Collaborating for Breast Cancer Cure

Leading researchers and thought leaders gathered in April at a Cleveland Clinic symposium to share vital information on new approaches to breast cancer detection and treatment. The seminar, “Cleveland Breast Cancer 2015 Collaborating for a Cure”, included discussion of promising data on treatment of HER2-positive and ER-positive advanced and metastatic disease, as well as new study results about protecting against ovarian failure in chemotherapy. Other important topics included usage of new breast cancer diagnostic techniques such as tomosynthesis, and new approaches in radiation therapy including intraoperative radiation therapy.

“We brought the best minds and leading breast cancer doctors and researchers in the world together to discuss important advances in breast cancer management,” said Jame Abraham, MD, FACP, Cleveland Clinic’s Director of Breast Medical Oncology and Co-Director of the Comprehensive Breast Cancer Program. Dr. Abraham was the symposium’s co-director along with Stephen R. Grobmyer, MD, FACS, Cleveland Clinic’s Chief of Surgical Oncology and Breast Services and Co-Director of the Comprehensive Breast Cancer Program.

“It was exciting for us to hear about the treatments that are now significantly extending survival for women with breast cancer, particularly those with advanced or metastatic HER2-positive or ER-positive breast cancer,” Dr. Abraham said.

The seminar included lectures, discussion and a cadaver lab, enabling participants to learn from each other, Dr. Grobmyer said. “In this kind of seminar, we gain knowledge that prepares us to provide the best care for our breast cancer patients.” In addition to new breast cancer treatments, the seminar provided perspective on the new breast cancer detection and screening technology, tomosynthesis.

Seminar participants were also able to learn about the newest research on intraoperative radiotherapy for breast cancer. Stephanie Valente, DO, discussed results from a large multicenter research study on intraoperative radiation therapy for breast cancer, performed at 19 North American medical centers and led by Cleveland Clinic. The research was presented at the latest annual meeting of the Society of Surgical Oncology. “The benefits of intraoperative radiation therapy for breast cancer are numerous, including a shorter time frame for treatment, fewer overall side effects and more rapid recovery,” Dr. Grobmyer said.

Five key takeaways from the meeting:

1. Data from the CLEOPATRA trial indicates that adding pertuzumab to the combination of docetaxel and trastuzumab can extend median overall survival in HER2-positive metastatic breast cancer by a significant amount—16 months—compared with the combination of placebo, docetaxel and trastuzumab. In the CLEOPATRA study, women on the pertuzumab + docetaxel + trastuzumab combination arm had a median overall survival of 56.5 months. “This combination therapy really made a difference in outcomes for women with HER2-positive disease,” Dr. Abraham said.
2. A new treatment approved by the Food and Drug Administration in February—palbociclib—shows promise for treating post-menopausal advanced ER-positive HER2-negative metastatic breast cancer when combined with letrozole. The FDA’s approval was based on a randomized, multicenter, open-label trial in postmenopausal women with ER-positive, HER2-negative, advanced breast cancer who had not received previous systemic treatment. In the trial, the 20.2-month median progression-free survival (PFS) in the palbociclib + letrozole arm was significantly longer than the 10.2-month median PFS in the letrozole arm. “The seminar provided us with a lot of insight into this newly approved treatment and how it can change our treatment of women with ER-positive breast cancer,” Dr. Abraham said.
3. A new study on the gonadotropin-releasing hormone agonist goserelin by Halle Moore, MD, and colleagues showed that it can safeguard against ovarian failure in women who receive chemotherapy for breast cancer. After 2 years, the ovarian failure rate was 8 percent among those who received goserelin, but 22 percent among those who received chemotherapy without the GnRH agonist, according to the study of 218 patients. Pregnancy also occurred in more women in the goserelin group (22 percent) than in those who received chemotherapy with no goserelin (11 percent).

“The issue of fertility is particularly important for younger women with breast cancer,” said Dr. Abraham. “They have long-term survivorship issues, so hearing about new studies on fertility preservation is crucial to those of us who treat young women with breast cancer.”

1. Tomosynthesis is an emerging technology with great potential for more accurately detecting breast cancer. Tomosynthesis has improved sensitivity and specificity when compared with mammograms, but more importantly, it decreases the need for additional imaging. “This is a crucial benefit, because it reduces extra tests for women who are being screened for breast cancer,” Dr. Abraham said. Tomosynthesis is more expensive and time-consuming than mammography, but because it reduces the need for callbacks, some experts predict that tomosynthesis could one day replace mammograms. It eventually may be the preferred first-line method to screen most women for breast cancer, Dr. Abraham noted.
2. Intraoperative radiotherapy has a number of advantages for women with breast cancer. Not only can treatment be accomplished in a shorter time span, but it also spares more normal tissue and produces fewer toxicities than traditional radiation. It is also less costly than radiation delivered in an outpatient setting. Intraoperative radiation therapy is usually used for patients over age 60 with hormone receptor-positive breast cancers that are less than 2 cm, and which have not spread to lymph nodes. Intraoperative radiotherapy has also been studied and used successfully for ductal carcinoma in situ (DCIs) and in breast cancer patients over age 70.