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New treatment option for young women with breast cancer

MD-FM Thursday June 5th, 2014 

 

 

SARAH:

MD FM — the latest medical news from around the world. Here’s Peter Goodwin.

 

SEGMENT 1: ONCOLOGY: In premenopausal women with ER+ breast cancer and ovarian suppression, aromatase inhibitor more effective than tamoxifen

 

PETER:

And with me is Sarah Maxwell. We start with news hot from the American Society of Clinical Oncology meeting held this week in Chicago. For premenopausal women with hormone-sensitive breast cancer and under ovarian function suppression, an aromatase inhibitor was more effective than the current standard of care, tamoxifen, at preventing recurrences…

 

SARAH:

Yes, that’s according to an analysis that looked at nearly 5000 premenopausal women, who had either exemestane or tamoxifen for five years. That was in addition to an LHRH agonist, to temporarily suppress their ovarian function, although some had oophorectomy or ovarian irradiation instead…

 

PAGANI:

Disease-free survival was the primary objective, which includes local and regional recurrences, distant recurrences, contra-lateral breast cancer, second malignancies and death. And this was reduced by a relative risk reduction of 28 per cent, which was an absolute reduction of 3.8 per cent.

 

SARAH:

That was lead study author Olivia Pagani, from Bellinzona, in Switzerland, who told us that they’re still waiting to evaluate overall survival.

 

PETER:

And aromatase inhibitors have already been proven more effective than tamoxifen in postmenopausal women, haven’t they?

 

SARAH:

Yes but before now, they hadn’t been tested in premenopausal women. That was because treatment requires women to have very low levels of oestrogen, so you have to suppress ovarian function. And this still isn’t very popular in the United States. Outgoing ASCO President Clifford Hudis, who didn’t participate in the study, gave us his perspective:

 

HUDIS:

So these drugs –all of them are available already and, for those doctors and patients who believe that ovarian suppression is already a good thing to do, and a lot of our colleagues in Europe believe that, I think this is an important addition to their therapeutic choices. And I think that for higher-risk, highly motivated younger patients, this new option is important. But I think that, by the same token, for lower risk young patients who really have limited tolerance for any more side effects, this may be a less relevant choice. And for them tamoxifen alone remains a pretty good option.

 

SARAH:

That was Clifford Hudis, from the Memorial Sloan Kettering Cancer Centre, in New York. And study author Dr. Pagani agreed with his statement:

 

PAGANI:

This does not mean that every woman should receive ovarian function suppression and every woman should receive an aromatase inhibitor, but in young women at high-risk, when we think that ovarian suppression is worth giving, then my suggestion would be to give exemestane or another aromatase inhibitor.

 

SARAH:

Finally, another important observation is that about 43 per cent of women, including some with high-risk features, didn’t have chemotherapy and still had very good outcomes with exemestane:

 

PAGANI:

Within this 43 per cent, 29 per cent had node positive disease. So the message here is that if you select appropriately women with hormone-receptor-positive breast cancer, you don’t need necessarily to give to all these women chemotherapy.

 

SARAH:

Dr. Olivia Pagani, from Switzerland.

 

SEGMENT 2: LHRH-agonist helps preserve ovarian function despite chemotherapy for breast cancer

 

PETER:

Also from the ASCO meeting: a hormone-blocking drug helped prevent early menopause after treatment for hormone-receptor negative breast cancer, according to a major phase-III trial…

 

SARAH:

Yes, at two years, women who had the LHRH-agonist goserelin added to cyclophosphamide-containing chemotherapy, had a 70 per cent lower risk of ovarian failure. What’s more: at five years, women who took goserelin were more than twice as likely to get pregnant than those who didn’t:

 

MOORE:

There are theories that, during chemotherapy, you may actually get an increase in follicular atresia, so more cycling of the ovaries, so this medication could theoretically interfere with that increased cycling response and suppress ovarian function in the hopes of making it less susceptible to the chemotherapy’s damaging effects.

 

SARAH:

That was Dr. Halle Moore from the Cleveland Clinic, in Ohio, speaking to MDFM from the Chicago meeting. Although these findings are from patients treated for early-stage breast cancer, Dr. Moore said the results should be valid in patients getting chemotherapy for other cancers to help preserve ovarian function. And she believes this treatment is ready for use in practice:

 

MOORE:

This treatment really just need to start only about a week before the chemotherapy, does not require a partner and should be much less costly that assisted reproduction. Also, this treatment can be used in addition to the assisted reproduction technologies, because this is the only treatment that has been shown to preserve ovarian function so that might make a women more able to carry a pregnancy and, also, to be able to avoid other consequences of early menopause.

 

SARAH:

Dr Halle Moore, from the Cleveland Clinic in Ohio.

 

SEGMENT 3: Obesity before menopause may raise mortality risk in some breast cancers

 

PETER:

And according to another study presented at ASCO this last week, obesity may significantly raise the risk of dying from breast cancers, but only in premenopausal women with early-stage oestrogen receptor-positive breast cancer. They had a 34 per cent greater risk of death than women with normal BMIs. But for women with cancer who were postmenopausal and for those with ER-negative breast cancer, obesity didn’t raise risk. These results, looking at 80,000 patients, come as a surprise, since previous studies had found that, being overweight seemed to be protective against breast cancer before the menopause…

 

SEGMENT 4: Bereavement can trigger psychiatric disorders

 

PETER:

The sudden loss of a loved one can trigger the onset of a variety of psychiatric disorders, even in people with no history of mental illness. That’s the finding of the first comprehensive wide-scale epidemiological study on this reported in the American Journal of Psychiatry.

 

SARAH:

That’s right, and bereavement increased the risk of a first psychiatric episode particularly in the elderly. The study looked at the effects of such a sudden loss on all types of psychiatric disorders and at all ages:

 

KEYES:

One of the really kind of novel findings from our study was an increase in risk for mania and manic episodes, which had never been documented in these large-scale epidemiological studies. And we found that, between age 30 and 50, about a 2-fold increase in risk and, after about age 50, the increase in risk goes up to almost 4 or 5-fold. For disorders such as major depression and dysthymia, the increase in risk ranges from about 1.5 to, again, in the older age group, about 5 to 10 times more likely to experience a first incidence concomitant with these unexpected death experiences. There are also some disorders that we really didn’t see major increases in risk, things like specific phobia and social phobia…

 

SARAH:

That was lead study author Dr. Katherine Keyes, from Columbia University in New York. She said that the highest risk was for developing post-traumatic stress disorder, and she had this take home message for practitioners:

 

KEYES:

The loss of these key close relationships really puts a profound stress on the psyche of the patients that people see in the clinic. And certainly, we don’t recommend pathologizing the grieving process, however we do think that the grieving and bereavement period is a sensitive period for the development of prolonged and pathological psychiatric symptoms so just because someone is in a bereavement period does not mean that their symptoms should be overlooked.

  

SARAH:

Katherine Keyes, from New York.

 

IN BRIEF 1: Systolic and diastolic blood pressures predict risk of several cardiovascular diseases

 

PETER:

Finally, in brief: raised systolic or diastolic blood pressures at different ages appear to predict cardiovascular diseases. That’s according to new research looking at 1.25 million patients, published in The Lancet. Overall, people with higher systolic blood pressures had a greater risk of: intra-cerebral haemorrhage, subarachnoid haemorrhage and stable angina. Whereas raised diastolic blood pressure appeared to be a better predictor of abdominal aortic aneurysm.

 

IN BRIEF 2: Stress degrades sperm quantity and quality

 

PETER:

Men who feel stressed appear to have fewer and slower sperm, which apparently are key indicators of reduced male fertility. That’s the finding of a study, reported in the journal Fertility and Sterility, that looked at semen samples collected from 193 adult men who also completed tests to measure stress at work and in life generally. Stress degraded semen quality even after accounting for confounding factors, such as history of reproductive health problems or other health issues.

 

PETER:

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!

 

 

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