Every year oncologists gather to hear presentations about the latest research and to discuss topics affecting the practice of medicine at the American Society of Clinical Oncology (ASCO) meeting. This year more than 37,000 doctors and other people connected to cancer research and treatment met to learn from more than 2,000 presentations during the five-day conference. Much of the research they hear about will need more trials and study before it is ready to be published in a peer-reviewed journal or change practice in local oncologists’ offices. Here are a few of the highlights of the ASCO 2015 meeting in Chicago that might affect you as a breast cancer patient today.
Bone drugs (Bisphosphonates). These drugs, which are used to prevent and/or treat osteoporosis, are also often used with breast cancer patients to treat the spread of breast cancer to the bones. One study looked at using zoledronic acid (Zometa) every three months and found it to be as effective as monthly infusions without as much risk of jaw injury. Another large randomized study compared three different drugs: zoledronic acid, ibandronic acid (Boniva) and clodronate (Bonefos, Loron) and found them to be equally effective in treating breast cancer patients. However, the patients getting the zoledronic acid had a higher rate of jaw problems, and the other drugs can be taken orally instead of requiring a visit to the doctor's office. Patients taking a bisphosphonate for breast cancer will want to ask their doctors whether these latest studies affect which drug they should take and its frequency.
PALOMA Trial for Estrogen Receptor Positive (ER+) metastatic breast cancer patients. Fulvestrant (Faslodex) has been used for at least a decade to treat ER+ metastatic breast cancer patients by reducing the amount of estrogen that can feed the tumor. This blind study Phase III trial of 521 patients wanted to see if adding a new type of drug called a CDK inhibitor to the fulvestrant would make it more effective in ER positive/HER2 negative patients. The study compared patients receiving fulvestrant alone with patients receiving fulvestrant plus palbociclib (Ibrance). The patients receiving both had better outcomes. According to Dr. Susan Love, this is promising news for other studies involving CDK inhibitor drugs currently in development.
MARIANNE Trial for HER2 Positive metastatic breast cancer patients. This randomized trial with 1,095 patients had three arms: T-DM1 (Kadcyla) plus pertuzumab (Perejta); T-DM1 (Kadcyla) plus placebo; or the standard of care treatment of trastuzumab (Herceptin) plus a taxane chemo. The study found that the standard of care treatment of Herceptin plus chemo worked as well as the investigational drugs. Other studies have found Perejta plus Herceptin and a taxane chemo to be effective. One issue for HER2 positive metastatic breast cancer patients to keep in mind is that your cancer hasn’t read these studies Each tumor responds differently to drugs. You and your doctor will want to start with the drugs that the research has found most effective, but just because the MARIANNE trial didn’t find Kadcyla to work better than other combinations for some people doesn’t mean that you shouldn’t try it if the first combo you try doesn’t work.
Breast-conserving surgery. Women who are having partial mastectomies want the least amount of tissue removed possible, but they also want the cancer out of their bodies. After surgery, a pathologist examines the tissue to see if all the cancer was removed. If no cancer cells are seen at the edges of the sample, the surgeon has achieved “clean margins” and the cancer is assumed to have been removed. In 20-40 percent of partial mastectomies, the margins are not clean, and a second surgery is needed to get all of the cancer. A randomized study of a surgical technique called “cavity shaving” showed taking out more tissue than regular partial mastectomies gave good cosmetic results and reduced the need for a second surgery to get clean margins.
Quality of life issues. Oncologists also discussed issues related to the high cost of medical care, side effects from drugs, how to discuss results of genetic testing with patients, and how to make the breast cancer treatment process more manageable. One study found that having a nurse navigator assigned to patients led to fewer emergency room visits and other problems. At these presentations on quality of life issues, your oncologist may have picked up some tips on how to make your life easier as you go through your treatments.
Many of the presentations were about treatments that will not be in your doctor’s office for years IF they work in continued trials. But your doctor may have some information about new clinical trials appropriate for you based on what he or she learned at ASCO 2015. Keep in mind that some presentations could have immediate impact. It was after ASCO 1998, that my doctor added Taxol to my treatment plan because new studies showed it to be useful for my type of cancer. Now Taxol is standard of care for many types of breast cancer. It is always worth asking your doctor if this year’s ASCO conference has any news that affects you.
For Further Reading:
Chagpar, A. et al. A randomized, controlled trial of cavity shave margins in breast cancer, , The New England Journal of Medicine, doi: 10.1056/NEJMoa1504473, published online 30 May 20105. Accessed June 29, 2015.
Love, S. "CVO Report: ASCO 2015." June 19, 2015. Dr. Susan Love Research Foundation. Accessed http://blog.dslrf.org/?p=2389 June 25, 2015.
MacGill, M. “Risk of second breast cancer operation ‘halved’ when surgeons cut more.” June 1, 2015. Medical News Today. Accessed from http://www.medicalnewstoday.com/articles/294669.php?tw June 29, 2015.
Smith, M. “Bone Drugs Equal as Breast Cancer Therapies.” MEDPAGETODAY. June 2, 2015. Accessed from http://www.medpagetoday.com/MeetingCoverage/ASCO/51908 June 29, 2015.
Turner, N. et al. “PALOMA3: A double-blind, phase III trial of fulvestrant with or without palbociclib in pre- and post-menopausal women with hormone receptor-positive, HER2-negative metastatic breast cancer that progressed on prior endocrine therapy.” Accessed from http://meetinglibrary.asco.org/content/154447-156 June 29, 2015.