2012 San Antonio Breast Cancer Symposium (SABCS)

Dr James Evans speaks to ecancer.tv about the advantages and concerns related to the use of genomic sequencing in cancer care. Sequencing of tumour DNA can allow clinicians to identify which treatment agents would be most effective, determine appropriate follow-up programmes and predict additional cancers that patients may be at risk of. However, Dr Evans warns that full sequencing may also uncover evidence of un-preventable diseases and influence the patient’s ability to obtain many types of insurance.

Dr Jason Carroll explains how the identification of the FOXA1 protein is allowing clinicians to improve clinical outcome in breast cancer. FOXA1 is a pioneer factor essential to the function of oestrogen receptors, a key feature in the majority of breast cancers. Dr Carroll discusses collaborations between his research laboratory and pharmaceutical companies essential to the commercial development of new cancer treatment therapies and outlines further research he is carrying out to understand and overcome resistance to oestrogen receptor antagonists.

Dr David Rimm explains how measurement of EGFR/HER1 signalling can be used to predict trastuzumab efficacy. Dr Rimm discusses the mechanism through which EGFR/HER1 signalling affects trastuzumab mechanism of action, outlines the technological advances required for this research and explains how these tests will help clinicians provide a better service to cancer patients. Dr Rimm concludes by discussing the NeoALTTO which will assess trastuzumab lapatinib combinations explains how this will facilitate further research into trastuzumab resistance.

At a press conference at SABCS 2012, Dr Peter Kaufman presents data on a A phase III multicenter study of eribulin mesylate in women with previously treated metastatic breast cancer failed to meet its co-primary endpoints of improved progression-free survival and overall survival compared with capecitabine.

Dr Peter Kaufman discusses the results phase III clinical trial comparing eribulin mesylate with the capecitabine for patients with locally advanced or metastatic breast cancer. The study failed to demonstrate a significant difference between the two arms, however there was a numerical trend favouring eribulin. Dr Kaufman concludes by suggesting that eribulin may in fact be superior within certain patient sub-groups, but further studies are required to establish this.

Dr Richard Finn talks to ecancer at SABCS 2012 about the cyclin-dependent kinase 4/6 inhibitor, in combination with letrozole vs letrozole alone for first-line treatment of ER+/HER2- advanced breast cancer. Dr Finn explains that PD 0332991 prevents cellular DNA synthesis by blocking cell cycle progression. Preclinical studies in a breast cell line panel identified the luminal ER subtype, elevated expression of cyclin D1 and Rb protein, and reduced p16 expression as being associated with sensitivity to PD 0332991

Dr Clifford Hudis talks to ecancer at SABCS 2012 about the effects of obesity on the overall health of the general population, especially in women with breast cancer.

At a press conference at SABCS 2012, Dr Peter Kaufman presents data on a A phase III multicenter study of eribulin mesylate in women with previously treated metastatic breast cancer failed to meet its co-primary endpoints of improved progression-free survival and overall survival compared with capecitabine.

A lower total dose of radiotherapy, delivered in fewer, larger treatments, is as safe and effective at treating early breast cancer as the international standard dose, according to the 10-year follow-up results of the Standardisation of Breast Radiotherapy Trials (START). Prof John Yarnold talks to ecancer.tv about the results of this long term study which demonstrate that radiation to the breast at a dose of 40 Gy delivered over 3 weeks is as effective as a dose of 50 Gy delivered over 5 weeks whilst reducing levels of chronic side effects by over 20%. The new treatment routine benefits patients in terms of quality of life whilst making valuable cost savings for the health service.

Dr Torsten Nielsen talks to ecancer at SABCS 2012 about how the immunohistochemical assessment of the cell proliferation marker Ki67 is of interest for potential use in clinical management. Dr Nielsen explains that a lack in consistency between labs detracts from Ki67's value as a marker. A working group was assembled to devise a strategy for Ki67 analysis and identify procedures to improve concordance.

Sentinel lymph node (SLN) surgery may provide a less-invasive alternative to axillary lymph node dissection (ALND) for patients with node-positive breast cancer. Dr Judy Boughey explains that the majority of women with node-positive breast cancer currently undergo ALND as a treatment, while SLN surgery is typically used for patients diagnosed with node-negative disease. However, results of the Z1071 study suggest that treating node positive patients with neoadjuvant chemotherapy can eradicate disease in the lymph nodes and allow successful treatment with SLN surgery. Dr Boughey discusses the results of this study, and outlines the levels of adverse effects and the effectiveness with which SLN surgery can correctly identify nodal status following neoadjuvant therapy.

Extensive mammographic density is associated with an increased risk of breast cancer and makes the detection of cancer by mammography difficult. Dr Norman Boyd explains that mammographic density has a greater influence on breast cancer risk than any other known factor and may be responsible for 1/3 of breast cancer incidences. Dr Boyd outlines how density could be addressed with drugs and offers advice to women with extensive density in the breast.

In-vitro exposure to an HDAC inhibitor indirectly impaired the ability of triple-negative breast cancer cells to repair damaged DNA and sensitised the cells to treatment with two therapies that have clinical activity in some patients with breast cancer — a PARP inhibitor and cisplatin, according to data presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.

Dr Justin Balko discusses the links between breast cancer prognosis and pathological complete response (pCR) following neoadjuvant chemotherapy. Patients who do not show a pCR following neoadjuvant chemotherapy have a worse prognosis. Dr Balko outlines the key genes and pathways thought to be related to pCR, talks about potential clinical trials to develop treatments and outlines the difficulties dividing patients according to their specific mutation.

Prof Antonio Wolff talks to ecancer at SABCS 2012 about the the National Comprehensive Cancer Network (NCCN) study on the diagnosis of blood cancer in women who have already been diagnosed with breast cancer. The study looked at cooperative group trials and institutional series reported the risk of MDS and/or AML after adjuvant chemotherapy for early stage breast cancer and examined the incidence of MDS and/or AML in breast cancer survivors.

Exposure to histone deacetylase (HDAC) inhibitors sensitise triple-negative breast cancer cells to treatment with a PARP inhibitor and cisplatin, according to preclinical research presented at the 35th San Antonio Breast Cancer Symposium. Dr Kapil Bhalla explains how HDAC inhibition indirectly causes DNA damage and impairs the cells ability to repair damaged DNA. These effects mimic those in BRCA1 mutated breast cancer cells and cause cells to become more susceptible to PARP inhibitor and cisplatin therapy.

At a press conference at SABCS 2012, Prof Cimprich presents data on a study looking at women undergoing chemotherapy who experience cognitive problems, commonly referred to as “chemo brain,” displayed alterations in neurocognitive responses prior to undergoing treatment.

Prof Christos Sotiriou discusses the results of the BIG-1-98 study. This trial demonstrated that the genomic grade index can separate histological grade 2 breast tumours into low or high categories with different clinical outcomes. Prof Sotiriou explains how this system could have considerable benefits to patients, reducing the level of chemotherapy required to treat low grade patients.

Prof Douglas Easton discusses the role that low penetrant factors may have on overall cancer risk. Although these factors have a considerably lower influence than genes such as BRCA1 and BRCA2, when found in combination they can result in a high overall risk. Prof Easton explains how these low risk polymorphisms are related to different cancer sub-types and considers how this can be used to predict patient risk or develop new targeted therapies.

Prof Robert Coleman talks to ecancer at the SABCS 2012 about the results from the AZURE trials. The AZURE trial evaluated the addition of zoledronic acid to standard adjuvant therapy on relapse rates and survival in pts with stage II/III breast cancer. While the overall analysis reported no benefit, a pre-planned subgroup analysis showed significant benefits in postmenopausal women. Prof Coleman expains results from a further investigation of this benefit.

Analysis of data from studies documenting breast cancer genome sequencing has confirmed that HER2 mutations can be effectively targeted with the drug neratinib. Prof Ron Bose discusses these results, presented at the 35th Annual San Antonio Breast Cancer Symposium, and explains what implications these have on the future of cancer therapy development.

Chemotherapy after surgery, or adjuvant chemotherapy, led to higher rates of disease-free and overall survival for women with isolated local or regional recurrence of breast cancer, according to data presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.

Adjuvant chemotherapy in women with completely resected locally recurrent of breast cancer improves both disease-free and overall survival according to the long term results of the randomised CALOR trial. Patients with isolated local and/or regional recurrence of their breast cancers are at high risk for developing metastases in other areas of the body. Dr Stefan Aebi explains that the use of adjuvant chemotherapy produced a 12% increase in five year rates of both disease free and overall survival and outlines what implications this research has for breast cancer standard of care.