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30th Annual Miami Breast Cancer Conference®

30th Annual Miami Breast Cancer Conference®


Resources

Clinical Trials Reference List

Online Resources for Patients With Breast Cancer



PER Pulse™ Recap:

Medical Writer: Jennifer Klem, PhD



1 of 3
30th Annual Miami Breast Cancer Conference®
Practical Issues for Physicians and Patients

 
The 30th Annual Miami Breast Cancer Conference®, which was held March 7-10, 2013, presented current standards and emerging data on the management of patients with breast cancer. This first of three PER Pulse™ Recaps from the Miami Breast Cancer Conference® is centered on practical issues for patients with breast cancer and the physicians who treat them. Dr. Hyman Muss discussed three of the most common long-term toxicities associated with chemotherapy: fatigue, peripheral neuropathy (PN), and congestive heart failure (CHF). Fatigue is highly prevalent among cancer patients, but there are a number of approaches to resolve or at least improve fatigue, including replacement of medications that might cause fatigue, treatment of depression, improvement of nutrition, and encouragement to exercise and/or participate in cancer rehabilitation programs. Although psychostimulants can reduce fatigue in selected patients, they also produce objectionable side effects. According to a recent phase III placebo-controlled study, American ginseng may significantly reduce fatigue. Cancer-induced PN is typically caused by taxane use and can manifest as paresthesia, burning sensation, or pain. Grade 3 neuropathy is serious, especially in the elderly, because a loss of balance or sensation in the feet can lead to a fall and subsequent broken bones. Pharmacologic treatment options for PN are largely ineffective, with the possible exception of duloxetine, which produced a significant reduction in pain in phase III placebo-controlled testing. CHF is associated with a poor prognosis, in which less than half of patients with CHF live more than 2 years. Anthracyclines used to be the primary cause of cardiotoxicity among cancer patients, but the bigger problem now is trastuzumab-associated CHF. Fortunately, trastuzumab-induced CHF is most often reversible with ACE inhibitors or beta-blockers, and may even be preventable with these agents.

Click here to download PDF version

Other important lectures covering additional practical issues included:
  • When Do You Need a PET/CT or MRI in Early Breast Cancer?
    Elizabeth Morris, MD
     
  • The Use of Blood Tests in Breast Cancer for Early Detection and Treatment
    Emanuel F. Petricoin III, PhD
     
  • Management of Early Menopausal Associated Symptoms in Patients With Breast Cancer
    J. Michael Dixon, MD
     
  • What Patients Can/Cannot Do After Axillary Surgery
    Anees Chagpar, MD, MSc, MA, MPH
     
  • The Need for Repeat Biopsy After Recurrence
    Anees Chagpar, MD, MSc, MA, MPH
     
  • How Do You Treat Chemotherapy-Induced Nausea and Vomiting?
    Hope S. Rugo, MD
     
  • Affordable Health Care Act:  What It Means for the Physician and the Patient
    Donna Shalala


2 of 3
30th Annual Miami Breast Cancer Conference®
Local Control of Breast Cancer

The 30th Annual Miami Breast Cancer Conference® was held March 7-10, 2013, to discuss and debate the cutting-edge management of patients with breast cancer. This PER Pulse™ Recap, the second of three presenting key topics from the Miami Breast Cancer Conference®, is focused on surgery and local control of breast cancer.

Dr. Anees Chagpar presented information on the use of sentinel lymph node biopsy (SLNB) after neoadjuvant therapy for patients with node-positive breast cancer. Issues concerning the timing of SLNB include a lower sentinel node identification rate and a higher false-negative rate with post-neoadjuvant therapy SLNB. The ACOSOG Z1071 study examining post-chemotherapy SLNB and axillary lymph node dissection (ALND) in node-positive breast cancer produced an identification rate of 92.5% and a false-negative rate of 12.8%, as long as two or more sentinel nodes were examined. The false-negative rate decreased even further if a dual tracer was used or if a previously placed clip could be found. Results from the German SENTINA trial demonstrated a similar false-negative rate of 14.2% when SLNB was performed after neoadjuvant chemotherapy. These data suggest that post-neoadjuvant therapy SLNB produces acceptable identification and false-negative rates, while permitting the avoidance of ALND in patients who have achieved a pathologic complete response to therapy. The important question now is whether a higher false-negative rate even impacts patient outcomes, and clinical trials are being conducted to address this question.

Click here to download PDF version


Other important lectures covering surgical or local control issues included:
 
  • Re-evaluating Axillary Dissection
    Virgilio Sacchini, MD
     
  • Targeting Surgery for Known Axillary Disease
    Abigail S. Caudle, MD
     
  • Skin- and Nipple-Sparing Mastectomy
    Virgilio Sacchini, MD
     
  • Main Factors That Influence Incomplete Excision After Breast-Conserving Surgery
    J. Michael Dixon, MD
     
  • Therapeutic Mammoplasty: Who, How, How Often?
    Lloyd Gayle, MD
     
  • Lipofilling: A New Technique for All
    Lloyd Gayle, MD
     
  • Contralateral Prophylactic Mastectomies: Risks and Benefits
    Patrick I. Borgen, MD
     
  • DEBATE: Are We Doing Too Many Mastectomies?
    J. Michael Dixon, MD, and Patrick I. Borgen, MD
     
  • What Is New in Breast Reconstruction?
    Lloyd Gayle, MD
     
  • Is There Value to Local Control in Selected Patients With Stage IV Disease?
    Anees Chagpar, MD, MSc, MA, MPH
     
  • Should Hypofractionation Be the New Standard After Breast-Conserving Surgery?
    Timothy Whelan, MD
     
  • DEBATE: Does Regional Radiation Improve Outcome?
    Timothy Whelan, MD, and J. Michael Dixon, MD
     
  • Intraoperative Radiotherapy
    Mattia Intra, MD
     
  • Current Update on the Standard of Care for Accelerated Partial-Breast Radiotherapy–Technique, Efficacy, Toxicities
    Lawrence J. Solin, MD
     
  • Does Everyone With 1-3+ Nodes Need Post-Mastectomy Radiotherapy?
    Lawrence J. Solin, MD



3 of 3
30th Annual Miami Breast Cancer Conference®
Advances in Systemic Therapies for Breast Cancer

The 30th Annual Miami Breast Cancer Conference®, which was held March 7-10, 2013, presented current standards and emerging data on the management of patients with breast cancer. This is the last of three PER Pulse™ Recaps from the Miami Breast Cancer Conference®, and it reviews recent and emerging advances in systemic therapies.
 
Dr. Mark Pegram gave a lecture on immunoconjugates in the adjuvant and metastatic settings, focusing on the antibody-drug conjugate T-DM1 (ado-trastuzumab emtansine), a trastuzumab molecule linked to several emtansine molecules, which inhibit microtubule polymerization. The EMILIA study was the registrational trial of T-DM1 in patients with HER2+ advanced disease. Nearly 1,000 patients who had already received a taxane and trastuzumab were randomized to T-DM1 or to lapatinib + capecitabine. The patient population was relatively young, with a performance status of 0 or 1; two-thirds of patients had visceral disease. T-DM1 produced a significant improvement in progression-free survival (PFS; HR = 0.65; P < .0001), and this benefit was observed in nearly all subgroups. In addition, overall survival (OS) with T-DM1 was improved by 5.8 months (HR = 0.68; P = .0006) compared with lapatinib + capecitabine. Common chemotherapy side effects are rare with T-DM1, but there are T-DM1-related adverse events (AEs), specifically thrombocytopenia and elevated hepatic function scores, including the rare but important toxicity, nodular proliferative hyperplasia. T-DM1 was approved in February 2013 for use in HER2+ metastatic breast cancer previously treated with a taxane and trastuzumab. Additional T-DM1 studies, including the MARIANNE trial, are under way in the first-line metastatic and adjuvant settings.
 
Dr. José Baselga presented data on the use of mTOR inhibition to reverse resistance to endocrine blockade therapy, showing that although single-agent mTOR inhibition with everolimus produces only modest activity, this agent synergizes with hormonal therapy in patients with ER+, HER2- disease. Everolimus has been successfully combined with letrozole and tamoxifen in phase II studies, and the large phase III, registrational study BOLERO-2 combined everolimus with exemestane. Compared with exemestane alone, combination therapy produced a 6.5-month improvement in PFS (HR = 0.36; P = 3.3 x 10-15), and this PFS benefit was observed in all patient subgroups. OS is still immature but promising, with a 6.2% absolute reduction in deaths with combination therapy. The main AE of concern with everolimus is stomatitis, which can develop early and be very painful, but can often be managed with dose reduction or other measures.

Click here to download PDF version
 
Other important topics discussed regarding advances in systemic therapies for breast cancer included:
 
  • Tailoring Adjuvant Hormonal Therapy 
    Lisa Carey, MD
     
  • Non-Anthracycline Adjuvant Therapy: When to Use?
    William J. Gradishar, MD
     
  • Adjuvant Therapy for HER2+ Breast Cancer: 1 vs 2 Years 
    Martine Piccart, MD, PhD
     
  • Adjuvant Therapy for Older Individuals 
    Hyman Muss, MD
     
  • Predicting Survival From Adjuvant Therapy 
    W. Fraser Symmans, MD
     
  • Targeting Tumor Vasculature–How to Move Forward? 
    Hope S. Rugo, MD
     
  • Managing Triple-Negative Tumors in Everyday Practice 
    Lisa Carey, MD
     
  • Lessons Learned From Pre-operative Therapy 
    Gunter von Minckwitz, MD, PhD
     
  • Front-line Chemotherapy for Advanced Breast Cancer: Is There a Standard? 
    Hope S. Rugo, MD
     
  • Chemotherapeutic Choices in Later Lines of Therapy 
    William J. Gradishar, MD
     
  • Progress in Treating Advanced Triple-Negative Breast Cancer 
    Lisa Carey, MD
     
  • Advanced HER2+ Breast Cancer: New Options and How to Deploy Them 
    José Baselga, MD, PhD
     
  • Combination of Two Anti-HER2 Therapies 
    Mark Pegram, MD
     
  • Future Prediction for Adjuvant Therapy 
    George Sledge, Jr, MD
     
  • Update on the New PI3K Inhibitors 
    José Baselga, MD, PhD
     
  • Strategies to Overcome Resistance to Trastuzumab 
    Mark Pegram, MD


Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
 
This activity is not approved for AMA PRA Category 1 Credit™.
 
Supported by educational grants from Celgene Corporation, Eisai Inc., Genentech, and Novartis Pharmaceuticals Corporation.






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