GRACE :: Breast Cancer

Breast Cancer Therapy

Dr West

Dr. Hy Muss on Breast Cancer in Older Women: Advanced/Metastatic Cancer and Importance of Functional Status

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Dr. Muss closes his presentation with a discussion of the importance of assessing functional status of older patients with breast cancer, as well as other cancers, in making recommendations for the optimal treatment approach.  Here he describes the potential value of more aggressive treatments, along with the need to be judicious in our recommendations in order to reduce the risk of patients developing prohibitive side effects from the therapy.

Below you’ll find the video and audio versions of the podcast along with the transcript and figures for this program.

Muss BC in Older Women Pt 4 Advanced BC and Functional Assessment Audio Podcast

Muss BC in Older Women Pt 4 Advanced BC and Functional Assessment Transcript

Muss BC in Older Women Pt 4 Advanced BC and Functional Assessment Figs

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Dr West

Breast Cancer in Older Women: Surgery and Adjuvant Therapy, by Dr. Hy Muss

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Dr. Hy Muss, breast cancer expert with a special expertise in treatment of older patients with cancer, continues his presentation on breast cancer in older women with a discussion of the evolution of surgery recommendations in breast cancer, along with a wonderful discussion of how he approaches the benefit vs. risk discussion for post-operative (adjuvant) therapy.  I found myself thinking that his explanation was so helpful that I’d want to incorporate elements of his presentation into my own discussions of the complex issues around adjuvant therapy.

Here are the video and audio versions of the program, along with the associated transcript and figures.

Muss BC in Older Women Pt 3 Surgery and Adjuvant Rx Audio Podcast

Muss BC in Older Women Pt 3 Surgery and Adjuvant Rx Transcript

Muss BC in Older Women Pt 3 Surgery and Adjuvant Rx Figures

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Is One Year of Adjuvant Herceptin for Early Stage Breast Cancer Really Optimal?

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Since the FDA approval of Herceptin in the adjuvant setting for HER2-positive, early stage breast cancer, one year of Herceptin has been the standard length of therapy. This was based on the design of multiple, large, randomized trials that were published in 2005. Many people, however, argued that the choice of one year was not based on scientific data, and that is was somewhat arbitrary. Two studies presented at the 2012 Congress of the European Society for Medical Oncology (ESMO) in Vienna this past week, however, supported the belief that one year of therapy is optimal. In the two studies presented at ESMO, investigators evaluated both shorter and longer durations of Herceptin treatment.

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New Targeted Therapy approved for ER-positive, HER2-negative Breast Cancer: Afinitor with Aromasin

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On July 20, 2012, the U.S. Food and Drug Administration (FDA) gave us another option for treating postmenopausal patients with metastatic, ER-positive, HER2-negative breast cancer whose disease has progressed on Arimidex or Femara by approving Afinitor (everolimus) in combination with Aromasin (exemestane). This new approval was based on the BOLERO-2 trial which was a randomized, double-blind, multicenter trial conducted in 724 postmenopausal women.  Patients were randomized to receive either Afinitor 10 mg/day plus Aromasin 25 mg/day or to placebo plus Aromasin 25 mg/day. Both Aromasin and Afinitor are oral drugs.

Aromasin is an aromatase inhibitor which works by lowering estrogen levels in postmenopausal women. This trial was based on the observation that resistance (either not responding or stopping responding) to hormonal therapy is associated with a tumor being able to use pathways other than the estrogen pathway to survive and grow. One example of this is activation of the mammalian target of rapamycin (mTOR) signaling pathway in cells. Afinitor targets the mTOR pathway and is classified as an mTOR inhibitor. 

On the BOLERO-2 trial, the median progression-free survival (PFS) was longer for the patients receiving Afinitor (7.8 vs 3.2 months). These results were consistent regardless of age, race, presence or extent of visceral metastases (such as liver metastases), and response to prior hormonal therapy.  The response rate was also better for the patients receiving Afinitor (12.6% vs 1.7%).  The analysis of overall survival (OS) was not significant however this was an interim analysis.  The final OS analysis isn’t expected to become available until June, 2014.

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Perjeta (Pertuzumab) Approved by FDA for HER2-Positive Advanced Breast Cancer

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On June 8, The U.S. Food and Drug Administration (FDA) approved Perjeta (pertuzumab) to treat patients with metastatic, HER2-positive breast cancer who have not received previous treatment with either chemotherapy or HER2-targeted therapy. Approximately 20-30% of breast cancer is HER2-positive.

Herceptin is a monoclonal antibody that works by blocking HER2. While Perjeta also targets HER2, it binds to a different area of the HER2 protein and prevents the HER2 protein from combining with other HER receptors (HER1, HER3, and HER4). This prevents tumor growth and survival. Perjeta’s mechanism of action is therefore believed to be complimentary to that of Herceptin. In fact, Perjeta by itself has very little activity; its real use is in combination with Herceptin.

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