FORCE has a strong commitment to promoting research to benefit our community. We advocate for more research funding, educate people about available studies, and report findings back to our community.
by Piri Welcsh, PhD, VP, Education and Research and Medha Sutliff, MS, Director, Education and Research
Each December, FORCE staff members travel to the San Antonio Breast Cancer Symposium (SABCS), one of the largest breast cancer meetings in the world. More than 7,000 oncologists, cancer researchers and patient advocates attend annually. SABCS focuses on new research and updates, including breaking news on studies, promising new potential treatments, less invasive or less toxic treatments, managing side effects and much more. Here are some highlights from the 2017 session:
Thousands of women are treated annually with aromatase inhibitors (AIs), medications that stop the production of estrogen and starve hormone receptor-positive breast cancer cells. Up to 50% of them experience treatment-related joint pain and stiffness. Many of them may be reluctant to take additional medication to relieve their symptoms. AI-induced joint pain is one of the primary reasons that early-stage breast cancer patients do not follow their prescribed AI treatment regimen. Dawn Hershman, MD, from Columbia University, and colleagues conducted a multicenter, randomized, blinded trial evaluating whether acupuncture could reduce joint symptoms from aromatase inhibitor treatment.
Acupuncture is a traditional Chinese medical treatment involving the insertion of fine, sterile needles into defined acupoints. Used for thousands of years in Asia, the benefit of acupuncture has been established by Western research, and it is now widely used to improve a variety of ailments. Data from the randomized, phase III SWOG S1200 trial showed that for breast cancer patients treated with AIs, acupuncture significantly reduced joint pain compared to both sham (shallow insertion of thinner, shorter needles near non-acupoints adjacent to affected joints) acupuncture and no treatment. On average, patients experienced less pain on the acupuncture arm experiencing relief for up to 24 weeks, well past the 12-week study period compared to patients on the sham and treatment-free arms. Dr. Hershman concluded, “We feel that acupuncture provides a non-pharmacologic option that can improve symptoms, possibly increase AI adherence, and improve subsequent breast cancer outcomes.” The investigators hope these results will influence health care providers as well as health insurers' willingness to reimburse for acupuncture during aromatase inhibitor treatment.
Dr. Matteo Lambertini, a SABCS clinical scholar awardee, presented results of a study to determine whether temporary ovarian suppression with gonadotropin-releasing hormone analog (GnRHa) during chemotherapy can preserve ovarian function and fertility in patients with premenopausal early breast cancer. (GnRHa is a synthetic version of naturally occurring GnRH that stimulates reproductive function in men and women.) Data were collected from 5 randomized clinical trials PROMISE-GIM6, POEMS/SWOG S0230, Angelo Celtic Group OPTION, GBG-37 ZORO and a trial led by Moffitt Cancer Center involving premenopausal women with early-stage breast cancer who were randomly assigned to chemotherapy alone or chemotherapy with GnRHa. More than two-thirds of the women were younger than age 40 at diagnosis.
Patients who received GnRHa had reduced rates of premature ovarian failure compared to controls (14.1 % versus 30.9%, respectively). After 5 years, however, no significant differences were observed in disease-free or overall survival between the two groups. This study suggests that administering GnRHa during chemotherapy can reduce the likelihood of chemotherapy-induced ovarian failure in young women, and may improve future fertility for premenopausal early-stage breast cancer patients who undergo chemotherapy. These results are significant because the practice of using temporary ovarian suppression with GnRHa during chemotherapy is controversial, and it is still considered experimental by both the American Society of Clinical Oncology and the European Society of Medical Oncology.
Joseph Sparano, MD, from the Albert Einstein Cancer Center, presented intriguing data regarding recurrence in women who had been diagnosed with hormone receptor (HR)-positive, HER2-negative stage II or III breast cancer. At 5 years beyond their initial diagnosis, those with circulating tumor cells (CTC) in their blood had an increased risk for late recurrence, even though they showed no other clinical evidence of recurrence.
Study participants were previously enrolled in a clinical trial that assessed the addition of bevacizumab, an agent that decreases the formation of blood vessels in tumors, to chemotherapy after surgery. Sparano and colleagues measured CTCs in blood samples from 546 patients who were between 4.5 and 7.5 years after initial diagnosis. More women with HR-positive disease had a positive CTC result (5.1% compared to 4.3% of HR-negative patients who had positive CTC results), and had an overall higher recurrence rate than the HR-negative group (4.5% and 0.5%, respectively). After a median follow-up of 1.6 years, a positive CTC result increased the risk of recurrence by nearly 20-fold in patients with HR-positive disease.
“We found that a single positive CTC assay result five years after diagnosis provides independent prognostic information for late recurrence,” Sparano said. He also stated that although researchers expected that women with CTCs were more likely to experience a recurrence, they were surprised that the risk was this high and this soon after diagnosis.
In 2017, the FDA approved the first liquid biopsy test (involving blood rather than surgical biopsy) for people with lung cancer. This study shows that a similar procedure for CTC screening may accurately identify patients with a high risk for recurrence who would most benefit from extended adjuvant endocrine (hormone) therapy or other treatments.
Richard Gray from the University of Oxford presented results from the Early Breast Cancer Trialists’ Collaborative Group on how the dose and length of anthracycline- and taxane-based chemotherapy affects breast cancer recurrence and mortality.
Results of several analyses were discussed. One analysis showed that compared to standard regimens, more frequent chemotherapy improved rates of recurrence and survival. In this study, the rate of recurrence was significantly reduced in women who received chemotherapy every 2 weeks compared with those who had the same, consistent dose treatment every 3 weeks (24% versus 28.3% respectively); the 10-year rate of mortality was also improved in the 2-week group (16.8% versus 19.6%, respectively).
Another analysis showed that increased doses of chemotherapy given every 2 weeks improved recurrence and mortality rates compared to a consistent dose (with no increase) given every 3 weeks. Overall, women who received the increased, more frequent doses had statistically significant reduced rates of recurrence (13%) and death (10%). Over a 10-year follow-up period, the increased rate, 2-week group had better results than the consistent-dose, 3-week group for recurrence (30% compared to 34%) and mortality (22% compared to 26%).
This study’s conclusion supports previous study findings. Combined data from 25 other trials show that shorter frequency/higher dose chemotherapy regimens resulted in an overall 15% reduction in recurrence and a 13% reduction in mortality compared to consistent-dose treatment. These significant reductions occurred among women with either ER-negative or ER-positive disease, and did not differ by any particular patient or tumor feature.
Arm morbidity is the most common late effect following axillary surgery, presenting as lymphedema in approximately 21% of patients with breast cancer, and shoulder impairment in 4% to 28% of patients. Results of a study, presented by Anne Kuijer, PhD, a postdoctoral research fellow at Dana-Farber Cancer Institute/Brigham and Women's Hospital, and a surgical resident at Diakonessen Hospital Utrecht, Netherlands, showed that younger breast cancer patients who underwent axillary lymph node dissection (ALND) (removal of many lymph nodes) were more likely to experience arm swelling and decreased range of arm motion than patients who received sentinel lymph node biopsies (SLNB).
Arm morbidity is of particular concern for young patients, given their long survivorship, active lifestyle and the importance of body image. Investigators examined patient-reported outcomes from 1,302 women aged 40 or younger who were enrolled in the Young Women’s Breast Cancer Study, a multicenter prospective cohort project established to explore biological, medical and psychosocial issues in young breast cancer patients.
The study results suggest that certain patient factors were associated with greater risk of arm morbidity. Being overweight at the time of diagnosis increased the risk for arm swelling and decreased range of motion. Financial status also played a part: women who described themselves as financially comfortable were less likely to develop arm swelling, suggesting that access to postsurgical counseling and services may also plays a critical role.
Investigators pointed out that these study results underscore the benefit of SLNB rather than ALND when appropriate in young breast cancer patients, and show that even conservative surgery can have long-lasting effects. These findings should encourage young women to talk to their doctors about all of their surgical options and expected outcomes.