Matrix Medical Communications is a medical publishing company that produces the Hot Topics in Breast Cancer multichannel journal series, as well as the Clinical Updates in Breast Cancer e-Newsletter series. Below are summaries and links from content included in each of those issues of Hot Topics and e-Newsletters, sorting and summarizing the latest clinical information in breast cancer for busy oncology HCPs.
Results from the international, double-blind postMONARCH trial showed that abemaciclib plus fulvestrant treatment led to investigator-assessed six-month progression-free survival (PFS) of 50 percent in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer who progressed on previous treatment with cyclin-dependent kinase 4/6 (CDK4/6) inhibitor plus endocrine therapy (n=182). The control group (placebo+fulvestrant; n=186) had a significantly lower six-month PFS of 37 percent. The objective response rate was also higher in the abemaciclib group versus the control group among patients with measurable disease (17% vs. 7%). Consistent efficacy with abemaciclib was observed in patients with ESR1 of PIK3CA mutations at baseline, as well as other clinical and genomic subtypes. Safety data was consistent with the known safety profile of abemaciclib.
Among 38 patients with breast cancer with leptomeningeal carcinomatosis (LMC), 57.9 percent had triple-negative breast cancer (TNBC). A total of 31.6 percent of patients had estrogen receptor-positive (ER+), HER2– disease, and 10.5 percent had HER2+ breast cancer. LMC diagnosis occurred at a median time of 11 months after Stage IV disease. Before LMC diagnosis, 11 patients (28.9%) presented with parenchymal brain metastasis. At LMC diagnosis, signs of LMC were detected on magnetic resonance imaging of the brain and/or spine for 32 patients. Of the 25 patients who underwent cerebrospinal fluid (CSF) cytology, 14 had positive CSF cytology. Of the 13 patients who received CSF circulating tumor cells (CTCs) evaluation, 10 had detectable CSF CTCs. Median overall survival (OS) between LMC diagnosis and death/last follow-up was five months. The difference in median OS was significant between patients with HER2+ disease (23 months); ER+, HER2– disease (8 months), and TNBC (3.5 months).
Female non-smokers who were exposed to secondhand smoke had a 24-percent increased risk of developing breast cancer, according to a study published in the British Journal of Cancer. Researchers conducted a meta-analysis 63 case-control/cohort studies, and case-control studies showed a significantly higher risk of breast cancer related to secondhand smoke exposure. Further analysis showed that individuals with over 40 years of secondhand smoke exposure had a 30-percent increased risk of breast cancer.
Recent research showed that, in a community oncology setting, 69.4 percent of breast cancer recurrences were detected by patient-reported symptoms; comparatively few cases were detected by routine mammograms (8.1%), routine physician exams (6.8%), or other diagnostic tests (10.9%). Distant metastatic disease was present in the majority of patients. These findings indicate a need for improved screening methods for breast cancer recurrence.
Analyzing data from 2004 to 2017, researchers found that the rate of breast reconstruction following mastectomy rose from 13 to 47 percent among American Indian/Alaska Native patients with breast cancer. Non-Hispanic White patients saw an increase in breast reconstruction from 29 to 62 percent. Unilateral mastectomy and having public insurance, both of which were more common in American Indian/Alaska Native patients, were associated with lower rates of breast reconstruction.
Of 2,791 patients with node-positive, hormone receptor-positive (HR+), human epidermal growth factor receptor-negative (HER2–), high-risk breast cancer who received twice-daily oral abemaciclib 150mg for two years in the monarchE trial, 1,221 (43.7%) had dose reductions. A greater proportion of patients with one dose reduction received over 12 and 18 months of treatment, compared to those with no dose reduction and those with two dose reductions. Invasive disease-free survival and distant relapse-free survival outcomes remained consistent with abemaciclib dose reductions to 100mg or 50mg, compared to the full dose of 150mg.
Among 4,294 premenopausal patients with early-stage breast cancer, younger age, higher histological stage at diagnosis, ER– disease, progesterone receptor-negative disease, and normal HER2 expression were associated with high CYP27A1 expression. There was no association between disease-free survival (DFS) and high CYP27A1 expression among the overall cohort or those with ER+ breast cancer. There was an association between improved DFS and ER negativity in crude analyses, but not adjusted analyses.
Here, Holm et al evaluated the impact of high hemoglobin A1c (HbA1c) levels on survival outcomes among patients without diabetes diagnosed with Stage I to III breast cancer from 2010 to 2020. HbA1c was measured at breast cancer diagnosis. Compared to patients in quartile 1 (HbA1c 21–33mmol/mol), those in quartile 4 (HbA1c ≥39mmol/mol) had a significantly higher risk of experiencing breast cancer recurrence, including contralateral breast cancer. According to body mass index (BMI)-stratified analysis, there was an association between high HbA1c and decreased breast cancer-free interval among patients with normal weight or obesity.
Researchers evaluated the sonographic and clinicopathologic characteristics associated with axillary lymph node metastasis (ALNM) in pure mucinous breast carcinoma. Lymphatic metastasis was significantly more frequent in tumors of the outer breast, compared to those of the inner breast. Ki-67 expression and tumor size were increased in patients with ALNM, but there was no significant association between either factor and ALNM.
Among 94 patients with cT1/2N0M0 stage HER2+ breast cancer who underwent surgery, five-year disease-free survival was 95.6 percent. Distant metastasis-free survival was significantly longer in patients with pT1 stage and cT1 stage disease, compared to those with pT2/3 and cT2/3 stage disease, respectively. Five patients experienced distant recurrence, and four patients developed ipsilateral/contralateral local recurrence.
Here, Rajan et al reviewed 35 studies including OS data on 909,077 patients who underwent either breast conserving surgery (BCS) with adjuvant radiotherapy or mastectomy with or without radiotherapy. All studies had a serious risk of bias. OS outcomes were superior with BCS with radiotherapy compared to mastectomy, but the certainty of evidence was low due to risk of bias and inconsistency of results.
Findings from the monarcHER trial showed that treatment with abemaciclib plus trastuzumab and fulvestrant or abemaciclib plus trastuzumab resulted in greater overall survival for patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer, compared to trastuzumab plus standard-of-care. Objective response rate was highest among patients who received abemaciclib plus trastuzumab and fulvestrant.
Boccuzzi et al assessed the rate of supplemental MRI screening among high-risk individuals aged 25 to 75 years without a personal history of breast cancer from July 2020 to July 2021. Of 1,144 individuals with a high risk for breast cancer, only 307 (27%) underwent supplemental breast MRI. A total of 842 patients were classified as having dense breasts, of whom 237 (28%) received supplemental breast MRI. Eighty-eight percent of patients with access to a high-risk breast cancer provider fulfilled the MRI order, compared to 33 percent of patients without access; this difference was significant.
In this study, Fleshner et al assessed the diagnostic timeline of 1,148 patients below the age of 40 years diagnosed with breast cancer. A total of 77.3 percent of patients presented for assessment with a palpable mass, and 27.7 percent presented with a painful mass. Patient delay of over four weeks from symptom onset to contact with the healthcare system was experienced by 31.7 percent of patients. The most common reason for patient delay was lack of concern about the symptom (27.7%), followed by false reassurance by practitioners (3.9%), difficulty accessing timely care (3.6%), and conflicting priorities (2.1%). A total of 116 patients (10.1%) experienced a system delay of over three weeks from patient presentation to first investigation.
Here, the authors reviewed a protocol that aimed to enhance the precision of contralateral breast cancer diagnosis following symmetrizing contralateral breast reduction; the protocol included resection in toto, excision specimen marking, and inking. The authors concluded that the protocol allowed for tailored treatment plans and improved shared decision-making.
Among 336 individuals who completed the Health Leads Social Needs Screening Toolkit, 255 (76%) underwent a screening mammography. According to multivariable analysis, increasing number of unmet social needs and increasing age at diagnosis were significantly associated with not undergoing screening mammography. Further analysis showed that increasing number of unmet social needs was associated with a diagnosis of late-stage disease.
Black women with breast cancer have a 40-percent increased mortality rate, compared to White women. Among patients under the age of 50 years, the risk of breast cancer death is doubled for Black women, compared to White women. Factors such as higher likelihood of being diagnosed with late-stage disease or aggressive subtypes contribute to these disparities.
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