 Forty percent of advanced estrogen-receptor-positive (ER+) breast cancer patients have mutations that result in uncontrolled activation of the PI3K pathway. This pathway is involved in resistance to endocrine therapies and can promote the growth of ER+ breast cancer cells. SOLAR-1 is a phase III clinical trial of 572 patients with advanced ER+, HER2-negative breast cancer. The trial investigated whether there is a benefit to adding alpelisib, a drug that blocks the PI3K pathway, to treatment with fulvestrant (Faslodex), an anti-estrogen receptor drug. The addition of alpelisib resulted in a clinically meaningful extension of median progression free survival from 5.7 months to 11 months in both endocrine therapy sensitive and endocrine therapy resistant patients. Overall survival data will be reported in the future. The main side effect due to inhibition of PI3K was hyperglycemia (elevated blood glucose levels), which was easily detected and managed with oral medication. (Abstract GS3-08) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org.
0 Comments
 The standard of care after lumpectomy for early-stage breast cancer typically includes whole breast radiation (WBI) to reduce the risk of local recurrence. WBI is usually delivered daily for 3–6 weeks. Several recent studies have investigated the effectiveness of accelerated partial breast irradiation (APBI), which restricts the radiation to the area of the original tumor. Partial breast radiation may be a more palatable option for patients and oncologists, as a smaller area of the breast is irradiated in a shorter time period compared to WBI. Vicini et al. reported the results of the NSABP B-39 trial involving three different types of partial breast radiation (balloon catheter, multi-catheter, and 3D-CRT) delivered twice a day for five days, compared to WBI delivered daily for 25 days. This study of 4,216 patients with early-stage breast cancer found that APBI was statistically not equivalent to WBI at preventing a recurrence in the breast, but the absolute difference between the two techniques was very small, less than 1%. Side effects were low but more common in patients treated with APBI. The authors concluded that APBI may be an acceptable option for some patients. (Abstract GS4-04) The RAPID trial found that delivering APBI twice a day with an external beam (3D-CRT) is equivalent to standard WBI at reducing recurrence in the breast. Short-term side effects (radiation dermatitis and breast swelling) were less with APBI; however, over time APBI resulted in more toxicity to normal tissue (fibrosis, spider veins) and worse cosmetic outcomes when compared to WBI. As a result of these late side effects, the researchers remarked that they are unable to recommend the twice-a-day 3D-CRT APBI regimen for routine use. They are currently investigating the use of once-a-day 3D-CRT APBI. (Abstract GS4-03) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org.  Triple-negative breast cancer is characterized by the lack of the estrogen receptor, progesterone receptor, and HER2 receptor. Chemotherapy is the mainstay of systemic treatment for this type of cancer. A study led by researchers in Peru found that the time to initiation of chemotherapy is important for women diagnosed with stage II-III triple-negative breast cancer. Women who started chemotherapy more than 30 days after surgery had a higher risk of recurrence and lower overall survival compared to women who started chemotherapy 30 days or less after surgery. The longer the delay in chemotherapy, the worse the outcomes. (Abstract GS2-05) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org.  A 2017 Gallup poll indicated that 64% of Americans now support cannabis legalization, as many are turning to cannabis to safely and effectively treat symptoms related to neurological disorders, cancer, psychological disorders, gastrointestinal disease, infectious disease, and inflammatory disease. How can one plant help with so many conditions and have so few side effects? To understand the answer, you must understand the endocannabinoid system. All living organisms regulate their internal environment to maintain the relatively narrow range of conditions needed for proper cell function. For example, your body temperature needs to be kept relatively close to 98.6 degrees Fahrenheit. Your body’s pH must be kept within a very narrow range to survive and function. Your blood must approximate specific levels of systolic and diastolic pressures to remain healthy. This maintenance of a stable internal environment, even in the face of an ever-changing external environment, is called homeostasis. All mammals have a physiologic system, called the endocannabinoid system (or ECS), and its job is to maintain this cellular homeostasis. Since its discovery in 1992, we’ve learned that the ECS regulates mood, appetite, sleep, pain, and memory. For example, a stimulation of the ECS can reduce inflammation, relax muscles, lower blood pressure, dilate bronchial passages, and normalize over-stimulated nerves. Research suggests that many disease states arise from a deficiency in the ECS. This condition is called Clinical Endocannabinoid Deficiency (CED), and there is speculation that this deficiency may be the cause of fibromyalgia, migraines, irritable bowel syndrome, cancer, depression, anxiety, heart disease, stress, cystic fibrosis, phantom limb pain, post-traumatic stress disorder, and dysmenorrhea. Dr. Ethan Russo has suggested that all humans have a base level of endocannabinoids (neurotransmitters that our bodies naturally produce), and when this level is deficient, it manifests in diseases marked by chronic pain, dysfunctional immune systems, fatigue, and mood imbalances. If your ECS is failing to function at its optimal level, can you address this deficiency with cannabis? The research clearly demonstrates that, because plant-based cannabinoids mimic the effect of our endocannabinoids, the cannabinoids found in cannabis can be palliative, preventative, and curative. How can cannabis help you? Cannabis has demonstrated safety and efficacy when treating the following symptoms and conditions: + Insomnia and Sleep-Related Issues You can use cannabis to help treat insomnia and other sleep-related conditions. Cannabis can be more effective and safer than many pharmaceutical sleep aids, which can cause harmful side effects, especially in seniors. Diphenhydramine and Zolpidem, for example, are not recommended for patients over the age of 65. Small amounts of THC (average doses range from 2.5 mg to 10 mg) when smoked or vaporized can help you fall asleep. Myrcene, a compound commonly found in many cannabis strains, can also help you fall asleep. Edibles and tinctures are also good options for treating sleep issues. The effects of orally and sublingually ingested cannabis last longer than the effects of smoked cannabis, and many patients use edibles to help stay asleep through the night. However, dosing is critical: 2.5 mg to 5 mg is commonly sufficient for an average quality of sleep. + Chronic Pain When used to treat chronic pain, cannabis is not toxic like opioids and other non-narcotic pain medications. Unlike opioids, cannabis does not cause constipation (though it can exacerbate it), does not cause any physical dependence, and has fewer side effects. Also, there is no lethal dose of cannabis. Cannabis works synergistically with opioids. Clinical studies have demonstrated that patients use fewer opioids when medicating with cannabis. The cannabis treatment recommended for chronic pain patients depends on the type of pain. An experienced healthcare professional can help you determine how best to use cannabis to treat pain. + Anxiety and Depression Anxiety and depression are often a result of other underlying issues: pain, insomnia, other health issues, fear of aging and dying, or the loss of a spouse. Many of the medications prescribed for anxiety and depression are associated with severe side effects. These medications can be addicting and nearly impossible to wean from completely. Benzodiazepines, for example, are extremely difficult to stop using. Cannabis has long been used to treat depression and anxiety—one of the first Western references was in 1621. Cannabis can help treat psychological disorders by enhancing mood, providing energy and focus, relieving anxiety, inducing hunger, and combating insomnia. Stress is one of the leading causes of depression, and moderate use of cannabis can alleviate stress and stabilize moods. A 2006 study demonstrated that both occasional and daily cannabis users have lower levels of depressive symptoms than non-users. Another study at McGill University in Montreal demonstrated that THC in low doses produces serotonin and can act as an antidepressant. + Appetite and Weight Loss Issues Appetite issues and weight loss are commonly a result of cancer, aging (because of changes to the taste buds), pain, or as a side effect of prescribed medications. Cannabis has demonstrated efficacy in increasing appetite when treating patients with HIV, cancer, or other diseases associated with muscle wasting (also known as cachexia). Cannabinoids can activate the CB1 receptor to affect appetite stimulation. This process may also be associated with the release of ghrelin (known as the “gut-brain hormone”), a peptide hormone that is secreted from the stomach and intestines to increase hunger. And, cannabis can be very effective for treating nausea and vomiting. Regardless of the symptom or side effect that you want to treat, you should work with an experienced and knowledgeable healthcare professional who can help you create an individualized treatment plan. Generally, you should start with a low dose, then slowly and iteratively increase the dose until you reach efficacy. Starting with a low dose minimizes unwanted side effects and reduces the chances of building a tolerance to the effectiveness of your dose. A treatment plan should always include how much of a medicine to take, how frequently to take it, how long to take a specified dose, when and under what circumstances you should increase your dose, as well as the predicted length of therapy. Also, a healthcare professional can help you determine which routes of administration might best affect your condition. For example, if you’re treating constant arthritic pain, you might need to apply a topical directly to the area, ingest cannabis to help treat the pain throughout the day, and inhale cannabis to treat breakthrough pain. Even with this guidance, some experimentation is often necessary. You might need to further individualize your treatment plan to fit your lifestyle by experimenting with different cannabinoids, dosages, and frequencies. And, of course (as with any therapeutic substance) cannabis can produce side-effects. Typically, adverse effects are dose-dependent and are much better tolerated than those associated with corresponding prescription medications. Despite these concerns, many patients find relief with cannabis—it can be a safe and effective choice for treating age-related and chronic illness, and for possibly reducing your intake of pharmaceuticals that have severe side effects. Patience and persistence often pay off. About the Author: Timothy Byars Timothy Byars, CEO, Radicle Health and Eloise Theisen, RN, MSN, AGPCNP-BC CVO, Radicle Health Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect those of Bay Area Cancer Connections. This article was selected for publication in response to requests from our clients, who have asked for information on cannabis. It is not considered comprehensive and is intended for informational purposes only. For additional information on cannabis, please explore the links listed below or contact our Medical Information Service. This information does not substitute for
medical care, and should not be used for the purposes of diagnosis or treatment. As each medical condition is unique, we strongly advise you to consult your physician with questions about your own situation, or about any of the information provided as it may relate to your specific case. If you are considering using cannabis, we encourage you to be informed and aware of the differences in state and federal laws regarding its use.  HER2-positive early breast cancer patients who have cancer remaining in their breast or lymph nodes after neoadjuvant (before surgery) chemotherapy plus HER2-targeted therapy have a high risk of recurrence and death. KATHERINE is a phase III clinical trial that randomized node-positive patients of all stages who did not fully respond to chemotherapy before surgery to receive T-DM1 (Kadcyla) or trastuzumab (Herceptin) for 14 cycles after surgery. They sought to answer the question of whether substituting T-DM1 for trastuzumab would improve outcomes. T-DM1 is an antibody drug conjugate that consists of the HER2 antibody joined with the chemotherapy drug, maytansinoid DM1. When T-DM1 interacts with HER2 receptors on the surface of cancer cells, it gets taken up by the cells and the chemotherapy drug is released into the cell. Analysis of the KATHERINE trial data showed that giving T-DM1 after surgery instead of trastuzumab resulted in a clinically meaningful improvement in invasive disease-free survival (IDFS). Three-year IDFS improved from 77% to 88.3% with T-DM1. This benefit was seen regardless of hormone receptor (ER/PR) status and the extent of disease that remained after chemotherapy. More follow-up is pending to evaluate the effect of T-DM1 on overall survival; however, T-DM1 is likely an essential part of the new standard of care for this patient population. (Abstract GS1-10) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org.  Five years of endocrine therapy with an aromatase inhibitor (AI) is highly effective in reducing the risk of recurrence of hormone-receptor-positive breast cancer; however, the risk continues beyond the five years of treatment. Researchers analyzed the combined results of 12 clinical trials involving 24,912 postmenopausal women with estrogen-receptor-positive disease to determine if there is a benefit to taking endocrine therapy for more than five years. All of the women in the trials had at least five years of endocrine therapy; with either tamoxifen alone, tamoxifen followed by AI, or AI alone. The study authors compared the outcomes of patients who received five additional years of AI to those who received no further therapy. Overall, they found extended therapy resulted in a quarter reduction in local recurrence (in the breast), a modest reduction in distant recurrence, and a very modest reduction in breast cancer mortality. The study authors noted that the follow-up period needs to be extended to truly evaluate the effect of extended AI therapy on breast cancer mortality. The beneficial effect of extended AI therapy differed by the type of prior endocrine therapy received, with a larger benefit for women who took five years of prior tamoxifen. Importantly, the benefit of extended therapy was greater for patients with positive lymph nodes. In women with four or more positive nodes, there was a 7.7% absolute risk reduction in local or distant recurrence. Patients with negative lymph nodes had a marginal benefit of 1.1% risk reduction. Risk of bone fracture increased by approximately 25% with prolonged AI therapy. The meta-analysis did not assess additional side effects and impact of AIs on quality of life. (Abstract GS3-03) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org. |
Quick Links |
Stay ConnectedNever miss an update. Join our email list today!
|
|
|
Bay Area Cancer Connections
Resource Center 2335 El Camino Real, Palo Alto, California 94306 |
Email: info@bayareacancer.org
Helpline: (650) 326-6686 Business: (650) 326-6299 | Toll Free: (888) 222-4401 Fax: (650) 326-6673 |