In another recently published NEJM article, investigators at the KATHERINE trial demonstrated significant disease-free survival in Her2 positive breast cancer patients who did not achieve complete pathologic response following neoadjuvant therapy, the study showed that such patients, when treated with T-DM1 following surgery, have better disease-free survival as compared to patients who received Trastuzumab only. This is indeed a practice changing trial. I wrote earlier about a similar trial for Her2 negative patients please find here
A recently published study at the NEJM showed that adding immunotherapy to standard chemotherapy in triple-negative metastatic breast cancer was beneficial in improving progression-free survival. I discussed treatment of triple-negative metastatic in an earlier blog here. This article brings new hope in such patients.
ASCO issued a new update on adjuvant chemotherapy recommendations in patients diagnosed with early breast, the new updated recommendations can be summarized as follow,
- Adding 6 months of Capcetabine for patients who received neoadjuvant chemotherapy and was found to have residual disease at surgery for details click here.
- For high risk Her2 positive patient-targeted therapy with trastuzumab and pertuzumab-based combination for 12 months.
- Consideration of adding Neratinib for high-risk Her2 positive patients for details click here.
For further details click here.
Not exactly news, this is well know fact. Eating more fresh fruits and vegetable and decreasing processed food was shown to prevent again breast cancer. This recently published BMJ study further confirm such facts.
Some breast cancer patients may safely avoid chemotherapy.
In a new NEJM study, breast cancer patients who are node negative with Oncotype Dx intermediate score between 11-25 was shown in a randomized prospective trial that they can achieve similar outcome when treated with endocrine therapy only as opposed to chemotherapy. This is a very welcome result to avoid confusion in patients with intermediate scores.
Treatments for breast cancer may harm the heart.
While this is not entirely new, but in a recent publication in the American Heart Association journal, the authors point to the fact that chemotherapy, targeted therapy, and radiation therapy do have a small chance for developing cardiac complications as breast cancer survivors are now living longer. The authors also point to the protective effect of exercise. Please click here for details, for my blog post on the role of exercise, click here.
New Guidelines for Breast Cancer Screening in High-Risk Women.
The American College of Radiology issued new breast cancer screening guidelines this April, this is the first time to recognize African American women as high-risk category. In summary, the ACR advocate that all high-risk women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30 so that those at higher risk can be identified and can benefit from supplemental screening. Please click here for details, for further details and actual recommendation, click here.
In Early breast cancer, low muscle mass is associated with poor overall survival.
In a recent study published in JAMA, patients diagnosed with stage II or III breast cancer and have lower muscle mass (Sarcopenia) appears to have poor overall survival, for details please click here.
Chemotherapy responders may not need sentinel lymph node biopsy.
Two new studies were presented at the 11th European Breast Cancer Conference indicate that patients who are either HER2 positive or triple negative and have no evidence of lymph node involvement at presentation (cN0) when given upfront chemotherapy with the subsequent complete resolution of the breast tumor, such patients are unlikely to have disease in the axillary lymph nodes at the time of surgery, thus such patient may be spared sentinel lymph node biopsy, for more details please click here.
Breast Cancer Genetic Screening Without Doctor Visit.
The FDA recently approved genetic screening through commercial kit provided by 23andMe. Now BRCA1, 2 screening can be done by patients without physicians ordering the tests. I should, however, instruct concerned patients to consult with their physicians for a much broader discussion regarding the implication of testing. For details please click here.
New Clinical Guideline for Whole Breast radiation.
The American Society for Radiation Therapy (ASTRO) issued new clinical guidelines regarding the use of shorter course of whole breast radiation therapy known as hypofractionated therapy. Under the new guidelines, more women with breast cancer can be treated in shorter duration and a higher dose of radiation. Hypofractionated therapy up until now was reserved for a specific group of patient, with the new guidelines more women can be candidates for such approach, for details please click here.
Lowering heart disease complications related to anti Her2 therapy.
A study recently presented at American College of Cardiology 2018 meeting demonstrated that patients who received either lisinopril or carvedilol had lower cardiac adverse effect associated with Herceptin therapy, for more details click here.