainty around treating early mets. My response would be that 1) most of us would rather be screened than dead and 2) with practice, therapies will get better. I am hopeful that further research on CTCNot sure I agree:
1) most of us would rather be screened than dead.
• Uncertainty, scanxiety, false positives, false negatives, extra radiation doses, and constant worry are not good for your health.
2) with practice, therapies will get better. I am hopeful that further research on CTC (circulating tumor cells) will allow blood tests to be an afordable means of monitoring for metastasis or recurrence. Then we may get some traction.
• Let's hope. Meanwhile, maintain a healthy diet, exercise regularly, and learn some relaxation techniques.0
