Cancer Treatment Today » Breast Cancer

Symphony suite of tests for Breast Cancer – pro

M Levin, MD — Fri, 03 Jan 2014 20:54:49 +0000

Symphony suite of tests includes Mammaprint, BluePrint and TargetPrint. According to the online article titled “Comparison of MammaPrint, BluePrint, and TargetPrint with Clinical Parameters in Patients with Breast Cancer: Findings from a Prospective United States Cohort”, it states that the multigene signature MammaPrint, as well as BluePrint and TargetPrint, provides additional information for treatment guidance. By combining MammaPrint with the BluePrint molecular subtyping profile, specific groups of patients can be recognized that are at high risk for recurrence and that would possibly benefit from specific treatment. It further stated that the study showed that TargetPrint provides a high quality second opinion for local IHC/FISH assessment. Another similar article titled “Comparison of molecular subtyping with BluePrint, MammaPrint, and TargetPrint to local clinical subtyping in breast cancer patients” states that the implementation of multigene assays such as TargetPrint, BluePrint, and MammaPrint may improve the clinical management of breast cancer patients. The TargetPrint is considered a macro array based gene expression test which offers a quantitative assessment of the patient’s overall level of estrogen receptor (ER), progesterone receptor (PR), and HER2/NEU overexpression within the breast cancer. By utilizing the TargetPrint studies, physicians are provided with additional insight into the biology of the patient’s individual tumor which can assist in the treatment decisions. Lastly, the BluePrint gene expression signature was developed for the classification of breast cancer into either a basal type, luminal type, or ERBB2-type. By identifying tumors that can be responsible for the hormonal interventions (which would be the luminal type), or sensitive to trastuzumab therapy or to cytotoxic therapy (which is basal type), the different subtypes can respond differently to different types of therapies and combination of therapies. Overall, the BluePrint provides a more personalized result to the physician which allows them to get the patient the most likely effective treatment for the patient—hormonal therapy, combined hormonal and chemo therapy, and combined chemo therapies alone. The three tests are put together in a panel in the Symphony panel.

At the same time, guidelines have not recommended this panel for this situation. Mammaprint is a test that purports to determine aggressiveness of breast cancer. It is widely accepted in Europe and less so in the USA. More recently. TargetPrint is another iteration that purports to provides reliable, quantitative assessment of mRNA expression levels of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) and BluePrint similarly attempts to provide prognostic information. BluePrint, an 80-gene expression signature for the classification of breast cancer into Basal-type, Luminal-type and ERBB2-type.

Besides that these two latter tests still need to be fully validated, there is no literature support for the three together being more accurate or productive of more benefit than either one. Therefore, it would be important to perform definitive comparison of combinations of these assays.

References:

Nguyen, B., Sinha, R., Kerlin, D., Barone, J., Garcia, A., Yao, K., … & Deck, K. (2011). P3-04-06: Comparison of MammaPrint, BluePrint, and TargetPrint with Clinical Parameters in Patients with Breast Cancer: Findings from a Prospective United States Cohort. Cancer Research, 71(24 Supplement 3).

Nguyen, B., Cusumano, P. G., Deck, K., Kerlin, D., Garcia, A. A., Barone, J. L., … & Generali, D. (2012). Comparison of molecular subtyping with BluePrint, MammaPrint, and TargetPrint to local clinical subtyping in breast cancer patients. Annals of surgical oncology, 19(10), 3257-3263.

Daniel D. Von Hoff et al, Pilot Study Using Molecular Profiling of Patients’ Tumors to Find Potential Targets and Select Treatments for Their Refractory Cancers JCO October 4, 2010

Companion Diagnostics in Personalized Medicine and Cancer Therapy, Trimark Publications (190 pages), published Apr 2008

Raman G, Avendano EE, Chen M.Update on Emerging Genetic TestsCurrently Available for Clinical Use in Common CancersEvidence Report/TechnologyAssessment.

(Prepared by the Tufts Evidence based Practice Center under Contract No.290-2007-10055-I.)Rockville, MD: Agency for Healthcare Research and Quality.July2013

www.effectivehealthcare.gov/reports/final.cfm

Alice P. Chung, Marissa K. Srour, Farnaz Dadmanesh, Sungjin Kim, Armando E. Giuliano, Jennifer Wei, Yen Huynh, Josien Haan, Shiyu Wang, Andrea Menicucci, Patricia Dauer, and M. William Audeh
Journal of Clinical Oncology 2022 40:16_suppl, 585-585

Tamoxifen and endometrial cancer – pro

M Levin, MD — Sun, 13 Oct 2013 12:44:48 +0000

Tamoxifen is a venerable drug that revolutionized breast cancer care when it was first introduced. More recently, it has been largely supplanted by aromatase inhibitors(AI), but tamoxifen is still useful in pre-menopausal women, in whom AIs do not work.

Tamoxifen has a variety of bothersome side effects, related mostly to forced early menopause.
In addition, a rare complication of tamoxifen is uterine lining overgrowth, which can proceed to endometrial bleeding. Abnormal uterine bleeding occurs in more than 50% of premenopausal women taking tamoxife and in this group of women, up to 23% will have an underlying endometrial abnormality such as polyps, hyperplasia, or EC. However, the incidence of endometrial disease is not markedly different compared with that in premenopausal women with breast cancer and AUB who are not taking tamoxifen. However, two meta-analyses found the risk of uterine/endometrial cancer nearly doubled with tamoxifen use. In the great majority of the cases, these are early stage cancers that are curable with hysterectomy. Unfortunately, there are no effective or generally accepted ways to monitor endometrial overgrowth. Given the higher rate of endometrial disease in premenopausal women taking tamoxifen who have development of uterine bleeding, further evaluation is warranted via endometrial sampling with an office biopsy or with operative curettage (with or without hysteroscopy). There are no guidelines that recommend preventative hysterectomy or cystoscopy.

Recently, USPTF recommended ten years of adjuvant tamoxifen instead of five. This greatly increases concern for the development of endometrial caner over this longer period. The ASCO guideline* (Visvanathan et al) has this to say: “Follow-up should include a baseline gynecologic examination before initiation of treatment and annually thereafter, with a timely work-up for abnormal vaginal bleeding.”
H.F. Kennecke,New guidelines for treatment of early hormone-positive breast cancer with tamoxifen and aromatase inhibitors, BCMJ, Vol. 48, No. 3, April 2006, 121-126

Kala Visvanathanet al, American Society of Clinical Oncology Clinical Practice Guideline Update on the Use of Pharmacologic Interventions Including Tamoxifen, Raloxifene, and Aromatase Inhibition for Breast Cancer Risk Reduction, JCO July 1, 2009 vol. 27 no. 19 3235-3258

Bushnell CD wt al, (2004) Risk of ischemic stroke with tamoxifen treatment for breast cancer: A meta-analysis. Neurology 63:12301233.

Jamie N. Bakkum-Gamez et al, Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer, Mayo Clin Proc. 2011 March; 86(3): 229–240.

For the Lay version see here

Prophylactic mastectomy and oophorectomy for BRCA mutation carriers – pro

M Levin, MD — Fri, 11 Oct 2013 16:31:52 +0000

Prophylactic bilateral mastectomy is the surgical removal of both breasts to help prevent breast cancer. Prophylactic mastectomy is a controversial procedure among members of the medical community. Based on recent scientific findings that show prophylactic mastectomy to be effective at preventing breast cancer, some physicians think that it is sometimes recommended even without evidence of genetic causation. According to the American Cancer Society Board of Directors, “only very strong clinical and/or pathological indications warrant doing this type of ‘preventive operation.” BRCA positivity is generally thought to be an strong indication for it.

A recent article in the Journal of American Medical Association suggests that in BRCA positive patients there is a benefit to bilateral prophylactic mastectomy. Prophylactic surgery reduced the high risk of breast and ovarian cancer among BRCA mutation carriers and improved survival, researchers affirmed. Similarly, all-cause mortality dropped from 10% without salpingo-oophorectomy to 3% with it (hazard ratio 0.40, 95% confidence interval 0.26 to 0.61). Even before theis information, ESMO was recommending bilararl mastectomy and oophorectomy. The American College of Obstetricians and Gynecologists’ guidelines on “Hereditary breast and ovarian cancer syndrome” (ACOG, 2009) stated that “risk-reducing salpingo-oophorectomy should be offered to women with BRCA1 or BRCA2 mutations by age 40 or after the conclusion of child-bearing”.

Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;11:CD002748.

J. Balma, BRCA in breast cancer: ESMO Clinical Practice Guidelines, Ann Oncol (2010) 21 (suppl 5): v20-v22.

Easer an j, Lessons learned from genetic testing. JAMA. 2010 Sep 1;304(9):1011-2.

Susan M. Domchek; Tara M. Friebel; Christian F. Singer; D. Gareth Evans; Henry T. Lynch; Claudine Isaacs; Judy E. Garber; Susan L. Neuhausen; Ellen Matloff; Rosalind Eeles; Gabriella Pichert; Laura Van t’veer; Nadine Tung; Jeffrey N. Weitzel; Fergus J. Couch; Wendy S. Rubinstein; Patricia A. Ganz; Mary B. Daly; Olufunmilayo I. Olopade; Gail Tomlinson; Joellen Schildkraut; Joanne L. Blum; Timothy R. Rebbeck. Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality. JAMA, 2010; 304 (9): 967-975

Laura Esserman; Virginia Kaklamani. Lessons Learned From Genetic Testing. JAMA, 2010; 304 (9): 1011-1012

DCIS and multifocal breast cancer – pro

M Levin, MD — Tue, 16 Jul 2013 15:29:12 +0000

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer. In DCIS, abnormal cells are contained in the milk ducts. It is called “in situ” (which means “in place”) because the cells have not left the milk ducts to invade nearby breast tissue. DCIS is also be intraductal (within the milk ducts) carcinoma, when it is larger but still not invasice. Without treatment, the abnormal cells could turn into invasive cancer over time. Some physicians however, argue that DCIS is a marker of cancer and not cancer in itself, and that prophylactic systemic therapy should be used when DCIS is present. Left untreated, about 20 to 30 percent of patients with low grade DCIS will progress to invasive breast cancer.

An update of the two NSABP studies was recently published by Wapnir et al. The goal of the update was to evaluate long-term invasive ipsilateral in-breast recurrence outcomes in the two studies. The update confirmed previous findings: mortality from DCIS is low regardless of treatment, and recurrence risk is highest in patients who do not receive radiation therapy or tamoxifen.

Standard treatment for DCIS includes breast-conserving surgery, often involving wire or radioactive seed localization; whole-breast radiation therapy; and tamoxifen for localized DCIS. Simple mastectomy and sentinel node biopsy are recommended for extensive or multicentric DCIS and for women in whom adequate cosmesis cannot be achieved because of breast size.

When DCIS accompanies invasive disease, it is called muticentric or multifocal and how to treat such patients is controversial. The consensus remains that mastectomy is standard of care, although more recent retrospective studies suggests that conservative treatment with breast preservation may be adequate (B. Fisher, 2011). There also remains a controversy whether MRI should be used to identify DCIS and make surgical decisions accordingly.

While a lumpectomy is not inappropriate, it should not be performed without a discussion with the patient and advising her of the need for radiation and the risk of finding multicentric disease, that would require additional resections or a completion mastectomy.

Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 12(1):21-9, 2011.

Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 103(6):478-88, 2011.

Bernard Fisher Role of Science in the Treatment of Breast Cancer When Tumor Multicentricity is Present J Natl Cancer Inst. 2011;103(17):1292-1298

Kane RL, Virnig BA, Shamliyan T, Wang SY, Tuttle TM, Wilt TJ. The impact of surgery, radiation, and systemic treatment on outcomes in patients with ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):130-3, 2010.

Swati Kulkarni Management of DCIS—A Work in Progress ONCOLOGY. Vol. 25 No. 9, 2011

Tamoxifen side effects and treatment – pro

M Levin, MD — Fri, 05 Apr 2013 10:40:13 +0000

Tamoxifen has a variety of bothersome side effects, related mostly to forced early menopause. In the trials reviewed by Kennecke al, hot flushes were commonly reported (40% to 60%).In the MA 17 trial, even women who were on no hormonal treatment after 5 years of tamoxifen had a 54% incidence of low-grade hot flushes. A;so gynecological side effects (such as vaginal discharge or bleeding) are common with tamoxifen. Rates of vaginal bleeding of 10% and hysterectomy at 5% were noted. Gynecological side effects tend to decrease and were less apparent after 2 years of tamoxifen use, as tamoxifen-induced gynecological symptoms predominate in the initial years of therapy. Although low, there is a significant risk of thromboembolic events and small risk of uterine cancer, which is usually noticed in early stages because of the bleeding and successfully treated. here is small increase in the risk of cataracts. On the other hand, proestrogenic effects of tamoxifen decrease fracture rate and may stave off dementia and cardiac problems.

Much work has been done on this. Cuzick et aldid a meta-analysis of the tamoxifen trials to examine both risks and benefits. Braithwaite et al conducted a meta-analysis of vascular and neoplastic events associated with tamoxifen use in 32 randomized controlled trials, which included the four tamoxifen risk reduction trials. In this meta-analysis, subanalyses were performed on the risk reduction trials alone. Bushnell and Goldstein conducted a meta-analysis on nine randomized trials, including the four tamoxifen risk reduction trials, to examine the association between ischemic strokes and tamoxifen use.

A variety of symptomatic approaches have been employed but none have been rigorously assessed(http://mydoctor.kaiserpermanente.org/ncal/Images/tamoxifen_tcm28-15153.pdf_). Pharmacologic treatments that are used for menopause symptoms management are also used for tamoxifen induced menopause.

H.F. Kennecke,New guidelines for treatment of early hormone-positive breast cancer with tamoxifen and aromatase inhibitors, BCMJ, Vol. 48, No. 3, April 2006, 121-126

Cuzick Jet al,(2003) Overview of the main outcomes in breast-cancer prevention trials. Lancet 361:296–300.21.↵

Braithwaite RS at al, (2003) Meta-analysis of vascular and neoplastic events associated with tamoxifen. J Gen Intern Med 18:937–947

Bushnell CD wt al, (2004) Risk of ischemic stroke with tamoxifen treatment for breast cancer: A meta-analysis. Neurology 63:1230–1233.

For Lay version see here

Zoladex and tamoxifen for premanopausal women

Aromatase inhibitors

Weekly Taxol for breast cancer – pro

M Levin, MD — Fri, 08 Feb 2013 20:04:36 +0000

Weekly paclitaxel is FDA approved; or, at least, the FDA indication does not exclude the weekly schedule. TAXOL is indicated for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy. Prior therapy should have included an anthracycline unless clinically contraindicated.

There are now several studies that confirm that it is of similar effectiveness to every three week single agent pacltaxel but less toxic. In the adjuvant setting, a randomized clinical trial showed that weekly doses of the drug paclitaxel (Taxol®) following surgery and standard chemotherapy improves disease-free and overall survival in women with breast cancer. For metastatic disease, NCCN lists both the three weekly and once weekly regimens on p. BINV-O, 2.

There are many studies of weekly Taxol in combination with other drugs.

Burris H 3rd, Yardley D, Jones S, et al. Phase II trial of trastuzumab followed by weekly paclitaxel/carboplatin as first-line treatment of patients with metastatic breast cancer. J Clin Oncol 2004;22:1621–1629.

Sparano JA, Wang M, Martino S, Jones V, et al. Weekly paclitaxel in the adjuvant treatment of breast cancer. New England Journal of Medicine. 2008 Apr 17;358(16);1663-1671.

I. Abdel Halim, M. El Ashri, W. El Sadda, Weekly paclitaxel versus standard 3-week schedule in patients with metastatic breast cancer. J Clin Oncol 29: 2011 (suppl; abstr 627)

JUN HORIGUCHI1, YOSHIAKI RAI2, KAZUO TAMURA3, TOSHIHIKO TAKI4, KAZUFUMI HISAMATSU Phase II Study of Weekly Paclitaxel for Advanced or Metastatic Breast Cancer in Japan, Anticancer Research February 2009 vol. 29 no. 2 625-630

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Faslodex for breast cancer – pro

M Levin, MD — Sun, 03 Feb 2013 17:34:43 +0000

(Faslodex)Fulvestrant is a selective estrogen receptor down-regulator (SERD). It acts not by competing with estrogen at the estrogen receptors, but by selectively down modulating it and causing it to be degraded and disappear. Fulvestrant is indicated for the treatment of hormone receptor positive metastatic breast cancer in postmenopausal women with disease progression following anti-estrogen therapy. It used to be thought that this unique mechanism of action gives fulvestrant greater efficacy than other hormonal treatments but that does not appear to be the case. Four comparative clinical trials showed similar efficacy to the other hormonal agents (aromatase inhibitors and tamoxifen) with good tolerability profile. Nevertheless, Fulvestrant provided effective second-line therapy in this setting for postmenopausal women who had relapsed or progressed after previous endocrine therapy.

One might wonder then if fulvestrant has anything to recommend it in first line, especially since it is very often used in that line. For this reason,creating quite a stir, the U.K. National Institute for Health and Clinical Excellence (NICE) said in 2011 that it found no evidence Faslodex was significantly better than existing treatments, and it did not recommend its routine use in the country’s National Health Service. It is a more convenient drug in some situations, since it is an injectable drug that is administered once monthly. There are patients, especially in institutional setting for whom once monthly fulvestrant is more realistic than either IV or daily oral drugs.

Fulvestrant and Xeloda were recently reported by Carreca et al to be tolerable and effective combination in the elderly patients.

In women with hormone-receptor-positive metastatic breast cancer, combining anastrozole and fulvestrant extends progression-free and overall survival, according to a paper released online today in the New England Journal of Medicine. Median progression-free survival – the primary outcome measure – was 13.5 months among the 345 women getting 1 mg of oral anastrozole per day, vs 15.0 months among the 350 who concurrently received 500 mg of fulvestrant followed by 250 mg at 14 days, 28 days and then at one month intervals (p=0.007).

Overall survival, a secondary outcome, rose to 47.7 months with combination therapy from 41.3 months in the anastrozole group (p=0.005), where patients were encouraged to switch to fulvestrant if their cancer progressed. The median follow-up time was 35 months. This combination is not recommended by NCCN(BINV-N, 2014).

Croxtall, J. D.; McKeage, K. (2011). “Fulvestrant”. Drugs 71 (3): 363–380.

Rita S. Mehta, M.D., William E. Barlow, Ph.D., Kathy S. Albain, M.D., Ted A. Vandenberg, M.D., Shaker R. Dakhil, M.D., Nagendra R. Tirumali, M.D., Danika L. Lew, M.A., Daniel F. Hayes, M.D., Julie R. Gralow, M.D., Robert B. Livingston, M.D., and Gabriel N. Hortobagyi, M.D. Combination Anastrozole and Fulvestrant in Metastatic Breast CanceR, N Engl J Med 2012; 367:435-444.

Mauri D, Polyzos NP, Mavroudis D, Georgoulias V, Casazza G. Fulvestrant in the treatment of advanced breast cancer: a systematic review and meta-analysis of randomized controlled trials. Valachis A, Crit Rev Oncol Hematol. 2010 Mar;73(3):220-7.

J, Madarnas Y, Franek JAFulvestrant for systemic therapy of locally advanced or metastatic breast cancer in postmenopausal women: a systematic review. Flemming . Breast Cancer Res Treat. 2009 May;115(2):255-68.

I. U. Carreca, R. Amelio, F. Bellomo, A. Galvano, G. Pernice, D. Combined treatment with fulvestrant plus capecitabine in elderly advanced breast cancer (EABC): Three-year evaluation of efficacy and safety. ASCO 2010, Abstract No: 283

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Votrient for GIST – pro

M Levin, MD — Thu, 29 Nov 2012 15:48:21 +0000

Pazopanib(Votrient) is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptor (VEGFR), platelet derived growth factor receptor (PDGFR), and KIT. These are important pathways for GIST tumors and several trials looked into using pazopanib for GIST. Although initial studies suggested that the drug is not effective for GIST, more recently a phase II study of 25 patients and a randomized study of 86 patients suggest that it is.The results of PAZOGIST, a randomised phase II study of pazopanib plus best supportive care (BSC) vs BSC alone in patients with unresectable metastatic and/or locally-advanced gastrointestinal stromal tumours (GIST), who are resistant or experienced toxicity to previous treatments with standard doses of imatinib and sunitinib, show an improvement in progression-free survival (PFS) in favour of pazopanib arm. The study was presented by Prof. Jean-Yves Blay of the University Claude Bernard Lyon I, Centre Léon Bérard, Lyon, France during the Proffered Paper session in Sarcoma at ESMO Congress 2014 in Madrid, Spain. The primary endpoint was PFS. It was planned to include 80 patients to detect an improvement in the 4-month PFS rate from 15% in the BSC arm alone to 45% in the pazopanib plus BSC with 5% two-sided α error and 80% power. Secondary objectives included overall survival (OS), objective response rate at 4 months, best response rate and tolerance.

P. G. Casali & J.-Y. Blay,Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upAnnals of Oncology 21 (Supplement 5): v98–v102, 2010

nccn, GIST 2012

Nishida T, Hirota S, Yanagisawa A, Sugino Y, Minami M, Yamamura Y, Otani Y, Shimada Y, Takahashi F, Kubota T; GIST Guideline Subcommittee.
Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version.Int J Clin Oncol. 2008 Oct;13(5):416-30.

K. N. Ganjoo et al, A multicenter phase II study of pazopanib in patients with advanced gastrointestinal stromal tumors (GIST) following failure of at least imatinib and sunitinib. Ann Oncol (2014) 25 (1): 236-240.

ESMO Abstract LBA45 – A randomized multicentre phase II study of pazopanib plus best supportive care (BSC) vs BSC alone in metastatic gastroIntestinal stromal tumors (GIST) resistant to imatinib and sunitinib, 2014.

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PET to stage axillae in breast cancer – pro

M Levin, MD — Mon, 29 Oct 2012 14:50:40 +0000

It is generally accepted that stage I and II breast cancer does not require staging. Stage II is divided into stage IIA and stage IIB based on tumor size and whether it has spread to the axillary lymph nodes (the lymph nodes under the arm). In stage IIA, the cancer is either not larger than 2 centimeters and has spread to the axillary lymph nodes, or between 2 and 5 centimeters but has not spread to the axillary lymph nodes. In stage IIB, the cancer is either between 2 and 5 centimeters and has spread to the axillary lymph nodes, or larger than 5 centimeters but has not spread to the axillary lymph nodes. Whether axillae are involved is determinded by physical exam, nodal dissection or, more recently, by sentinel node scintigraphy or imaging and/or biopsy.

The sensitivity of PET to stage axillae is limited. A multicenter trial cast doubt on the early supportive studies, and more recent single-center trials performed in the era of sentinel lymph node mapping showed that, compared with sentinel lymph node biopsy, the sensitivity of FDG PET and PET/CT for axillary nodal metastases was as low as 20%–40%. Therefore, PET should not be used as an axillary staging modality

Lee JH, Rosen EL, Mankoff DA: The role of radiotracer imaging in the diagnosis and management of patients with breast cancer: Part 1–Overview, detection, and staging. J Nucl Med 50:569-581, 2009

Lovrics PJ, Chen V, Coates G, et al: A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early stage breast cancer. Ann Surg Oncol 11:846-853, 2004

David A. Mankoff and Jennifer M. Specht, University of Washington; Seattle Cancer Care Alliance, Seattle, WA William B. Eubank, University of Washington; Puget Sound Veterans Affairs Medical Center, Seattle, WA Larry Kessler, University of Washington, Seattle, WA [18F]Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Breast Cancer: When… and When Not?
JCO April 20, 2012 vol. 30 no. 12 1252-1254

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Taxotere and Cytoxan for metastatic breast cancer – pro

M Levin, MD — Thu, 18 Oct 2012 02:41:24 +0000

Preclinical data demonstrate in vitro synergy for combinations of docetaxel (Taxotere) and cyclophosphamide. As single agents, both drugs have proven highly active against breast cancer, and the activity of the combination has been confirmed by several phase II studies. More recently, it has proven adjuvant efficacy on par with anthracycline containing regimen in a trial to directly compare AC to Taxotere/Cytoxan (TC) as adjuvant treatment in breast cancer. This recent trial showed that TC improves disease-free survival compared with AC for the treatment of adjuvant breast cancer. Although cardiac side effects were not presented, the researcher noted that TC does not appear to have the cardiotoxicity issues associated with AC, which is a very important issue for some patients. NCCN considers TC an appropriate regimen for adjuvant treatment for breast cancer. and NCCN 2012 lists this regimen on p. BINV-K.However, NCCN does not list it for metastatic disease.

MB Whitmore, JA Waddell, DA Solimando, JrCancer Chemotherapy Update-Docetaxel and Cyclophosphamide Regimen in the Treatment of Breast Cancer, Hospital Pharmacy, 2008

nccn, 2012, BINV-O

Dennis Slamon, M.D., Ph.D., Wolfgang Eiermann, M.D., Nicholas Robert, M.D., Tadeusz Pienkowski, M.D., Miguel Martin, M.D., Michael Press, M.D., Ph.D., John Mackey, M.D., John Glaspy, M.D., Arlene Chan, M.D., Marek Pawlicki, M.D., Tamas Pinter, M.D., Vicente Valero, M.D., Mei-Ching Liu, M.D., Guido Sauter, M.D., Gunter von Minckwitz, M.D., Frances Visco, J.D., Valerie Bee, M.Sc., Marc Buyse, Sc.D., Belguendouz Bendahmane, M.D., Isabelle Tabah-Fisch, M.D., Mary-Ann Lindsay, Pharm.D., Alessandro Riva, M.D., and John Crown, M.D. for the Breast Cancer International Research Group Adjuvant Trastuzumab in HER2-Positive Breast Cancer N Engl J Med 2011; 365:1273-1283 October 6, 2011

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