Breast Cancer News from ASCO 2013

Christine Wilson, cancer survivor, shares her experiences from the The American Society of Clinical Oncologists (ASCO) national conference in 2013. Every year in the first week of June, over 30,000 cancer specialists and researchers from around the world gather to present their latest findings on the prevention, diagnosis and treatment of science. At a recent continuing medical education meeting, experts from the Abramson Cancer Center summarized some of the most important research from ASCO 2013 for a packed room of over 300 local oncologists. 

In this blog, Chris presents information from Kevin Fox, MD, director of the Rena Rowan Breast Center at Penn Medicine

Extending Tamoxifen Therapy Beyond Five Years

Tamoxifen has proven remarkably effective in preventing recurrences of hormone dependent breast cancer, but it is also associated with some significant side effects. A major study done in Great Britain showed a slight advantage to extending tamoxifen therapy for 10 years, but also a higher incidence of pulmonary embolism and uterine cancer. The study reinforces the need for women with this type of breast cancer to talk to their doctors about their preferences.

Neoadjuvant Therapy for HER2 Positive Patients

Neoadjuvant therapy means treating people before their surgery. It is in Dr. Fox’s words, “a rich area for clinical research.” For patients with aggressive or high risk disease, it offers the prospect of attacking the cancer when it is in its earliest stage, for other women, it can provide a way of making breast conserving surgery possible. It also subjects women to additional treatment. The two major issues with neoadjuvant therapy are:

1. Which women will benefit from this approach?
2. How can the success of this treatment be measured. Most trials measure success in terms of disease free survival, progression free survival or overall survival, but these endpoints cannot be applied to neoadjuvant trials. The current outcomes measurement is called pathologic complete response, pCR, or the complete disappearance of all evidence of disease prior to surgery.

The bottom line for now is that, if the decision is made to give neoadjuvant therapy to HER2 positive patients, the regimen should trastuzumab and one additional agent. Questions remain, however, as when to use this therapy and how best to measure its success.

In another study, neoadjuvant therapy did result in changing the decision about the type of surgery from mastectomy to breast conservation in 43% of patients.

Sentinel Lymph Node Dissection

Sentinel lymph node dissection has now been established as standard for most women with breast cancer. Two studies presented at ASCO 2013 addressed issues related to this procedure.

• The first determined that although microscopic signs of cancer can be found in 25% of sentinel nodes identified as negative when they are more closely examined, this finding has little clinical significance, and in Dr. Fox’s words “is not worth doing.”
• The AMAROS trial randomized women undergoing SNL biopsy with a positive lymph node into either completion lymph node dissection or radiation therapy. The study found no difference in the axillary recurrence rate-which was very low in both groups--but did determine that women who had the additional surgery had twice the incidence of lymphedema as those who got radiation therapy.

The Natural History of Small HER2 Positive Tumors

HER2 Positive tumors are known to have a poorer prognosis, but the tendency has been not to treat very small tumors aggressively. A new analysis showed that patients with small HER2 Positive tumors do benefit from systemic adjuvant therapy.

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