What are the top 5 breast cancer advancements of 2017?
The rollout of more effective and affordable screening programs alongside advancements in treatment options has resulted in declining death rates in breast cancer over the last few decades. Yet, despite this, breast cancer remains the most common type of cancer in women globally: approximately 1.7 million new cases were diagnosed in 2012 and breast cancer continues to rank as the fifth-largest cause of death from cancer overall [1].
In this article we explore the five biggest advancements that have been made in the field over the last year. We’d also love to hear your thoughts; let us know in the comments section below if you agree with our selection, or if you think a different research highlight should have made it into our top 5 list!
Targeted therapies: PARP inhibitors
A highlight from American Society of Clinical Oncology (ASCO) this year (2–5 June 2017, IL, USA) was the OlympiAD trial data. This Phase III clinical trial compared PARP inhibitor (olaparib) monotherapy with standard therapy in approximately 300 patients with a germline BRCA mutation and HER2–negative metastatic breast cancer. Data from the study demonstrated that olaparib provided a significant benefit over standard therapy, reduced the chance of progression of advanced BRCA-related breast cancer by 42%, and delayed progression by 2.8 months [2, 3].
ASCO President Daniel F Hayes commented on the significance of the findings [3]: “These long-awaited findings show that this new class of treatment can deliver better results for women with BRCA-positive breast cancer. What’s remarkable is that we are now able to not only tailor breast cancer treatment based on the genetic changes in the tumor but also on the inherited factors driving its development.”
Following this promising news, researchers are now exploring whether these PARP inhibitors could also be used in different subsets of breast cancer, such as triple negative breast cancer [4].
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Pre-pectoral implants
Pre-pectoral implant-based surgery, which works by placing the implant directly under the skin and over the muscle, has gained popularity due to its more minimal approach compared with traditional breast reconstruction methods. This transition to muscle-sparing reconstruction has demonstrated excellent short-term outcomes; the key advantages being that it avoids animation deformity, helps prevent shoulder dysfunction, and has a lower incidence of capsular contracture. While the initial short-term results are promising, long-term outcomes are yet to be reported and this is an area that will be one to watch over the coming year [5].
Read more about breast cancer surgery in this review from Pain Management
A review of postoperative analgesia for breast cancer surgery
Avoidance of further axillary surgery in sentinel node-positive patients
Another clinical highlight from this year was the results from the American College of Surgeons Oncology Group ACOSOG Z0011 trial, which questioned the belief that all breast cancer axillary nodes must be removed.
The multicentre, randomized Phase III trial demonstrated that 10-year overall survival for patients treated with sentinel lymph node dissection alone was noninferior to overall survival for those treated with axillary lymph node dissection (among women with T1 or T2 invasive primary breast cancer, no palpable axillary adenopathy and one or two sentinel lymph nodes containing metastases) [6].
“Axillary lymph node dissection is an effective method of maintaining regional control but it is associated with a significant risk [for] complications such as lymphedema, numbness, axillary web syndrome and decreased upper-extremity range of motion,” first author Armando E. Giuliano from Cedars-Sinai Medical Center (CA, USA) and colleagues wrote.
The findings demonstrated that avoidance of further axillary surgery in sentinel node-positive patients was feasible and did not support routine use of axillary lymph node dissection in this patient population, based on 10-year outcomes.
Despite its controversy, the results from the ACOSOG Z0011 trial had a substantial effect on breast cancer treatment, Edward H Livingston and Hsiao Ching Li, both from University of Texas Southwestern Medical Center (TX, USA), explained in an editorial exploring the trial.
These results have “shattered a century of belief” that physicians must remove all breast cancer-containing axillary lymph nodes, Livingston and Li concluded [7].
Would you like to find out more about axillary surgery?
CDK4/6 inhibitors
At this year’s ASCO meeting, data were presented from the MONARCH 2 Phase III trial, which demonstrated that adding abemaciclib to fulvestrant reduced the risk of disease progression or death by 45% versus fulvestrant alone in patients with HR+/HER2- advanced breast cancer who progressed on endocrine therapy.
Later in the year, the US FDA approved abemaciclib for use in combination with fulvestrant in women with HR+/HER2- advanced breast cancer with disease progression following endocrine therapy. This CDK4/6 inhibitor was approved as a monotherapy for patients with HR+/HER2- breast cancer with metastatic disease who have previously received endocrine therapy and chemotherapy [8].
“This study showed that the combination of abemaciclib and fulvestrant is an effective treatment in patients with HR+/HER2- advanced breast cancer who progressed on endocrine therapy. The study showed significant improvements in progression-free survival and response rates compared to fulvestrant alone. This study confirms the strong potential of CDK4/6 inhibitors to improve the efficacy of endocrine therapy in the metastatic setting,” explained clinician Francisco J Esteva from NYU Langone School of Medicine (NY, USA) in a recent interview[9].
“Abemaciclib provides a new targeted treatment option for certain patients with breast cancer who are not responding to treatment, and unlike other drugs in the class, it can be given as a stand-alone treatment to patients who were previously treated with endocrine therapy and chemotherapy,” added Richard Pazdur, Director of the FDA’s Oncology Center of Excellence and acting director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research [10].
Interested in finding out more about CDK4/6? Click below
APHINITY trial
Data from the APHINITY Phase III trial, presented at ASCO in June and published in the New England Journal of Medicine in July, demonstrated a very small benefit of chemotherapy plus trastuzumab plus placebo versus chemotherapy plus trastuzumab plus pertuzumab as adjuvant therapy alone on risk of recurrence of invasive disease in patients with HER2-positive early breast cancer [11].
“The addition of pertuzumab to trastuzumab-based chemotherapy improved disease-free survival in the adjuvant setting for patients with early-stage HER2-positive breast cancer. Double antibody therapy using trastuzumab and pertuzumab is commonly used in the neoadjuvant setting, but long-term outcomes data were lacking. Results from the APHINITY trial support the use of pertuzumab in the adjuvant setting, especially in women at high risk of distant metastases,” Francisco J. Esteva from NYU Langone School of Medicine commented [9].
Following on from this, the FDA granted a priority review to a supplemental biologics license application for pertuzumab for use in combination with trastuzumab and chemotherapy for the adjuvant treatment of patients with HER2-positive early breast cancer.
Following the supplemental biologics license application, manufacturers of pertuzumab are seeking to convert the accelerated neoadjuvant approval into a full approval [12].
Want to discover more about trastuzumab and pertuzumab? Click below:
- Adoption of trastuzumab for breast cancer in four emerging countries in the use of HTA: a case study
Where is the field of breast cancer heading?
The emergence of advances in early diagnosis and more effective treatments have continued to aid the steady increase of long-term survival rates for breast cancer patients and shifted our perception of breast cancer from a life-threatening illness to a chronic condition [13]. The focus going forward will be to refine our understanding of disease mechanisms in order to further advance drug development and treatment responses. Alongside this, we need to gain a deeper understanding of the individual molecular patterns and aberrations of each patient. This could revolutionize the current stratified treatment approach that is based on the intrinsic subtype groups, to a truly individualized treatment based on specific molecular characteristics of each patient [14].
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References:
[1] Globocan 2012 http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx (Accessed 23 October 2017).
[2] Robson M, Im SA, Senkus E et al. Olaparib for metastatic breast cancer in patients with a germline BRCA Mutation N. Eng. J. Med. 377:523–533 (2017).
[3] Olaparib slows growth of brca-related metastatic breast cancer www.asco.org/about-asco/press-center/news-releases/olaparib-slows-growth-brca-related-metastatic-breast-cancer (Accessed 23 October 2017).
[4] ASCO 2017: Breast Cancer Research News www.patientpower.info/video/asco-breast-cancer-research-news (Accessed 23 October 2017).
[5] Vidya R & MujtabaIqbal F A guide to prepectoral breast reconstruction: a new dimension to implant-based breast reconstruction Clin. Breast Cancer 17(4), 266–271 (2017)
[6] Giuliano AE, Ballman KV, McCall L et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis The ACOSOG Z0011 (Alliance) randomized clinical trial JAMA. 318(10), 918–926 (2017).
[7] Livingston EH & Ching Li H. Breast cancer surgery less is more JAMA. 318(10), 909–911 (2017).
[8] Sledge GW, Toi MJ, Neven P et al. MONARCH 2: Abemaciclib in combination with Fulvestrant in women with HR+/HER2− advanced breast cancer who had progressed while receiving endocrine therapy J. Clin. Oncol. 35(25), 2875–2884 (2017).
[9] ASCO 2017: Oncology Leaders Pick Their Top Abstracts www.onclive.com/web-exclusives/asco-2017-oncology-leaders-pick-their-top-abstracts?p=5 (Accessed 23 October 2017).
[10] FDA approves new treatment for certain advanced or metastatic breast cancers www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm578071.htm (Accessed 23 October 2017).
[11] von Minckwitz G, Procter M, de Azambuja E et al. Adjuvant Pertuzumab and Trastuzumab in early HER2-positive breast cancer N. Engl. J. Med. 377,122–131 (2017).
[12] FDA approves Abemaciclib for HR+/HER2- breast cancer www.onclive.com/web-exclusives/fda-approves-abemaciclib-for-hrher2-breast-cancer (Accessed 23 October 2017).
[13] Bodai B & Tuso P. Breast cancer survivorship: a comprehensive review of long-term medical issues and lifestyle recommendations Perm. J. 19(2), 48–79. (2015).
[14] Ades F, Tryfonidis K & Zardavas D The past and future of breast cancer treatment—from the papyrus to individualised treatment approaches Ecancer 11(746) (2017).
