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Adjuvant Chemotherapy for Local or Regional Breast Cancer Recurrence Prolonged Survival

MD-FM Thursday December 13th, 2012




GENERIQUE
Carillon
 
SARAH:
MD FM — medical news from around the world with Peter Goodwin.

P1

PETER:
Hello, and with me is Sarah Maxwell. Firstly: from the San Antonio Breast Cancer Symposium: clarification of whether to add chemotherapy to standard surgery and radiotherapy for patients with isolated local or regional recurrence of their breast cancer.
 
SARAH:
The authors of the randomized CALOR trial found that chemotherapy was definitely beneficial. Patients who had chemotherapy had fewer relapses and lived longer than those who did not. And women with estrogen receptor-negative breast cancer showed the greatest benefit of all: nearly double the disease-free survival at five years; and overall survival increasing by 10 percent:
 
Bob-Wapnir: “I think it’s the first time that we have a solid road map on what to do with this patient population: in addition to surgery for local treatment, radiation as needed — again tailored to what the prior treatments of the patient --we can now say that chemotherapy overall seems to benefit patients in a very significant way. It was a large effect: an absolute 12 per cent benefit in disease free survival with a short term median follow up of five year; and that we saw a similar benefit in overall survival. So to see that kind of impact of treatment  intervention resulting from the use of chemotherapy is very dramatic, and I think it’s very useful for practicing clinicians to consider this very seriously and apply it to their patients”
 
SARAH:
That was study co-chair doctor Irene Wapnir, from Stanford University. Doctor Stefan Aebi, from Switzerland presented the findings in San Antonio and said: in practice, the SPECIFIC choice of WHICH chemotherapy to use, is up to the clinician and depends things like the patient’s history and individual characteristics.

P2

PETER:
And staying with the 2012 San Antonio meeting: how best to treat very young women with breast cancer, and evidence that neo-adjuvant therapy could be an important first step – even more so than in older women:

SARAH:
Yes, complete remission from the using chemotherapy first was significantly higher for women under 35 years old: 23% — compared to 13.5% for the over 50’s. That’s from a study with 9000 women treated with neo-adjuvant chemotherapy for their early breast cancer, 700 of whom were under 35.
 
PETER:
But younger women do have more aggressive forms of breast cancer, and yet it seems they’re more treatable!

 
SARAH:
Yes: but their disease is still dangerous! But the study found subsets of patients who get more benefit from neo-adjuvant chemotherapy. Sibylle Loibl told us the estrogen receptor and the HER2 status of younger women, makes a difference to their rates of pathological complete response: pCR:
 
Bob 2 -Loibl: “We found that, especially in the triple negative breast cancer cohorts, so no HER 2 and no hormone receptor status (peter should verify this is what she is saying) present in the tumor, we found the highest pCR rate with 45 per cent for the very young going down to about 25 per cent for the women older than 50 years and the other age group  is in the middle, and we found a difference also in the group which was hormone receptor positive but HER 2 negative — and they have a much lower pCR rate but there’s still the same age difference for the young women having a higher pCR rates compared to the other age groups”
 
SARAH:
Professor Sibylle Loibl, from the University of Frankfurt in Germany  —who added that, all young patients should be considered for adjuvant chemotherapy — whatever their hormone and HER2 status.

VIRGULE MUSICALE

P3

PETER:
Finally from the San Antonio symposium, a genetic study suggests, current screening tests may miss as many as one in 50 women with breast cancer who might benefit from treatment with anti-breast cancer drugs. In a study with 1,500 women found to be HER2 negative using routine HER2 testing, further genetic analysis showed 25 actually did have HER2 mutations — that could potentially drive tumor growth.

VIRGULE MUSICALE
 
P4

PETER:
Now hot from the plenary session at the American Society of Hematology meeting in Atlanta. For patients with polycythemia vera, keeping hematocrit levels below 45%, is very important for avoiding the risk of thrombosis…

SARAH:
Yes, and the first hard evidence of this has just been presented at ASH and simultaneously published in the New Engalnd Journal of Medicine. A randomized trial from Italy showed patients whose hematocrit levels were kept between 45 and 50%, had nearly four times more risk of thrombosis than those who were kept below 45%.  Just a small small difference but one which needs to be achieved with phlebotomy, and this makes all the difference according to Professor Tiziano Barbui:
 
Bob-Barbui: “If you use phlebotomy + chemotherapy to keep the hematocrit low it doesn’t matter whether the difference of hematocrit is not so huge because it is clear that you reduce some other components that can account for the thrombosis. In our interpretation, it’s because the leucocytes go down during the study as a consequence of hydroxy-urea given during the study”

SARAH:
Tiziano Barbui, from Ospedali Riuniti di Bergamo, in Italy.
 
PETER:
A case has been made in the past on practical grounds for being less aggressive with hematocrit reduction hasn’t it, and clinical studies even suggested that keeping it below 50% was ok…
 
SARAH:
Yes, and that’s exactly what this study set out to test: and they proved — to a high level of significance — that the 45% threshold is paramount for lowering risk.

VIRGULE MUSICALE

P5

PETER:
Reducing overall dietary fat intake led to small reductions in weight and had benefits on major cardiovascular risk factors in a study published in the British Medical Journal …
 
SARAH:
Yes, researchers compared people on a ‘lower than usual fat intake’ diet with people having ‘usual fat intake’, in a systematic review and meta-analysis of randomized controlled trials and cohort studies including over 73,000 people. After at least six months, they measured the effects on body fat:
 
Bob Hooper-1: “The amount of weight difference depended on the amount of fat that had been reduced on the people that were cutting down on fat so it they were cutting down more on fat they lost a bit more weight. So all these studies were in people who were not trying to loose weight so we excluded all the trials where they were aiming to have some people loose weight or all people loose weight because we wanted to see what happened when people were just eating their normal food but cutting down a bit on fat.”
 
SARAH:
That was lead study author Lee Hooper, from the University of East Anglia. The study was commissioned by the WHO, to figure out the best guidance to give, on fat intake. Doctor Hooper said lowering saturated and processed fats should be the focus:
 
Bob-Hooper-2: “So if we want to prevent heart attacks we want to prevent strokes we want to cut down a bit on the saturated and the processed food fat and have more of the nice and natural olive oil type fat. So if we do a bit of both –we cut down a bit overall on fat but the fats that we cut down on are the saturates and the processed fats, that will leave us in the best position for gaining both outcomes if you like: gaining a bit of weight loss and also protecting us from heart disease and stroke .”
 
SARAH:
That was Lee Hooper, from the UK.


BREVE 1 Sur fond musical:

PETER:
Finally, in brief:

Cognitive behaviour therapy — or CBT — reduced depression in patients who didn’t respond to antidepressants, in a randomized study published in The Lancet. At six months, 46% of people who had CBT — on top of their usual care — had improved, compared to only 22% of those who’d continued with their usual treatment. They were also more likely to have a remission and fewer symptoms of anxiety with CBT.

And…..

BREVE 2

Zinc could be a life-saver for victims of lethal stings from the Australian box jellyfish — one of the most venomous animals on earth. This finding was published in PlOS One by a group of Hawaiian researchers who discovered that zinc can slow down the well known ‘pore-forming process’ inside human red blood cells, induced by the jellyfish’s venom.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me Peter Goodwin, goodbye!
 
JINGLE FIN    

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