CBCN had the pleasure of attending the San Antonio Breast Cancer Symposium in December. Below you’ll find the latest research for early-stage breast cancer. Watch out for the latest research on mBC.
Terms to note while reading:
De-escalation: To reduce or omit certain parts of a treatment plan “without compromising survival and perhaps even improving quality of life”.
Pathological complete response (pCR): There is no evidence in any biopsy or tissue sample taken from the body that cancer is present following treatment.
Neoadjuvant therapy: systemic therapy given to shrink the tumor and thar occurs prior to breast cancer surgery.
Adjuvant therapy: systemic therapy given after surgery.
Recurrence prevention
Less frequent post treatment mammography screening may be an option for some breast cancer patients
Annual mammogram screening is standard for most breast cancer patients once surgery has been completed. In the MAMMO-50 trial, UK investigators explored whether breast cancer patients aged 50 or older who were 3+ years post treatment were able to de-escalate the frequency of mammography screening. They compared the annual screening to patients with lumpectomies screened every 2 years and patients with mastectomy screened every 3 years. After 5 years follow-up, overall survival for patients screened annually was 94.7% and 94.5% for those screened less frequently.
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Radiation
De-escalation of radiation for certain low risk breast cancers may be an option for some
The most notable updates in the field of radiation for breast cancer focused on ways to de-escalate radiation therapy:
The E4112 clinical trial showed that using MRI and Oncotype DX to guide decision making, some individuals with low-risk DCIS could potentially skip radiation after breast-conserving surgery.
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The IDEA trial also used Oncotype DX to effectively eliminate radiation for postmenopausal patients aged 50 to 69 with stage 1 HR+ breast cancer. The results showed that patients had a very low risk of recurrence within 5 years but noted that longer follow-up past 5 years is important to determine long-term safety. Read more
The NSABP B-51 trial investigated whether lymph node radiation may be omitted for individuals whose cancer had spread to the lymph nodes but was successfully eradicated with neoadjuvant chemotherapy. The results showed that skipping regional nodal irradiation did not increase a person’s risk of recurrence within 5 years after surgery; long-term follow-up is continuing.
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TNBC
A small Phase I study showed promise for future vaccine to treat and prevent TNBC
The study showed that immune response was achieved in 7 of 10 patients allowing for future trials researching an alpha-lactalbumin vaccine. Next steps will include trials that use the vaccine as part of adjuvant treatment in high-risk TNBC patients as well as a preventative measure for patients at a high genetic risk (BRCA1, BRCA2 or PALB2 positive) of developing TNBC.
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Stage I and II TNBC patients may see a reduction in neoadjuvant chemotherapy with the addition of nivolumab (Opdivo)
Neoadjuvant nivolumab combined with a 12-week regimen of carboplatin/paclitaxel chemotherapy (less than half the chemotherapy used in the current standard of care for this population) achieved a median pathological complete response (pCR) rate of 53%. This means that over half of patients had no detectable disease after completion of neoadjuvant treatment at 12-months follow-up. PD-L1 positive patients saw the highest pCR rates on this regimen.
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HER2+
Neoadjuvant atezolizumab shows positive results when combined with anthracycline and cyclophosphamide (AC)
Patients in the APTneo trial were randomly assigned to receive neoadjuvant trastuzumab, pertuzumab, carboplatin and paclitaxel (HPCT) plus atezolizumab (Tecentriq) or AC plus atezolizumab for half of the regimen followed by HPCT plus atezolizumab for the other half. Both groups were then compared to patients receiving HPCT alone. Treating atezolizumab with HPCT did not improve pCR but with the addition of the AC chemotherapy regimen, patients did see a higher pCR when compared to patients who received only HPCT (61.9% and 52% respectively).
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HR+
Fertility preservation can be used without an increased risk of recurrence
Results from the POSITIVE trial found that pausing endocrine therapy for up to 2 years to attempt pregnancy did not increase the risk of breast cancer recurrence for patients with HR+ breast cancer after a 3-year follow-up. A variety of methods were used to become pregnant among study participants including fertility preservation (freezing eggs or embryos before cancer treatment) as well as assisted reproductive technologies (ovarian stimulation for in vitro fertilization or cryopreserved embryo transfer). A younger age and cryopreserved embryo transfer were associated with higher chances of pregnancy. There was no apparent negative impact on short-term breast cancer outcomes.
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Presence of circulating tumour DNA (ctDNA) correlated with disease recurrence, highlighting its potential for predicting risk of recurrence
Researchers presented findings on using the Signatera™ assay to detect ctDNA in patients with HR+; HER2-, node-positive breast cancer. This study specifically focused on patients from the monarchE trial treated with abemaciclib (Verzenio) and endocrine therapy. All patients who became ctDNA positive at 24 months experienced a recurrence; the timing of the ctDNA presence varied among them, with a median of 5 months before the recurrence of disease. Further analysis will explore how ctDNA can identify patients at high risk of recurrence.
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CBCN’s attendance at SABCS was made possible thanks to travel funding support provided by Pfizer Oncology.
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