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Top News From SABCS 2016: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Kate Johnson; Robin Jerstad; Megan Brooks  |  December 21, 2016

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Slide 1

The 2016 San Antonio Breast Cancer Symposium (SABCS), the premier meeting devoted to breast cancer, was held December 6 to 10 and featured a wide array of studies in the treatment and management of one of the world's most common malignancies.

Slide 2

Among the key presentations:

  • A push to study cyclin-dependent kinase (CDK) 4/6 inhibition in early-stage disease
  • Top cancer doc with HIV: "'people are far more than their illness'"
  • Extending adjuvant endocrine therapy: three trials yet few answers
  • Scalp cooling device helps prevent hair loss from chemotherapy
  • Ibandronate defies bone drug-breast cancer boost — so far
  • IBM Watson often agrees with oncologists on treatment decisions
  • Acupuncture eases chemo-induced peripheral neuropathy
Slide 3

Next Big Thing in ER+ Breast Cancer: For Early-Stage Too?

In the first randomized neoadjuvant trial of a CDK4/6 inhibitor in postmenopausal women with early-stage estrogen-receptor (ER)–positive, human epidermal growth factor 2 (HER2)–negative breast cancer, twice-daily treatment with the investigational abemaciclib (Eli Lilly), alone or in combination with anastrozole (Arimidex, AstraZeneca), significantly reduced Ki67 expression after 2 weeks of presurgery treatment in comparison with anastrozole alone. Thus, the study met its primary endpoint. "Ki67 is a well-validated surrogate endpoint for disease-free survival," said lead author Sara Hurvitz, MD, from the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles. These new findings are akin to results from two earlier, single-arm neoadjuvant trials with the CDK4/6 inhibitors palbociclib and ribociclib that also showed reductions in Ki67 levels among patients with early-stage disease. Together, these results raise the question: Is CDK4/6 inhibition well suited to be a curative therapy for early-stage disease? Dr Hurvitz wants to find out: "We need to push this into early-stage disease," she said concerning adjuvant and neodadjuvant studies.

Slide 4

Top Cancer Doc: I Have HIV — Stigma Can Be Devastating

Eric Winer, MD, the prominent breast cancer clinician and researcher from Dana-Farber Cancer Institute in Boston, Massachusetts, revealed here for the first time publicly that he is infected with HIV. Born with hemophilia, Dr Winer became one of about 10,000 Americans who were infected with HIV between 1979 and 1983 from contaminated blood products. He said the stigma associated with HIV was so immense that he led an "undercover life" in the late 1980s and 1990s. "I could barely tell my friends and colleagues," he said, referring to his HIV diagnosis. "The stigma...based on medical illness can be devastating," he said, referring to both his illness and breast cancer, which is still stigmatized in "many parts of the world" and continues to be "in some places in the United States." He reminded the audience that "people are far more than their illness" and that "there is always room for hope because science marches forward." Dr Winer delivered these and other life reflections during his William McGuire Memorial Lecture, an annual honor given to an oncologist who has made significant contributions to breast cancer medicine.

Slide 5

Extending Adjuvant Endocrine Therapy: Three Trials, Few Answers

Despite three new trials examining the extension of adjuvant endocrine therapy in hormone-positive breast cancer, there were no easy answers here. One trial in particular, the NASBP B-42 trial, was much anticipated because it examined extending adjuvant therapy with the aromatase inhibitor (AI) letrozole (Femara, Novartis) for 5 years in patients who had initially received 5 years of adjuvant therapy with an AI (alone or mixed sequentially with tamoxifen). The first extended adjuvant therapy trials investigated AIs after tamoxifen and demonstrated significant benefits for patients. "However, those trials did not answer the question, should we also use extended AI treatment after AIs were used in initial adjuvant therapy? This is why NASBP B-42 is so important," said discussant Michael Gnant, MD, from the Medical University of Vienna, Austria. But the answer to that question is not a clear yes or no, reported NASBP B-42 investigator Terry Mamounas, MD, from the Comprehensive Breast Program at the University of Florida Health Cancer Center at Orlando Health.

Slide 6

First-Ever RCT: Cold Cap Works for Chemo Hair Loss

An early look at results of the first-ever randomized clinical trial of a modern scalp cooling device to prevent hair loss from chemotherapy has found that the device is "highly effective" and tolerable. The Orbis Paxman Hair Loss Prevention System consists of a compact floor-based refrigeration unit that circulates coolant via a tube into a silicone rubber cap that is placed on the head and is adjusted for a tight fit. In the study, scalp cooling was done 30 minutes before, during, and 90 minutes after each chemotherapy session. About half of the 95 patients randomly allocated to scalp cooling had "success" compared with none of the 47 patients who did not receive the intervention (P < .0001). Success was defined as no hair loss (grade 0) or loss of up to 50% (grade 1). Lead author Julie Nangia, MD, from the Baylor College of Medicine in Houston, acknowledged that the new data were from an interim analysis from the Scalp Cooling Alopecia Prevention Trial (SCALP). She said more data would be reported as they are collected.

Slide 7

Ibandronate Defies Bone Drug-Breast Cancer Boost — So Far

In light of growing excitement about the ability of bisphosphonates to boost survival and bones in early breast cancer, first results from the TEAM IIB trial seem like a let-down. "Unfortunately, we could not confirm our hypothesis that we should treat our patients with ibandronate," reported investigator Sonja Vliek, MD, from the Netherlands Cancer Institute, Amsterdam. "There was no proof of additional benefit of ibandronate added to exemestane over 3 years; however, there was a trend toward improved disease-free survival," added her coinvestigator, Sabine Linn, MD, PhD, from the same institution. But, despite their results, the researchers say they're encouraged by their findings, a sentiment echoed during a question period by a senior expert who called them "quite impressive" but suggested the analysis may simply be premature. "I do beg you to continue follow-up maybe up to 6 years because these patients will likely relapse later," said Alexander Paterson, MBChB, MD, chair of the Alberta Canada Breast Cancer Program at the Tom Baker Cancer Center. "To me that is a trend that's really important," Dr Paterson said.

Image courtesy of Medscape

Slide 8

Watson vs Oncologists: 90% Agreed on Treatment (Eventually)

The artificial intelligence platform IBM Watson for Oncology achieved a high degree of agreement (90%) with the recommendations of a panel of oncologists in a double-blind validation study of 638 breast cancer cases — but only after some of the cases were bolstered with more data and analyzed a second time. The findings were reported here by S.P. Somashekhar, MBBS, chairman of the Manipal Comprehensive Cancer Center in Bengaluru, India. Watson's recommendations were concordant 79% of the time in nonmetastatic disease but only 46% of the time in metastatic cases. In cases of triple-negative breast cancer, Watson agreed with the oncologists 68% of the time, but in HER2-negative cases, they agreed only 35% of the time. Dr Somashekhar emphasized that Watson "will always be consultative" and that it "cannot replace human clinical judgment and the essential patient-doctor relationship."

Slide 9

Postmastectomy Implants? Radiotherapy Affects Outcomes

Women who received postmastectomy radiation therapy (RT) had higher complication rates if they had implant reconstruction compared with autologous reconstruction in the large, prospective, multicenter Mastectomy Reconstruction Outcomes Consortium study. "The impact of radiotherapy on breast reconstruction is widely feared but poorly understood," said investigator Reshma Jagsi, MD, DPhil, professor and deputy chair in the Department of Radiation Oncology at the University of Michigan, who reported the results here. RT can cause skin changes, vascular compromise, and fibrosis, which may compromise the viability and outcomes of breast reconstruction, necessitating repeat interventions for correction, Dr Jagsi explained. "These data are critical to inform the growing number of patients who are considering postmastectomy radiotherapy and who may desire breast reconstruction, so that they may make informed and preference-concordant decisions," she said.

Image from iStock

Slide 10

Needling the Pain of Peripheral Neuropathy

For patients with breast cancer who have chemotherapy-induced peripheral neuropathy, acupuncture may provide relief where other approaches have failed, according to a pilot study. The study randomly assigned 40 patients with taxane-induced peripheral neuropathy to receive acupuncture therapy or usual care. The acupuncture was delivered for 8 weeks, on average twice a week, and usual care consisted of follow-up by the patients' regular doctor without any particular intervention. All acupuncture was delivered according to a standardized protocol, with the addition of electrostimulation. Overall, pain measures improved 33% and functional assessment improved 35% in the acupuncture group compared with controls. "We were pleasantly surprised at how strong the effect was, especially in these women who had been suffering with this for years," said senior investigator Jennifer Ligibel, MD, from the Dana Farber Cancer Institute in Boston, Massachusetts.

Slide 11

Aromatase Inhibitors: Is Cancer Benefit Worth Cardiac Risk?

Endothelial dysfunction, a predictor of cardiac disease, may be a side effect of AI therapy among postmenopausal women with breast cancer. In a small cross-sectional study, AI therapy was associated with reduced endothelial function. But the findings should not alter appropriate breast cancer management, at least initially, said investigator Anne H. Blaes, MD, associate professor of hematology and oncology at the University of Minnesota, in Minneapolis. "I think in the first 5 years of breast cancer treatment, for sure I wouldn't recommend something different," she said. "We know there's a survival advantage and a disease-free survival advantage from using aromatase inhibitors. I do think it means we have to manage other risk factors, such as high blood pressure, high lipid profile, and tobacco use, very well instead of forgetting about them." But with extended AI therapy, this issue is less clear and is in fact a much-debated question, she noted.

Slide 12

BELLE-3: PI3K Inhibition Meets Endpoints, But With Toxicity

Adding the investigational PI3K inhibitor buparlisib (BKM120) to fulvestrant in postmenopausal women with hormone-positive, human epidermal growth factor receptor–negative locally advanced or metastatic breast cancer led to significant improvements in progression-free survival (PFS) compared with placebo in the phase III BELLE-3 study. The study "confirms the importance of continued inhibition of the mTOR [mammalian target of rapamycin]/PI3K axis in hormone-refractory breast cancer, and supports PIK3CA mutations as predictors of benefit from agents targeting this pathway," said trialist Ruth O'Regan, MD, from University of Wisconsin in Madison. However, a high toxicity rate in patients receiving buparlisib "may represent a clinically relevant challenge," she acknowledged. "As has previously been reported, there were increased transaminases [aspartate transaminase and alanine transaminase], and also psychiatric issues like depression and anxiety — there were a number of patients that attempted suicide in the buparlisib arm," she said.

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