The annual San Antonio Breast Cancer Symposium was held from Dec. 4 to 8 in San Antonio and attracted more than 7,500 participants from around the world, including medical oncologists, radiation oncologists, researchers, and other health care professionals. The conference highlighted recent advances in the risk, diagnosis, treatment, and prevention of breast cancer, with presentations focusing on emerging treatments in hard-to-treat patient populations, including patients with metastatic breast cancer.
In one study, Francois-Clement Bidard, M.D., Ph.D., of the Institut Curie and Versailles Saint-Quentin-en-Yvelines University in France, and colleagues evaluated the effectiveness of using circulating tumor-cell (CTC) count to determine which treatment should be used to treat a patient with estrogen receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer.
“CTC count was tested as a tool to choose between first-line endocrine therapy (single agent) or chemotherapy (followed by maintenance endocrine therapy),” Bidard explained. “In the CTC arm, patients were treated according to the CTC count (endocrine therapy if less than five CTC; chemotherapy if greater than or equal to five CTC), while patients randomized in the standard arm were treated according to the clinician’s best choice.”
The investigators found that the CTC test was reliable as a standalone biomarker.
“Patients with low CTC count and no adverse clinical characteristics (about half of the total population) achieved excellent progression-free survival (18 months) with single-agent endocrine therapy. In patients with high CTC count or unfavorable baseline characteristics (according to the clinicians’ estimate), frontline chemotherapy followed by maintenance single-agent endocrine therapy was apparently better than single-agent endocrine therapy,” Bidard said. “Taking a CTC count, a U.S. Food and Drug Administration-cleared reproducible prognostic marker, is reliable and isolates subgroups in which frontline chemotherapy and endocrine therapy maintenance is a better treatment option than frontline single-agent endocrine therapy.”
Bidard disclosed financial ties to Menarini Silicon Biosystems, which funded the study.
In another study, Roberto A. Leon-Ferre, M.D., of the Mayo Clinic in Rochester, Minnesota, and colleagues found that oxybutynin may serve as an alternative for the management of hot flashes in breast cancer survivors and other women with contraindications to hormone replacement therapy.
“Oxybutynin led to a significant improvement in hot flash frequency and severity, and its use was associated with improvement in multiple quality-of-life metrics compared to placebo,” Leon-Ferre said.
In this study, the investigators noted that two-thirds of patients were taking tamoxifen or an aromatase inhibitor. Side effects associated with oxybutynin were mild and mainly consisted of dry mouth, abdominal discomfort, and difficulty urinating.
“Since oxybutynin is a drug that is available (approved by the FDA for overactive bladder), clinicians may elect to use it for patients with hot flashes,” Leon-Ferre said.
In the Energy Balance and Breast Cancer Aspect-II trial, including 545 women aged 18 to 75 years who had undergone surgery for stage 1 or stage 2 breast cancer, Inger Thune, M.D., Ph.D., of the Oslo University Hospital in Norway, and colleagues found that a tailored exercise regimen during a 12-month period counteracted some of the cardiovascular decline associated with adjuvant breast cancer treatment.
“Our results were observed among all breast cancer treatments, but these results were particularly pronounced among those receiving chemotherapy,” Thune said.
Specifically, the investigators found that patients in the control arm who had undergone chemotherapy experienced a decrease of 6.4 percent in maximal oxygen uptake after 12 months in comparison with women in the exercise group who experienced only a 1.4 percent decrease in maximal oxygen uptake. These results were even more marked among those who underwent treatment with taxanes.
“Our results strongly support a change in clinical practice resulting in incorporation of supervised and safe clinical exercise programs into daily practice among newly diagnosed breast cancer patients and [these programs] should be included as part of breast cancer treatment guidelines,” Thune said.
Laura Spring, M.D., of the Massachusetts General Hospital Cancer Center and Harvard Medical School in Boston, and colleagues conducted a comprehensive patient-level meta-analysis of studies on neoadjuvant chemotherapy for localized breast cancer. The investigators aimed to evaluate the potential association between pathological complete response (pCR) after neoadjuvant therapy and subsequent breast cancer recurrence, as well as survival, with careful consideration of tumor subtype. Additionally, they aimed to understand the impact of adjuvant chemotherapy on modulating the relationship between pCR and outcomes and to determine the association between the amount of change in pCR and the corresponding impact on outcomes.
“In the largest meta-analysis to date on this topic, we demonstrated pCR was strongly associated with improved event-free and overall survival, and receipt of additional adjuvant cytotoxic chemotherapy following surgery did not further improve outcomes for those who achieved a pCR after neoadjuvant chemotherapy, supporting the concept of additional therapeutic escalation and de-escalation based on initial neoadjuvant response,” Spring said. “Our findings support the use of the neoadjuvant treatment approach when indicated, as well as the use of escalation and de-escalation strategies based on response to neoadjuvant therapy.”
Two authors disclosed financial ties to the pharmaceutical and biotechnology industries.
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