San Antonio Breast Cancer Symposium 2012 Helen K. Chew, MD, FACP Professor of Medicine.
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Transcript of San Antonio Breast Cancer Symposium 2012 Helen K. Chew, MD, FACP Professor of Medicine.
Objectives
1. Adjuvant tamoxifen duration (S1-2)
2. Adjuvant trastuzumab duration (S5-2)
3. Adjuvant chemotherapy for isolated local regional recurrence (S3-2)
4. Role of bevacizumab? (S1-7, S6-5)
Figure 5 Effects of about 5 years of tamoxifen on the 15-year probabilities of recurrence and of breast cancer mortality, for ER-positive disease Outcome by allocated treatment in trials of about 5 years of adjuvant tamoxifen. Event rate ratio (...
Early Breast Cancer Trialists' Collaborative Group (EBCTCG)
Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials
The Lancet Volume 378, Issue 9793 2011 771 - 784
http://dx.doi.org/10.1016/S0140-6736(11)60993-8
ATLAS
• Very large, pragmatic study (1996-2005)• No restrictions on age, hormone receptor
status, nodal status or other treatments• No protocol-defined visits or evaluations
except for yearly MD questionnaire• Protocol amended in 2000 when 5 years
of tamoxifen was superior to 2 years
Published online Lancet 12/5/12
Table 1, ER+ tumorsTamoxifen x 5 years
n=3418Tamoxifen x 10 years
N=3428
Age, years %
<45 18 19
45-54 32 32
55-69 40 40
>70 10 9
Nodal status %
N0 54 53
1-3 nodes 26 27
>4 nodes 16 16
Tumor size %
T1 47 48
T2 39 38
T3 7 7
Menopausal status %
Premenopausal 9 10
Postmenopausal 89 89
Figure 3 Recurrence (A) and breast cancer mortality (B) by treatment allocation for 6846 women with ER-positive disease Bars show SE. Recurrence rates are percentage per year (events/patient-years of follow-up). Death rates (overall rate???rate ...
Christina Davies , Hongchao Pan , Jon Godwin , Richard Gray , Rodrigo Arriagada , Vinod Raina , Mirta Abraham , V...
Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial
The Lancet null 2012 null
http://dx.doi.org/10.1016/S0140-6736(12)61963-1
Figure 2 Treatment compliance (A) and proportion of patients in follow-up (B) by year since randomisation for 6846 women with ER-positive disease (54% node-negative) *>99% tamoxifen.
Christina Davies , Hongchao Pan , Jon Godwin , Richard Gray , Rodrigo Arriagada , Vinod Raina , Mirta Abraham , V...
Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial
The Lancet null 2012 null
http://dx.doi.org/10.1016/S0140-6736(12)61963-1
How does this impact clinical care?
• For patients who are appropriate candidates for tamoxifen therapy, 10 years of tamoxifen is recommended.
• This trial cannot be compared to any strategies that have incorporated aromatase inhibitors.
How does this impact clinical care?
• One year of adjuvant trastuzumab remains the standard of care.
• PHARE trial (abstract #S5-3) was a subset analysis of non-inferiority of 6 versus 12 months of adjuvant trastuzumab.
How does this impact clinical care?
• A course of adjuvant chemotherapy after an isolated local regional recurrence improves DFS and OS.
• The benefits appear less convincing for hormone receptor positive disease.
• Sites of recurrence (ipsilateral breast versus chest wall) and timing of recurrence and their correlation with outcomes were not reported in detail.
How does this impact clinical care?
• The addition of bevacizumab to first-line endocrine therapy in hormone-receptor positive MBC did not improve PFS.
• This addition of bevacizumab to first-line chemotherapy for early stage triple negative breast cancer did not improve DFS.
• The role of bevacizumab in breast cancer is not well defined and bevacizumab should not be used outside of a clinical trial.
Thank you.Questions?