"n an interview after the presentation, moderator Kathy S. Albain, MD, Professor of Medicine in the Division of Hematology/Oncology at Loyola University Medical Center, said the report would probably not affect clinical practice very much “because we've already been pretty confident to switch the dose to 500 mg. But it was important to show to a large audience that the initial report of a benefit to the double-dose state was robust, and didn't go away.”"
"Barlow said that unfortunately, ATLAS can't be directly compared with the randomized, Phase III MA.17 trial, which found that five years of letrozole after discontinuation of tamoxifen extended disease-free survival and, for some patients, overall survival, due to different outcome measures and duration of follow-up. “But in general, the disease-free survival and recurrence rates [of MA.17] would tend to favor switching to the aromatase inhibitor letrozole rather than continuing with tamoxifen,” he said."
Susan Zager's insight:
This is great analysis of the ATLAS trial showing it's flaws and strengths.
"The clinical options available to treat HER2-positive breast cancer, in both the early and late stage setting, have been informed by the results of large, pivotal clinical trials. These trials have not only provided guidance to the optimal way to utilize adjuvant trastuzumab, but also expanded therapeutic options with new agents available for treatment of metastatic, HER2-positive breast cancer. The 2012 San Antonio Breast Cancer Symposium highlighted several important presentations that add to our body of knowledge and re-affirm the impact of anti-HER2 agents."
The first generic version of the cancer drug Doxil (doxorubicin hydrochloride liposome injection) has been approved by the U.S. Food and Drug Administration, which says the action should help relieve shortages of the brand-name medication.
The Avon Breast Health Outreach Program has awarded a $20,000 one-year grant to the Northwest New Jersey Community Action Partnership, Inc. (NORWESCAP) to increase awareness of the life-saving benefits of early detection of breast cancer.
"Young Asian and Pacific Islander women born in California have higher risks of breast cancer than young white women, and some groups, including Filipinas, might have higher risks than African-Americans, according to a new study that challenges the perception that these women are at a much lower risk of breast cancer than white women."
"Researchers found that 62.4 percent of African-American women and 59.3 percent of Hispanic women received a diagnosis of stage II or stage III breast cancer compared with 48.9 percent of white women, and past research has linked diagnosis at advanced stages to lower survival rates. Delays in treatment were apparent in the new study, as African-American and Hispanic women had higher risks of 30-, 60- and 90-day delays compared to white women."
"After breast cancer surgery, a follow-up regimen that includes regular mammograms offers a survival benefit over a follow-up regimen that does not include mammograms, according to a new systematic review."
"I found this study interesting for what it points to in our future. If one has to screen 50 patients to find one with a HER2 mutation, then one has to screen 500 patients to perform a 10-patient pilot therapeutic trial. We will see this again and again in the genomic era, where raw driver mutations are routine, and it will force us to change the way we study the disease. A consortium of investigators is now actively screening patients for HER2-activating mutations for entry into a neratinib trial."
The doubling of progression-free survival in BOLERO-2 shows it is one of the most positive studies—“and this just on our first try, so now we can refine things tremendously,” he said, adding that an analysis of gene sequencing from BOLERO-2 will be presented this spring at the American Association for Cancer Research Annual Meeting.
“Now imagine if we can begin to refine the whole approach by trying to identify who responds better,” he said."
"The sequential use of endocrine agents has been the mainstay therapeutic approach for patients with hormone-receptor (HR) metastatic breast cancer for decades, resulting in median survivals in the range of four years. However, eventually resistance to endocrine therapies occurs in all patients with HR-positive metastatic breast cancer. The approval of everolimus for metastatic breast cancer, resistant to non-steroidal aromatase inhibitors, represents a new era in the treatment of this disease, and demonstrates that targeting growth factor pathways appears to reverse resistance to endocrine therapies. An improved understanding of the mechanisms underlying endocrine-resistance should yield new therapeutic approaches and improve outcomes for patients with HR-positive metastatic breast cancer. However, some approaches appear to be more fruitful than others."
"Triple-negative breast cancer has recently received much media attention with the publication of the Cancer Genome study in Nature with its molecular characterization and relation to ovarian cancer (2012;490:61-70). At this year's San Antonio Breast Cancer Symposium, ER-positive breast cancer still took front stage, where the most talked about and potentially practice-changing news was the findings from the ATLAS study of adjuvant tamoxifen and updated results for large trials focusing on HER2 disease. As for triple-negative metastatic breast cancer (TN MBC), though, unfortunately there was no major practice-changing news. Rather, the spotlight was on the continued quest to better understand the molecular driver pathways of triple-negative disease and identify therapeutic targets."
"A retrospective analysis of data from a phase III study showed that amplification of VEGFA was associated with poor survival outcomes in patients with metastatic breast cancer who received bevacizumab with paclitaxel, compared with those who did not have amplified VEGFA."
"Patients with breast cancer report greater satisfaction with care when their cancer doctor co-manages their care with other specialists. However, some specialists are more likely than others to share decision-making with other physicians, finds a new study in Health Services Research."
"More White women are diagnosed with breast cancer than Black women, yet Black women with breast cancer have a higher mortality rate. One potential explanation for this disparity is delayed treatment, perhaps due to differences in socioeconomic status and access to care. However, a new study in Ethnicity & Disease finds that some disparities persist even when Black and White patients have the same Medicaid health insurance and similar economic status. "
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