Breaking Research News from sources other than Breastcancer.org
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CLEOPATRA End-of-Study Analysis in Metastatic Breast Cancer: 37% Alive at 8 Years
The end-of-study analysis of the landmark CLEOPATRA trial shows that 37% of patients with HER2-positive metastatic breast cancer are still alive at 8 years... The unprecedented overall survival improvement earlier shown with a first-line regimen of pertuzumab, trastuzumab, and docetaxel was maintained after an additional 4 years of long-term follow-up, as were the safety and cardiac safety profiles, she reported.
"These are 'knock-your-socks-off' data! There's never been another study in metastatic breast cancer to show anywhere near this kind of survival benefit with this length of follow-up," "As of November 2018, the data cutoff, 59 patients are still on study and have not progressed. It's a possibility—though I hesitate to use the word—that these patients are cured," she commented.
"These are spectacular results. Over one-third of patients who would have died years ago without HER2-targeted treatment are now alive at 8 years. The question now is when to stop treatment?" Dr. Swain said. "As of November, many patients were still on HER2-targeted treatment in this trial, and we see the same thing in our clinical practices. Patients often don't want to stop treatment."
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Standard HER2 Regimen Still Going Strong
Seven-year relapse-free interval of 97.5% with paclitaxel-trastuzumab
Long-term follow-up in a large phase II trial of early HER2-positive breast cancer showed high rates of disease control and survival with a longstanding standard regimen.
Treatment with adjuvant paclitaxel and trastuzumab (Herceptin) led to a 7-year disease-free survival (DFS) of 93% and overall survival (OS) of 95%. Additionally, 97.5% of the 410 patients remained relapse-free for at least 7 years...
"...I think we're learning there might be more potent anti-HER2 therapies that are emerging, particularly antibody-drug conjugates, that might be able to provide highly effective therapy and potentially replace chemotherapy and trastuzumab."
"I'm hoping that the field continues to evolve, because I think the goal is to provide the right amount of therapy to the right patient. We'd like to avoid overtreating patients, particularly with these lower-risk tumors,"
Primary Source
Journal of Clinical Oncology
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Great news for stage I patients.
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I'll take it!!
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Mine didn't show up on anything EXCEPT a MRI and by that time it was 6 cm because I have dense breasts and it couldn't be seen on regular mammogram. I never had a recommendation from a radiologist to have any follow up for all of the years I was having mammograms and mentioning in the "normal" results that I had dense breasts. It was only diagnosed (finally) because they saw two enlarged nodes on the mammo. It was only then that I had the MRI. If I had known then what I know now about dense breasts I would have insisted on a MRI at least every couple of years. BS said it could have been there for 10 years.
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Gussy: Yeah... I am not sure which article you are referencing but I am with you. The dense breasts thing is a controversial issue. Which I don't really understand. But that is probably because I have strong opinions. I believe that we have a "right to know" and that our caregivers don't have a right to withhold information about our bodies and health status. If our caregivers don't believe that identified information is useful or that we might be confused about whether it presents a legitimate hazard to our health, then absolutely, they should share that information, counsel us and refer us to appropriate educational tools if needed. That is their professional opinion and that is why we consult them. From many quarters, however, it is argued that this information should be withheld because patients will be confused or are not competent to use it in making decisions about how to manage their health. Withholding information is always a bad idea. Education is always a good idea. Education has the misfortune to be expensive and time consuming.
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Lumpie, Amen!
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Ditto on the Amen.
I think a lot of us are on this sight, not just for emotional support, but also for bits of information that we suspect out doctors don’t share.
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How Are States Dealing With Challenges Facing Patients With Cancer?
High costs of care, particularly for prescription drugs, dominated a discussion of cancer care at the state level during the June 27, 2019, National Comprehensive Cancer Network Policy Summit in Washington, DC.
July 31, 2019
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Cost of Breast Cancer Surgery Influences Many Women's Treatment
But doctors seldom discuss financial differences between similarly effective treatments
Even among well-educated women with health insurance coverage, a significant proportion said the costs of cancer treatment influenced the type of surgery they chose for breast cancer treatment, a study led by the Duke Cancer Institute found.
"While other side effects of surgical choice are routinely discussed with their physicians, the potential for financial harm is not explicitly addressed, including both the out-of-pocket payments and lost productivity for patients and their families," she said. "Our study suggests this should change."
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Long-term effects of moderate versus high durations of aerobic exercise on biomarkers of breast cancer risk: Follow-up to a randomized controlled trial | Cancer Epidemiology, Biomarkers & Prevention
http://cebp.aacrjournals.org/content/early/2019/08...0 -
Wanderingneedle: Thanks for the link to the LA Times article. Sharing the general theme:
"...we published a research letter in JAMA Internal Medicine summarizing industry payments to the 53 physicians who direct major academic cancer centers across the United States. These are the nation's most prominent cancer centers, those designated by the National Cancer Institute in recognition of their scientific leadership.... About a third of all directors...{received industry payments in 2017} above {$5,000} – typically receiving payments for research and consulting. A few were well above it (one had payments exceeding $2 million)."
The data are public and available to anyone with an internet connection.
{The article goes on to discuss the conflicts of interest that this situation creates given that these centers conduct clinical trials.}
"The public has an interest in the unbiased evaluation of new products....Industry-funded evaluations are more likely to reach pro-industry conclusions."
https://www.latimes.com/opinion/story/2019-08-05/directors-cancer-centers-money-drug-companies
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740204
doi:10.1001/jamainternmed.2019.3098
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Yes, I found one doctor who received over two hundred thousand dollars from drug companies and decided not to see him. You think they push the drugs they receive payments for? I do.
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Shelligirl - that's what brought me here - trying to find answers that my doctors didn't share. Maybe that's a method they employ with purpose, but I don't think it works for some people.
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Breast Cancer Navigation and Survivorship Care
- Interview with Lillie D Shockney RN, BS, MAS, ONN-CG
- Interview by Farzanna S Haffizulla MD, FACP, FAMWA
- {Many of you are familiar with Lillie D Shockney RN, BS, MAS, ONN-CG who is known for her pioneering work as a B.C. oncology nurse navigator. In this interview, she shares insight on her work.}
- https://www.practiceupdate.com/C/84565/56?elsca1=emc_enews_topic-alert
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Not bc-specific...
Researchers have opened up a possible avenue for new cancer therapies that don't have the side effects that oftentimes accompany many current cancer treatments by identifying a protein modification that specifically supports proliferation and survival of tumor cells...
Researchers led by Franco and Oregon State undergraduate student Jeanine Pestoni found that schwannoma cells produce an oxidant and nitrating agent, peroxynitrite, which modifies an amino acid, tyrosine, in proteins.
When tyrosine becomes nitrated in specific proteins, an effect is the reprogramming of the tumor cells' metabolism, enabling them to proliferate...
"We are uncovering a completely new category of targets for the treatment of solid tumors, and not only tumors of the nervous system -- it may have broader implications for the treatment of several cancer types. We can go after proteins that usually aren't modified in normal cells; we can target those modified proteins with inhibitors that don't affect normal cells, hopefully developing a treatment with minimal side effects."
https://www.sciencedaily.com/releases/2019/08/190805155916.htm
Study referenced: Peroxynitrite supports a metabolic reprogramming in merlin-deficient Schwann cells and promotes cell survival. Journal of Biological Chemistry, 2019; 294 (30): 11354 DOI: 10.1074/jbc.RA118.007152
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Spreading the word: Triage Cancer has a number of good educational resources related to cancer. They have a webinar on genetics and genomics coming up on 8/8. You can register for the webinar and watch pre-recorded webinars here:
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Decreased CTCs/ctDNA Post-Chemo Prognostic in Advanced Breast Ca
Clearance of both associated with improved outcomes, largest prospective cohort assessing the two shows
New data from the French cohort COMET study, presented at the 2019 ASCO annual meeting, evaluated the role of circulating tumor cells (CTCs) and circulating tumor (ct) DNA in predicting patient outcome to first-line treatment...While more data are needed, this study suggests the feasibility and importance of CTC/ctDNA testing in guiding chemotherapy choices in breast cancer patients. Additionally, it highlights the need for further quantification of CTC/ctDNA to assess tumor response to treatment, and the need for use of both serum markers in the measurement of tumor aggressiveness.
Primary Source
Journal of Clinical Oncology
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New Super-Sensitive Liquid Biopsy Test For Breast Cancer Described As Possible "Game-Changer"
A new blood test for tracking breast cancer in patients with early stage disease may enable physicians to more sensitively monitor patients, including looking at responses to treatment, tailoring treatments more effectively and preventing some invasive surgeries...
The research published today in Science Translational Medicine is a collaborative effort between the Translational Genomics Research Institute (TGen), an affiliate of City of Hope in California and the Mayo Clinic in Arizona and the Cancer Research UK Cambridge Institute.
The test called "TARDIS" (TArgeted DIgital Sequencing) has been suggested to be up to 100 times more sensitive than other existing blood-based cancer monitoring tests.
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There Is Such Thing as a Too-High LVEF
Study suggests sweet spot and proposes fourth left ejection phenotype
Higher is not necessarily better when it comes to left ventricular ejection fraction (LVEF), according to a retrospective study.
Compared with an LVEF of 60-65%, both reduced and elevated LVEFs were associated with worse all-cause mortality that persisted after multivariable adjustment...
Primary Source
European Heart Journal
{Those of use who get regular echos may have wondered....}
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Very interesting Lumpie, thanks! Met with Cardio on Monday and with exercise EF is up to 58% from a dip to 53% 🙂
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I am due for my next echo. My last one put me in 55-60% range. I have been duen as low as 35% twice in my life. Both times I was removed from herceptin. I have bounced back every time. I dipped to 40% this two echos again but s changevin heart meds brought me back o do I am still on herceptin.
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Lumpie, Thanks for posting the links about resveratrol. I followed the links and didn't see mention of how it was administered. Was it just through drinking red wine? or through supplements? Do you know? I guess I could email the researcher. I'm wondering if it might help my chemo brain side effects? I've been avoiding wine because it gives me unpleasant feelings the next morning--sort of like a hang over but after only a little bit--like 1/4 of a glass.
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Study says antidepressant could inhibit breast cancer
Researchers from National Chiao Tung University (NCTU) and Taipei Medical University (TMU) yesterday said they discovered that the antidepressant bupropion can be used as an anti-metastasis drug for triple-negative breast cancer...
For the study, researchers used big data and artificial intelligence to analyze large-scale cancer gene expression maps, and designed regulatory networks for nearly 2,000 types of different kinds of membrane proteins in 15 types of cancer to explore the roles membrane proteins play in different cancers, and their importance, the NCTU team said.
http://www.taipeitimes.com/News/taiwan/archives/2019/08/09/2003720184
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Assessment of Molecular Relapse Detection in Early-Stage Breast Cancer
- This prospective, multicenter, sample collection study assessed the clinical validity of molecular relapse detection with circulating tumor DNA (ctDNA) in early-stage breast cancer. The primary endpoint was relapse-free survival. Detection of ctDNA during follow-up was associated with relapse (HR, 25.5; P<.001). Detection of ctDNA at diagnosis, prior to any treatment, was also associated with shorter relapse-free survival (HR, 5.8; P=.01). Detection of ctDNA had a median lead time of 10.7 months compared with clinical relapse and performed better in distant extracranial metastatic relapse (detected in 96%) versus brain-only metastasis (17%).
- These important findings suggest the potential for ctDNA in follow-up of early-stage breast cancer. Further studies to assess the potential for this information to guide adjuvant therapy are needed.
- Meaning The findings suggest that molecular relapse detection has high levels of clinical validity, and clinical trials of treatment initiated at molecular relapse without waiting for incurable metastatic disease to develop are needed.
doi:10.1001/jamaoncol.2019.18380 -
Book note: Healthcare Choices
5 Steps to Getting the Medical Care You Wand And Need
Author: Archelle Georgiou, MD
Published 2017
I skimmed this book. I found a section on pages 38 and 39 particularly helpful. The physician author discusses her recommended approach to decision making and taking action in the face of a diagnosis (or progression) that can feel "overwhelming"/frightening. {Perhaps after taking time to vent and grieve as needed} She recommends taking a "clinical" approach. She calls this the "CARES" model. These are the steps:
1) understand your Condition
2) know your Alternatives
3) Respect your preferences
4) Evaluate your options
5) Start taking action.
In my experience, once I have a defined a plan in which I have some confidence and can focus on executing the plan, I feel much better.
I thought this approach might be helpful for others.
ISBN: 978-1-4422-6033-7 (978-1-4422-6033-4 for the e-book)
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Re: the LVEF, my MO told me early on that greater was not necessarily better--that too high means the heart is having to work too hard to circulate the blood.
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I take resveratrol in capsule form.
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aterry: Based on the discussion in the referenced articles and other things I have read, I believe that the resveratrol is extracted from the wine. And like santabarbarian says, I believe that it can be purchased in capsule form. When I did a search for "resveratrol capsules" many "opportunities" popped right up. I have heard about the alleged merits of resveratrol for decades so it is great to learn that it is being studied.
As with any supplement, care should be taken to try to identify a reputable purveyor. And it goes without saying that clearing such with your care providers is a good idea.
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