San Antonio Breast Cancer Symposium 2012

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Just listened on the radio to Larry Norton, MD,Deputy Physician-in-Chief for Breast Cancer Programs; Medical Director, Evelyn H. Lauder Breast Center; Norna S. Sarofim Chair in Clinical Oncology at Memorial Sloan Kettering discuss the study.  In brief, here's what he said.  If a PREMENOPAUSAL woman was in the process of completing 5 years of Tamoxifen, he would recommend that she continue to take it UNTIL THEY LOOK MORE CAREFULLY AT THE DATA.  He said, the sample population of women must have been YOUNG if they took Tamoxifen for 10 years because for post menopausal women they now have other more effective drugs to use.  He said when he scrutinizes the data, he will be looking for whether or not the Tamoxifen prevented a recurrence or a new breast cancer.  He also said that some of the women did NOT complete the full 10 years of Tamoxifen....so I'm assuming from THAT statement he'll be looking at the "carry-over effect."

    That being said, without a doubt there are women who are going to have side effects and CHOOSE NOT to take Tamoxifen.  That is a very personal decision that should be respected.  However, what Dr. Norton concluded by saying was that if the data proves that Tamoxifen was PREVENTATIVE at stopping a new breast cancer from forming, he thought it was "thrilling." 

    He also said that he was excited to see all these new targeted therapies that target the molecular base of the tumor and don't "hurt" the rest of the body.  He said that we are now entering a new world of treatment for breast cancer....

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Here are today's important press releases issued from the symposium:

    http://www.sabcs.org/PressReleases/Documents/2012/aaa9d6b390d017ad.pdf

     

    Young Women With Breast Cancer Were More Likely Than Older Women to Respond to Neoadjuvant Chemotherapy

    Finding was confined to those with triple-negative and luminal-type breast cancer.

     Better outcomes seen for young women with luminal A-like tumors who achieved a pathological complete response compared with those who did not.

     Neoadjuvant chemotherapy needed for young women, even those with HR-positive, HER2-negative disease.

    http://www.sabcs.org/PressReleases/Documents/2012/ac59aa4e03d9ae94.pdf

     

    Chemotherapy After Complete Surgical Removal of Local or Regional Breast Cancer Recurrence Increased Survival Rates

    Disease-free and overall survival improved with postsurgical chemotherapy.

     Patients with ER-negative breast cancers were most responsive to treatment

    http://www.sabcs.org/PressReleases/Documents/2012/a4d71e27584748de.pdf

     

    Diverse Genetic Alterations Found in Triple-negative Breast

    Cancers After Neoadjuvant Chemotherapy

    Residual tumor cells are found in up to 70 percent of these patients.

     Multiple types of potentially actionable somatic genetic changes in the residual cancer remain in the breast after treatment.

     Molecular information from the tumor remaining after neoadjuvant therapy could lead to targeted therapies postsurgery

    http://www.sabcs.org/PressReleases/Documents/2012/a3e6cca6893ec2c0.pdf

     

    HDAC Inhibitors Sensitized Triple-negative Breast Cancer Cells to PARP Inhibition and Cisplatin Treatment

    HDAC inhibitors indirectly caused DNA damage and impaired DNA repair.

     Cellular conditions created by HDAC inhibition mimicked those in BRCA1-mutated breast cancer cells.

     Findings could have implications for hard-to-treat triple-negative breast cancer.

    http://www.sabcs.org/PressReleases/Documents/2012/8f5936de321e2688.pdf

     

    Hypofractionated Radiotherapy Was Safe, Effective for Early

    Breast Cancer Treatment at 10-year Follow-up

    Low local relapse rates were observed after breast cancer radiotherapy.

     Lower total radiation dose in fewer, larger fractions was effective.

     Three-week, 15-fraction schedule is the standard of care in the United Kingdom

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  • gpawelski
    gpawelski Member Posts: 564
    edited December 2012

    voraciousreader

    As Dr. Wolff has stated, triple-negative disease is not just one type of phenotype but an umbrella within a larger umbrella of breast cancer in which there may be patients that have what is now described as the basal-like phenotype which is derived from DNA expression studies. We have tumors that have more BRCAness to them. We have tumors that appear to have even improved prognosis because not all patients with triple-negative disease have a high risk of recurrence. Some of these tumors may have a more immune profile.

    So all of that information is beginning to be dissected in laboratory studies where they are trying to describe the "omics" of all these subtypes and generate information. The so-called "omics" techniques are yielding tremendous insights in the biology of cellular organisms. The concept of Systems Biology and the prospect of integrating transcriptomics, proteomics and metabolomics data is exciting and the integration of these fields continues to evolve at a rapid pace. What better why than to combine molecular analysis, chemosensitivity testing and therapy monitoring?

    Dr. Wolff has made a very good point. "We are getting to a point where we are moving away from a more traditional qualitative, descriptive diagnosis that in the past has served us mostly for diagnostic purposes. We are gradually moving into a future where we are beginning to understand the role of molecular observations that can allow us to do a more quantitative, a more predictive assessment of what is actually the future risk of cancer recurrence for someone diagnosed with early-stage disease, and most important, if we make a treatment decision guided by these findings, whether we will, ultimately, improve patient outcome, which is the true meaning of clinical utility."

    He further elaborated, "It has been impressive to see what has happened in the last 15 years, which truly builds on the investigations that have started years ago and are taking us to a moment where we can begin to individualize treatment decisions, not just for patient populations or groups of patients or patients participating in clinical trials, but increasingly for patients that we see in the clinical on a day-to-day basis."

    Greg

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Thanks for elaborating!  That's EXACTLY what Dr. Topol discusses in his book and what Dr. Norton discussed today as well.  I really welcome the day when we see more individualized treatment AND clinical trials based on genomics.  I think, one day soon, we will be able to look back at the last decade and say, this is where the revolution began....I have been very involved in genetics since the DH was diagnosed with an extremely rare genetic metabolic muscular dystrophy 15 years ago.  Back in the day, the specialty used to be called "Inborn Errors of Metabolism."  The progress takes my breath away.....

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  • cp418
    cp418 Member Posts: 7,079
    edited December 2012

    http://www.medpagetoday.com/MeetingCoverage/SABCS/36305

    Femara Benefits Vary by Breast Cancer Type

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    http://www.sabcs.org/PressReleases/Documents/2012/9bbbc23e9cd579ad.pdf

     

    Extending Adjuvant Trastuzumab Treatment Time

    Provided No Additional Benefit

    High number of patients who received one year of trastuzumab were disease-free eight years later.

     One year of trastuzumab showed superior safety profile with no major cardiac toxicity.

     Efficacy of two years of trastuzumab treatment was comparable to one year.

    http://www.sabcs.org/PressReleases/Documents/2012/b4f7bddc1335372c.pdf

     

    Breast Cancer Genome Sequencing Identified HER2

    Mutations as Targets for Drug Treatment

    HER2 mutations occurred separately from HER2 gene amplification and DNA sequencing is required to detect them.

     HER2 mutations are rare but can be immediately treated with existing drugs.

     Phase II study using neratinib to treat HER2 mutations is under way.

    http://www.sabcs.org/PressReleases/Documents/2012/867fefca39d34c46.pdf

     

    Cognitive Problems May Be Present Before Chemotherapy in Women With Breast Cancer

    "Chemo brain" may be an inaccurate descriptor of cognitive issues.

     Fatigue is a key contributor to cognitive problems.

     Interventions to reduce stress and fatigue may alleviate postchemotherapy neurocognitive problems.

    http://www.sabcs.org/PressReleases/Documents/2012/9d3662dd5ddcc852.pdf

     

    Adjuvant Bevacizumab Did Not Improve Invasive Disease-free Survival in Triple-negative Breast Cancer

    Safety profile was consistent with previous trials of bevacizumab.

     More understanding of triple-negative breast cancer is still needed.

     Final overall survival data are expected in 2013.

    http://www.sabcs.org/PressReleases/Documents/2012/a32a9c93d3d2859f.pdf

     

    Phase III Trial Did Not Show Superiority of Eribulin Compared

    With Capecitabine in Metastatic Breast Cancer

    Eribulin showed trend toward improved overall survival versus capecitabine.

     Eribulin showed greater activity in certain subsets of patients.

     Researchers are still gathering quality-of-life data



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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    CP418....Regarding Femara out performing Tamoxifen...our sisters need to keep in mind  in THAT study's sample population the women were POST-menopausal, whereas, in the other study regarding the benefit of 10 years of Tamoxifen being superior to 5 years of Tamoxifen, those women were PRE-menopausal.....

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  • cp418
    cp418 Member Posts: 7,079
    edited December 2012

    It was not my intent to compare medications.  I just posted the link as another presentation at the symposium.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    CP418....I figured that!Laughing  I just wanted our sisters to be aware of the differences because after awhile we all get battle fatigue and confused by all the data!

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  • cp418
    cp418 Member Posts: 7,079
    edited December 2012

    You bet!!  Just adding more topics to the list!!

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  • Racy
    Racy Member Posts: 2,651
    edited December 2012

    Thanks for the good news on Femara :-).

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  • cp418
    cp418 Member Posts: 7,079
    edited December 2012

    http://www.medpagetoday.com/MeetingCoverage/SABCS/36317

    Gentler Radiation Safe for Early Breast Cancer

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  • cp418
    cp418 Member Posts: 7,079
    edited December 2012

    http://www.medpagetoday.com/MeetingCoverage/SABCS/36336

    Best to Add Chemo After Breast Cancer Surgery

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  • lago
    lago Member Posts: 17,186
    edited December 2012

    To Clarify: Long-term results suggest that after resection of locally recurrent breast cancer, patients should also undergo adjuvant chemotherapy, researchers found.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Lago...Yes! And here's the press release regarding the announcement:

    www.sabcs.org/PressReleases/Do...

    Chemotherapy After Complete Surgical Removal of Local or Regional Breast Cancer Recurrence Increased Survival Rates

    Disease-free and overall survival improved with postsurgical chemotherapy.

     Patients with ER-negative breast cancers were most responsive to treatment

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited December 2012

    Maybe its just me but I find this discouraging. I don't see anything new here. The same old 'how long to take the post treatment drugs' discussion. I'm a triple negative and the only thing they've managed to come up with is 'its a big umbrella inside a big umbrella' disease.



    Sorry if I ruined the cornflakes for everyone but after all this time and millions of dollars (years since I was diagnosed) this seems pretty poor to me.



    I'm all about hope and I still have plenty of it but come on you doctors, scientists, etc. You can do better than this.

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  • lago
    lago Member Posts: 17,186
    edited December 2012

    AlwaysHope I agree that there hasn't been any huge news this year but these things happen in spirts. I do think that it looks like in the near future people may not be overtreated. That is a huge deal

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Alwayshope...The great news IS seen in trends.  We are beginning to see MORE and LESS treatment based on genomics and THAT'S GREAT NEWS.  And, as Dr. Larry Norton pointed out, more targeted therapies are being developed that target the bad cells and don't hurt the good cells. AND THAT'S ALSO GREAT NEWS because fewer patients will die of complications from treatment.  Don't despair....the annual ASCO conference is a few months away....

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  • MiniMacsMom
    MiniMacsMom Member Posts: 595
    edited December 2012

    My mda mo is going to a BC conference in Egypt in January. Maybe more new will be released then.

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  • besa
    besa Member Posts: 1,088
    edited December 2012

    voraciousreader-  When I looked at the full text of the tamoxifen study and my interpertation of what I read was that 89-90% of the women in the study were postmenopausal (artifical or natural menopause).  The study covers the time period from 1995 or 1996 until 2005 and I imagine that early on AIs were not being used.

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  • 1Athena1
    1Athena1 Member Posts: 6,696
    edited December 2012

    I am also slightly disappointed. Knowing that one cannot expect breakthroughs all the time, of course, but it's a shame that we can be offered no better option in this case. Some people do not respond to TAM. Some people cannot tolerate the SEs. Others may see their receptor status switched - what then? My concern is how the media is presenting this as a bc drug, when it is only a drug for bc with certain receptors.

    And given that the CYP2D6 response has been discredited as a telltale sign for who responds best to Tamoxifen, we still haven't responded to the question: who benefits? That, to me, is the most important one.

    Nor is there a response to the question of dose and frequency. Most drugs have therapeutic effects for different people at different doses and what for one person may be toxic for another may be all right.

    In short, this "more of the same" message is not the one I, personally, wanted to hear.

    I'm even less excited to hear news that, one again, is based on statistics and not on molecular biology.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Besa... Where did you find the full text? Dr. Norton mentioned on Thursday that they needed to closely scrutinize the data to determine exactly who these patients were. He said they MIGHT have been younger women and probably likely to be more PREmenopausal. That's one of the questions. If you have additional info, please let us know.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Athena... I welcome the day when the data is exclusively based on genomics. Wouldn't it be nice to know based on one's genomics which drug is most beneficial and has the least side effects??



    We are getting there. Rest assured, the revolution Dr. Topol describes is underway...

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  • besa
    besa Member Posts: 1,088
    edited December 2012

    voraciousreader- I got a copy of  the Lancet article.  It is 12 pages including references.  This is a full text journal article with LOTS of information - the breakdown of the women used in the study by diagnosis - node positive, node negative, ER+, ER-, ER unknown, etc and a breakdown of results and much more.   If I am reading the paper correctly.... I was surprised to see that the RR (relative risk) looking at distal recurrence (site of 1st recurrence) was only 0.9 comparing 10 years of tamoxifen to 5 years.  I didn't understand why Dr. Norton said he had to look at the data -- I was wondering if he just hadn't read the published paper yet.  If you read the article tell me what you think.

     

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Besa... I will have to get it from my library. Did it specifically break down pre and post menopausal and stage and grade?

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  • besa
    besa Member Posts: 1,088
    edited December 2012

    voraciousreader-  I am not sure you can get the article in the library yet - it may still be available only online.  (Published online December 5, 2012)  It broke down the women by ER status, node status, tumor size but I don't think grade.  They don't give you all the overlaps -say looking at ER positive, node negative and a certain tumor size but there is a lot of information.  I will send you a PM.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    Besa... Thanks! I appreciate it. My library usually gets me everything I request. They also have access to many online journals. I rarely pay for anything. I once got what felt like a 20 lb textbook from some medical school library delivered to me at my local library. The circulation desk and reference librarians can hardly keep up with my requests....the DH has a very rare disorder and my mucinous breast cancer is not common, so both diseases keep me very busy...

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  • pegnie
    pegnie Member Posts: 17
    edited December 2012

    Hi besa and voracious.  I got the article online using the Google search you mentioned.  But, darn if I could understand the charts.  Thought I was smart enuf to figure them out, but no, apparently not.  If either of you have the time to interpret the charts, I'll be grateful to read your notes.  Peggy

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  • Beesie
    Beesie Member Posts: 12,240
    edited December 2012

    besa and pegnie, how were you able to get the full article?  I am registered with The Lancet, although I don't have a subscription, and the most I could get was the abstract. I like digging through research tables... I wish I could get hold of the full text with the tables. 

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited December 2012

    I could only see the abstract as well. I can't wait to dig through the data!

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