LBBC Teleconference Call: Breaking News from 2009 ASCO Meeting

Living Beyond Breast Cancer Teleconference, June 11
Speaker:
Virginia Kaklamani, MD, DSc, of Northwestern University, provided an overview of the latest medical research and quality-of-life news reported at the 2009 meeting of the American Society of Clinical Oncology.

Dr. Kaklamani is an assistant professor of hematology/oncology at Northwestern University. She completed her fellowship in hematology/oncology in 2003 and received a Master of Science in clinical investigation from Northwestern University. Dr. Kaklamani has a certification from the American Board of Medical Oncology and her interests include breast cancer, cancer genetics, studying high risk families and the role of exercise and diet in breast cancer.

Lymph nodes
whether to do therapy directly on the lymph nodes or not
benefit to adding radiation to lymph node region if 1-3 positive nodes?
if larger tumor (2+ cm) and positive nodes, then some benefit to add radiation to axillary, if smaller tumor, not so beneficial.

Tamoxifen
metabolism of tamoxifen. It is the metabolized form that is the active drug. If can metabolize tamoxifen well, then it is very effective.
anti-depressants (Lexepro, Zoloft and commonly used antidepressants) may affect tamoxifen (endoxifene levels). For example, taking Zoloft reduces effectiveness. Lexepro does not interfere, so is fine to use.

Chemotherapy trials
Avastin
inhibits the blood vessels from forming. Avastin is an antibody that goes to the tumors and keeps them from growing. Allowed to use it with Taxol in breast cancer. The Ribbon 1 trial is looking at taxane and zolota to see how effective it is in combo with these. It showed that it is effective, no matter what the treatment using in combo.

Aromatese inhibitors
how they affect brain function - short term memory issues
large adjuvant trial looked at cognitive function between tamoxifen and letrozol. Letrozol did a little bit better than Tam. Study found that all participants had lower cognitive function than women of the same age

Diet, Exercise
Exercise
not a lot of data, not a lot of randomized trials -- but women who exercise do better. IT is a predictor of how women will do.
Diet
There doesn't seem to be a specific diet related to decreased breast cancer recurrence. Weight loss or at least weigh maintenance do better than women who either gain or lose weight. Weight more important than diet.
Supplements
no supplement has been foind to be helpful in protecting against or helping women with breast cancer
Vitamin D -- no difference found -- but when start measuring Vit D levels only 25% of patients are Vit D sufficient. 75% of us are Vit D deficient, therefore, we should encourage women to take supplement to maintain a healthy level of Vit D.
Ask doctor to measure Vit D level!

PARP Inhibitors
Help repair DNA -- if inhibit, it keeps DNA from being repaired -- in cancer cells this is good. For Triple Negative, there already is an issue with the repair mechanism of the cell, so if add a PARP inhibitor, the cell won't be able to survive and will die. Use PARP in Triple Negative and BRCA1/2+ carriers.
-Alaporit (oral PARP Inhibitor) -- gave only PARP Inhibitor (had had chemo before and didn't respond) 41% had response to PARP Inh. -- not much toxicity (fatigue, nausea only), so can be used effectively by itself.
-BSI201 (intravenous) -- looked at chemo with gemcitobine and carboplatin with and without PARP. By adding the PARP Inh. to the chem, respond rate increased hugely. 16% to 48%! Progression free survival increased, and significant improvement in overall survival. It is showing effectiveness in population that hasn't had many alternatives when standard treatment not working.

Excellent News about Triple Negative Breast Cancer

"Unprecendented Partnership between the Triple Negative Breast Cancer Foundation and Susan G. Komen for the Cure will Fund Collaborative Team at University of Alabama at Birmingham"

http://ww5.komen.org/KomenNewsArticle.aspx?id=16262

Yep, that's a $6.4 Million research project being funded! The project will be looking at an antibody that the researchers developed to target triple negative breast cancer tumors. A targeted therapy for Triple Negative.....that is awesome news and way overdue.

Another news story I saw today, unfortunately brings up controversy concerning legislation introduced a few weeks ago. Arguments are being made that the legislation gives false hope to young women and is unnecessary. I personally think it is wonderful to mention women under 40 in legislation and to bring awareness to the unique needs of young adults. So phooey on the politicians who think this is unnecessary and that breast cancer in women under 40 is so "rare". 

http://www.sun-sentinel.com/news/nationworld/sfl-wasserman-schultz-cancer-_a0sbapr11,0,342954.story

Notes from LBBC Teleconference "Breaking News from 31st Annual San Antonio Breast Cancer Symposium"

Speaker: Dr. Kathy Miller

Adjuvant Hormone Therapy

-Increased use of Aromatase Inhibitors -- better survival than Tamoxifen 

-Also discussed: OncoDX Score, Big 198 Study

Studies now looking at how women metabolize Tamox and Aromatase inhibitors and seeing if it is possible to choose the therapy based on the enzymes inherited (how well a person metabolizes these). Can hormone therapy be individualized to people?

-Bone health -- aromatase has increased bone loss risk, studies show bisphosphanates are important to administer immediately with aromatase therapy

Adjuvant Chemotherapy (CURE article here)

FinnXx Study -- incorporating Xeloda (capecitabine) -- HER2-, lymph node involvement 

NSABP30 Trial & BCROG(?) Trial (gave 6 cycles instead of 4). These trials looked at the TAC (Taxotere, Adriamycin, Cytoxin) regimen  and compared dosage, sequence. 

Three arms of the trials:

1. 4 Adria then 4 tax on 3 week cycle each (sequential arm) -- lower risk of recurrence of all 
   
2. 4 A + 4 T
   
3. 4TAC
   

Summary:

The second trial adminstered 6 doses versus 4. There was no significant difference found between fewer doses, but the sequential arm had the lowest recurrence of all and fewer side effects (probably due to lower dosages of the high toxicity drugs). Conclusion is that the TAC schedule does not offer improved outcome and TAC should be "retired".  Recommendations coming out are to make treatment interval every 2 weeks or taxanes weekly and get rid of the TAC regimen.

HER2+ news

Lapatnib -- benefit for metastatic HER2+ 

TDM1  (Trastuzumab)

Triple Negative Breast Cancer and Chemotherapy

approval of drug ixabepilone shows benefit for Triple Negative  (in combination with Xeloda)

Again, no studies being reported at San Antonio broke out pre- vs post-menopausal women! Argh! 

Why I Freak Out Over Being Triple Negative

Not only am I BRCA1+ and only about 5-10% of all breast cancers are hereditary breast cancers, but I was also diagnosed with Triple Negative breast cancer (TNBC), the most aggressive type of breast cancer. TNBC only represents 15% of all breast cancer cases, but accounts for as many as 25% of all cancer deaths. I feel like the odds are stacked against me. 

And you know what else is scary? Read about the founder of the Triple Negative Breast Cancer Foundation:

"Launched in 2006 in honor of Nancy Block-Zenna, a young woman who was diagnosed at age 35 with triple negative breast cancer and died less than three years later, the Triple Negative Breast Cancer Foundation focuses on raising awareness and supporting research to find a cure for the disease."

Hope For Triple Negatives?

Ran across this article about a vaccine that targets the MUC-1 protein in breast cancers, which studies are showing most triple negative breast cancers express. Wow, there might be something out there for us Triple Negs after all!

http://www.sciencedaily.com/releases/2008/12/081212141847.htm

And then go on and read this article to understand why it is so important to have something like that vaccine. And now that I am sufficiently freaking out, I will stop reading.