Trending Clinical Topic: Breast Cancer

Ryan Syrek


December 18, 2020

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The "hottest" presentations at the 2020 San Antonio Breast Cancer Symposium (SABCS) and new insights into treatment-related concerns resulted in this week's top trending clinical topic.

Findings from the RxPONDER trial (abstract GS3-00) presented at SABCS garnered much attention. The major randomized clinical trial assessed use of a recurrence score among women with lymph node–positive, early-stage breast cancer to determine which patients may be able to safely forgo chemotherapy (see Infographic below). RxPONDER is similar to TAILORx, results of which were first presented in 2018 and have changed treatment practice in women with early-stage disease and no lymph node involvement. The difference is that the RxPONDER trial focused on lymph node–positive breast cancer. Although still early, findings suggest that some women may be able to avoid the associated side effects of chemotherapy without risking increased recurrence.

A separate presentation at SABCS discussed data from a new meta-analysis about the use of a blood test that measures circulating tumor cells (CTCs) as a way to assess treatment efficacy in patients with metastatic breast cancer. Data from more than 4000 patients pointed to the presence or absence of CTCs as "strongly" predictive of overall survival. However, some experts believe that the approach should remain only a research tool at this point.

Prior to SABCS, several other studies recently captured interest. A study published in The BMJ examined the impact of hormone therapy in nearly 100,000 women with breast cancer and more than 450,000 controls. Researchers found that use of estrogen-progestin therapy (EPT) was associated with an odds ratio for breast cancer of 1.26, whereas the use of estrogen therapy (ET) had an odds ratio of 1.06. Among women aged 50-59 who used EPT for 5 years or longer, 15 additional breast cancers were diagnosed per 10,000 person-years. Among those who used ET, the attributable risk was three additional breast cancers per 10,000 person-years. Andrew M. Kaunitz, MD, suggests that patients be told that although EPT increases the risk for breast cancer, the magnitude of this excess risk is small and should be weighed against benefits, including the prevention of osteoporosis.

Elsewhere, a review found that pregnancy after treatment for breast cancer among patients with BRCA mutations is safe. The study included 1252 women who were no older than 40 years when diagnosed with stage I-III BRCA-mutated invasive breast cancer. The miscarriage rate was 10.3%, which is lower than expected in the general population. Delivery complications occurred in 13 of the 112 pregnancies with available data (11.6%), while congenital anomalies were seen in just two pregnancies (1.8%), a lower rate than expected in the general population. Of note, no difference was found in either disease-free survival or overall survival between the women who became pregnant and those who did not.

From new insights into whether chemotherapy can be avoided in certain populations to encouraging findings about other treatment-related concerns, potentially critical breast cancer news helped make the condition this week's top trending clinical topic.

Read more clinical information about breast cancer.


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