Metastatic Breast Cancer - News and Views

2009 San Antonio Breast Cancer Symposium

noreply@blogger.com (Musa Mayer) — Sat, 12 Dec 2009 19:09:00 +0000

If it's December, you'll find me hanging out with 8,400 scientists, doctors, researchers, pharma folks and advocates at the San Antonio Breast Cancer Symposium, the largest annual scientific meeting devoted exclusively to breast cancer research. Once again, I blogged the conference for CR Magazine, published by the American Association for Cancer Research.

You can read my four blog posts at http://crmagazine.wordpress.com/

Consensus on treating metastatic breast cancer

noreply@blogger.com (Musa Mayer) — Wed, 22 Jul 2009 20:34:00 +0000

What happens when a group of breast cancer experts from around the world get together and talk about the state of the art of treating metastatic breast cancer?

Find out by reading (it's a PDF you can print) this recently published, free full text article from the July 16, 2009 Annals of Oncology entitled the Third consensus on medical treatment of metastatic breast cancer

Not only does this article do a decent job of laying out treatment philosophy in a standard form, but it also pulls together the latest studies upon which current treatment practice is based. This means that if you look for your particular treatment, line of therapy or kind of breast cancer, it will be footnoted with the most relevant, most recent research findings. This is a real time and energy saver for all of us.

ASCO 2009 - PARP Inhibitors show promise with triple-negative metastatic breast cancer

noreply@blogger.com (Musa Mayer) — Thu, 11 Jun 2009 17:33:00 +0000

On May 31st, the results of a randomized Phase II study of biotech BiPar's new PARP inhibitor BSI-201 were presented at a plenary session of ASCO, the annual meeting of the American Society of Clinical Oncology, the premier scientific conference attended by over 30,000 cancer doctors from around the world. Only a very few scientific presentations from among the more than 4,000 offered at this conference get highlighted at the plenary sessions at ASCO each year, so we knew this one would be important.

This study compared Gemzar and Carboplatin with and without BSI-201 in women with triple-negative metastatic breast cancer as either the first chemo for metastatic disease, or after one or two prior chemo regimens. PARP inhibitors target a gene responsible for DNA repair, and in these women's tumors, the gene was found to be overexpressed. BiPar, recently purchased by Sanofi-Aventis--which will market the drug when it is approved--had announced interim safety data from this trial at the San Antonio Breast Cancer Symposium, finding no additional signigicant toxicity attributed to the experimental drug.

Women with triple negative metastatic breast cancer should be on the lookout for a Phase III trial of this drug very soon at www.ClinicalTrials.gov According to the BiPar website this clinical trial will be in first-, second- and third-line triple negative breast cancer, and all patients in the trial will have an opportunity for access to BSI-201 at some point in the study.

BRIDGE Global Survey: Bridging Gaps, Expanding Outreach to Metastatic Breast Cancer Patients

noreply@blogger.com (Musa Mayer) — Sat, 21 Mar 2009 21:39:00 +0000

I've just returned from a trip to Switzerland and Egypt, where as a member of the Steering Committee for the BRIDGE Survey (explained below) I presented the first results of our international study at the St. Gallen 11th International Conference and at the 2nd Annual Africa Breast Cancer Conference (AABCC). Here is some of the coverage:

"A new global survey of 950 women living with metastatic breast cancer (MBC) in nine countries (the United Kingdom, France, Spain, Belgium, Poland, the United States, Argentina, Egypt and Mexico) found that despite the negative impact of their disease, a majority still enjoy life and desire public attention that recognizes their unique experiences. Based on the survey results, the international committee of experts overseeing the survey advocate tailored education programs to raise awareness of the needs of women with MBC." Click here to read more: http://www.medpagetoday.com/HematologyOncology/BreastCancer/13258

For more about the BRIDGE Survey, including a press release, fact sheet, the steering committee and more on the Pfizer website check out www.BridgeMBC.com

More San Antonio Treatment Research News

noreply@blogger.com (Musa Mayer) — Fri, 16 Jan 2009 13:10:00 +0000

Maybe you've read my blog from the 2008 San Antonio Breast Cancer Symposium. Below are results of some of the more promising clinical trials of drugs for metastatic breast cancer that were presented at this annual meeting. Abstract numbers have links for more information.

Doxil, Avastin and Zolinza are FDA approved, while access to Omnitarg (pertuzumab) and Everolimus (RAD001) is possible through enrolling in a clinical trial.

Find more information by searching at ClinicalTrials.gov.

DOXIL There was improved time to progression and a higher response rate with Doxil (pegylated liposomal doxorubicin) plus Taxotere vs Taxotere alone in women already treated with Adriamycin or epirubicin in metastatic breast cancer. Overall survival was similar. There were comparable cardiac (heart) and hematologic (bone marrow/blood) side effects between the two arms of the study, but increased rates of hand-foot syndrome and mouth sores with the combination of Doxil and Taxotere. Abstract 80.

AVASTIN In the AVADO study, addition of Avastin (bevacizumab) to Taxotere significantly improved progression-free survival in patients with locally recurrent or metastatic breast cancer. Continued use of maintenance Avastin after discontinuation of Taxotere delayed disease progression and death compared with placebo maintenance therapy. This benefit was unrelated to particular patient and disease characteristics. Abstract 903.

PERTUZUMAB Two phase II trials have already shown there is synergistic activity of Omnitarg (pertuzumab) and Herceptin (trastuzumab) in patients with HER2-positive metastatic breast cancer. No side effects that require limiting the dose were seen. A Phase III trial of pertuzumab plus trastuzumab is currently recruiting patients with previously untreated HER2-positive metastatic breast cancer. Abstract 3138.

EVEROLIMUS (RAD001) in combination with Navelbine (vinorelbine) and Herceptin(trastuzumab) is a feasible treatment combination in patients with Herceptin-resistant metastatic breast cancer. Preliminary efficacy data from this Phase I study show high rates of stable disease. A 30 mg/week dose seems feasible, while a 5 mg/day dose is still under investigation. The treatment was generally well tolerated, with neutropenia being the most common treatment-related serious side effect. Abstract 406. In another Phase I study, Evorolimus in combination with Herceptin and Taxol, there was promising response in heavily treated patients whose tumors showed prior Herceptin resistance. Abstract 3119.

VORINOSTAT Given at 300 mg twice daily in combination with Avastin (bevacizumab) and Taxol (paclitaxel) Zolinza (vorinostat) showed activity in patients with previously untreated metastatic breast cancer. The treatment was generally well tolerated; however serious side effects included neutropenia, diarrhea, and sensory neuropathy. Abstract 404.

From Fear to Hope

noreply@blogger.com (Musa Mayer) — Fri, 26 Dec 2008 17:08:00 +0000

I sometimes write for CR Magazine, published by the American Association for Cancer Research. A recent article on a research Center of Excellence I've been working with is posted on their website:

"From Fear to Hope: New research efforts aim for better understanding and treatment of brain metastases"

Blog from the 2008 San Antonio Breast Cancer Symposium

noreply@blogger.com (Musa Mayer) — Sat, 13 Dec 2008 15:25:00 +0000

I am writing this from the 2008 San Antonio Breast Cancer Symposium, where I'm blogging for CR Magazine on the largest annual breast cancer research conference in the world. Over 9,000 researchers, oncologists, pharmaceutical industry people and advocates from around the world are spending four days in San Antonio, Texas, listening to the most interesting and newsworthy research of the year.

You can reach my blog, and some interesting podcasts by following this link.

Of particular interest to women with metastatic disease will be today's blog, which I entitled: "Something old, something new: Promising treatments and strategies for metastatic breast cancer."

Let me know what you think!

A step towards individualizing chemotherapy for triple-negative breast cancer

noreply@blogger.com (Musa Mayer) — Wed, 12 Nov 2008 21:43:00 +0000

Here's a step in the direction of individualizing chemotherapy choices.

A small study published in this month's Annals of Oncology, "Platinum-based chemotherapy in triple-negative breast cancer," supports earlier findings that women with triple-negative (TN) breast cancer may be more likely than other patients to respond to one of the platinum chemotherapy drugs, Carboplatin and Cisplatin.

In the study, the response rates of women with TN and other forms of breast cancer were compared after treatment with platinum chemotherapy. Some of these patients had locally advanced breast cancer and some were being treated for metastatic disease, but in both groups, the TN patients responded significantly better.

Annals of Oncology 2008 19(11):1847-185
Platinum-based chemotherapy in triple-negative breast cancer

B. Sirohi, Smith, I. et al. Breast Unit, Royal Marsden NHS Foundation Trust, London. E-mail for reprint: ian.smith@rmh.nhs.uk

Background: Experimental data suggest that triple-negative (TN) breast cancer may have increased sensitivity to platinum-based chemotherapy but clinical data are limited. We present our long-term results with platinum-based chemotherapy for TN breast cancer.

Patients and methods: In all, 94 (17 TN), 79 (11 TN) and 155 (34 TN) patients receiving platinum-based chemotherapy in neo-adjuvant/adjuvant and advanced setting were included. Response rates and outcome were compared for TN tumours versus others.

Results: Neo-adjuvant complete response rates were significantly higher for TN tumours (88%) than others (51%; P = 0.005). The 5-year overall survival (OS) for TN tumours following adjuvant/neo-adjuvant chemotherapy was 64% [95% confidence interval (CI) 44% to 79%] compared with 85% (95% CI 79% to 90%) for others. Five-year disease-free survival for TN tumours was 57% (95% CI 37% to 73%) compared with 72% (95% CI 64% to 78%) for others. For patients with advanced breast cancer, overall response rates were 41% for TN tumours and 31% for others (P = 0.3). Patients with TN tumours had a significantly prolonged progression-free survival of 6 months compared with 4 months for others (P = 0.05), though the OS was not significantly different between the two groups (11 versus 7 months).

Conclusion: Platinum-based chemotherapy achieves increased response rates for TN tumours, with a trend towards worse survival in early breast cancer through an improved survival in advanced disease. Prospective randomised trials are warranted.

Write your heart out!

noreply@blogger.com (Musa Mayer) — Wed, 12 Nov 2008 21:36:00 +0000

This interesting randomized trial confirms what a lot of other research has shown: that people with all sorts of serious diseases feel better (and may even do better) when they express their strong feelings through writing. This study finding builds on a lot of prior research.

I've always felt that this is one of the unsung effects of cancer mailing lists like the BCMETS list (and bulletin boards and blogs, and of course journaling where people not only exchange information, but often write on a deep level of their experiences). Not only do people make contact with one another and feel less alone, and get good advice and information, but they have an opportunity to articlulate their deepest feelings.

Journal of Pain and Symptom Management, Volume 35, Issue 6, June 2008, Pages 623-631

Emotional Disclosure Through Patient Narrative May Improve Pain and Well-Being: Results of a Randomized Controlled Trial in Patients with Cancer Pain

M. Soledad Cepeda MD, PhD et al.

Narrative medicine is based upon physicians' awareness of patients' narration of their suffering, their hopes, and how illness has affected them. It offers a model for improving health outcomes.

To determine whether incorporating a narrative approach in patients with cancer decreases pain intensity and improves their global sense of well-being, we performed a randomized, single-blind controlled trial in adult patients with cancer and average pain intensity levels of at least 5/10.

Two hundred thirty-four patients were randomized into three groups: (1) narrative (n = 79), in which patients wrote a story about how cancer affected their lives for at least 20 minutes once a week for three weeks; (2) questionnaire (n = 77), in which patients filled out the McGill Pain Questionnaire; and (3) control (n = 78), in which patients came weekly to medical visits during which they received usual customary care. Patients rated their pain on a 0�10 scale and their well-being on a seven-point Likert scale weekly for eight weeks. Two raters independently evaluated the emotional content of the narratives.

Pain intensity and sense of well-being were similar in all groups before and after treatment.
Subgroup analyses showed that patients whose narratives had high emotional disclosure had significantly less pain and reported higher well-being scores than patients whose narratives were less emotional. Further study is needed to demonstrate whether the implementation of narrative medicine is associated with health benefits in this and other contexts.

Resveratrol and BRCA mutations

noreply@blogger.com (Musa Mayer) — Mon, 13 Oct 2008 13:34:00 +0000

A number of studies have suggested that a substance found in red grapes and red wine may serve as a cancer preventive. Now research outlines a mechanism whereby inherited BRCA mutations, which occur in about 8% of breast cancers, may be inhibited by resveratrol.

New Findings May Improve Treatment Of Inherited Breast Cancer
(from ScienceDaily Oct. 11, 2008, published in the journal Molecular Cell)

This research in animals and cell cultures will have to be confirmed in human subjects, of course. Initial studies are underway looking at a cancer preventive role for resveratrol in health subjects, as well in colon cancer and lymphoma patients.

--Musa

Bone mets pain and IV Bisphosphonates--what is the evidence?

noreply@blogger.com (Musa Mayer) — Mon, 13 Oct 2008 04:37:00 +0000

Here's a just-published survey of studies on various methods for the relief of the pain of bone mets, available in full text. Metastatic bone pain: treatment options with an emphasis on bisphosphonates is by a group of Swiss researchers, and is published in the journal Supportive Care in Cancer.

What I find interesting is this article's focus on the available evidence for the use of IV bisphosphonates, Aredia (pamidronate) and Zometa (zoledronic acid) for the relief of pain. Taking one of these two drugs is the recommended standard of care for all women with bone mets--although optimal frequency is still unclear, because of osteonecrosis of the jaw (ONJ) in some patients.

Today, painful broken bones and the surgeries to repair them are far less common than they were a decade ago. Very high levels of calcium dissolved into the blood, known as hypercalcemia, are no longer a frequent late complication.

Now, evidence from many randomized controlled trials confirms that these drugs also help to reduce bone pain. Of course, women have been telling us this for years!

Musa

Welcome and metronomic therapy

noreply@blogger.com (Musa Mayer) — Thu, 09 Oct 2008 23:35:00 +0000

I'm Musa Mayer, advocate and author. I've just re-launched my website AdvancedBC.org with lots of new information and resources for people living with metastatic breast cancer, gathered on one convenient website. In this blog, I'll be sharing new research and treatment information about metastatic breast cancer as it emerges.

The most intriguing research I've seen in the last couple of weeks was a low-dose metronomic treatment study in 46 Italian women with metastatic disease. In this study patients were given low-dose Xeloda and Cytoxan on a daily basis, combined with Avastin every three weeks. Two-thirds of patients showed clinical benefit, with either their tumors shrinking or their disease stabilizing for at least six months. It's a small study, but promising. Write me for the full text of this paper.

Metronomic Cyclophosphamide and Capecitabine Combined With Bevacizumab in Advanced Breast Cancer
Silvia Dellapasqua, Marco Colleoni et al.
Journal of Clinical Oncology 26, 2008

Purpose. Metronomic chemotherapy has shown efficacy in patients with metastatic breast cancer. When used in association with targeted antiangiogenic drugs, it was more active than metronomic therapy alone in preclinical and clinical studies.

Patients and Methods. Patients with advanced breast cancer were candidates to receive metronomic oral capecitabine (500 mg thrice daily) and cyclophosphamide (50 mg daily) plus bevacizumab (10 mg/kg every 2 weeks).

Results. In 46 assessable patients, we observed one complete response (CR; 2%), 21 partial responses (PR; 46%), 19 patients (41%) with stable disease (SD), and five patients (11%) with progressive disease, for an overall response rate of 48% (95% CI, 33% to 63%). Additional long-term disease stabilization (SD 24 weeks) occurred in eight patients, for an overall clinical benefit (CR+PR+SD=24 weeks) of 68% (95% CI, 51% to 81%). Median time to progression was 42 weeks (95% CI, 26 to 72 weeks). Toxicity was generally mild. Grade 3 or 4 nonhematologic adverse effects included hypertension (n 8), transaminitis (n 2), and nausea/vomiting (n 2). Higher baseline circulating endothelial cells (CECs) were correlated with overall response (P .02), clinical benefit (P .01), and improved progression-free survival (P .04).

Conclusion. Treatment with metronomic capecitabine and cyclophosphamide in combination with bevacizumab was effective in advanced breast cancer and was minimally toxic. The number of baseline CECs significantly correlated with response and outcome, therefore supporting further studies on this surrogate marker for the selection of patients to be candidates for antiangiogenic treatments.

--Musa