San Antonio Breast Cancer Symposium 2014, Day 3

This day consisted of a review of the important endocrine (hormonal) therapy data that was presented the day before. This laid the groundwork for new guidelines to be put in place regarding the treatment of hormone receptor positive breast cancer patients. The long and short of it was really that options for endocrine therapy in both pre-and post-menopausal women need to be individualized based on the patient’s age at diagnosis, risk factors for aggressive disease and other medical issues that might make one regimen more favorable over another.

There was also some new data presented regarding the use of a Ductal Carcinoma In Situ (DCIS) Recurrence Score developed by Genomic Health, the company that developed Oncotype DX. The DCIS Score was developed to distinguish patients in the DCIS population who might be at low risk of local recurrence. Based on this better prognosis, they are suggesting that these women may not need radiation after surgery, as is commonly offered to most patients with DCIS. The study looked at 571 women with DCIS who underwent breast-conserving surgery alone over the course of 9 years. The DCIS Score was run on their surgical specimen and was categorized as low, intermediate or high risk. The study found that the DCIS Score was able to predict which groups had a higher risk of local recurrence for DCIS (5.4% for the low risk group, 14.1% for the intermediate group and 13.7% for the high risk group) and for invasive cancer (8.0% for the low risk group, 20.9% for the intermediate group and 15.5% for the high risk group). Interestingly, the DCIS Score was not as good at differentiating intermediate risk from high risk, thus, the company may decide to make the score have either “low” or “high” results, without the intermediate.

Either way, this may be another tool we can use in the future to help minimize exposure of women to unnecessary therapy. However, we are still waiting on important data that includes patients who have been treated with radiation therapy to see if radiation makes a difference in those with low and/or high risk scores. This information is essential for determining if the DCIS Score is not only good at telling us information on prognosis but will also provide information on who benefits from different types of therapy, particularly radiation therapy. Until this data is presented, I believe most breast specialists will not be using this test routinely in practice.

There was a whole lot more interesting data presented at San Antonio this year…to be continued in my newsletter. Please sign up to get all these and more updates via the Contact page.


San Antonio Breast Cancer Symposium 2014, Day 2

Today we shift our focus to premenopausal women with early stage breast cancer. The SOFT trial reported with over 5 years of follow up. This trial randomized early stage breast cancer patients to one of the following for a 5 year course:

Tamoxifen  OR

Tamoxifen + Ovarian suppression OR

Exemestane + Ovarian suppression

Ovarian suppression = either monthly injections, surgical removal or radiation to the ovaries

The main question they were trying to answer in this study was what is the optimal hormonal therapy for premenopausal women with hormone receptor positive breast cancer.

The results were interesting. They found that women with higher risk breast cancer, particularly those who required chemotherapy and regained their periods, benefitted from ovarian suppression. Whereas, those with lower risk tumors, mainly those who did not require chemotherapy, did exceptionally well with tamoxifen alone.

The most striking results were found in patients who were under the age of 35 and required chemotherapy (which was most of that age group). There was a fairly striking benefit of adding ovarian suppression to tamoxifen (11.2% decrease in the risk of breast cancer recurrence) over using tamoxifen alone. Adding ovarian suppression to an aromatase inhibitor offered even more benefit over tamoxifen alone (15.7% decrease in the risk of breast cancer recurrence).

However, the potential side effects are sobering. We worry about the long-term effects of ovarian suppression with regard to sexual dysfunction, mood issues, late cardiac effects including high blood pressure, bone aches, and bone density, especially in this very young patient population. Aromatase inhibitors can exacerbate many of these symptoms and health issues.

So, the hormonal therapy options have become increasingly complicated and our discussions with patients who fit these criteria are likely to get a whole lot more complicated. However, the end goal is to individualize care as much as possible and with this data, we should be able to do this a little better…even if it does mean some more intensive treatment for our young patients.

Side note: All premenopausal women with hormone receptor positive breast cancer should be discussing this data with their medical oncologist. You can reference the SOFT and TEXT trials and ask how these trials will impact your care. Breast Cancer Consultants can also help apply this information specifically to your breast cancer diagnosis and treatment plan.