The Evolving Complexity of Treating Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2 (HER2)-Negative Breast Cancer: Special Considerations in Older Breast Cancer Patients —Part II: Metastatic Disease

AbstractBreast cancer is a disease of aging, and the incidence of breast cancer is projected to increase dramatically as the global population ages. The majority of breast cancers that occur in older adults are hormone-receptor positive, human epidermal growth factor receptor-2 (HER2)-negative phenotypes, with favorable tumor biology; yet, because of underrepresentation in clinical trials, less evidence is available to guide the complex care for this population. Providing care for older patients with metastatic breast cancer, with coexisting medical conditions, increased risk of treatment toxicity, and frailty, remains a clinical challenge in oncology. In this review, we provide an overview of the current evidence from clinical trials and subanalyses of older adults with hormone receptor-positive, HER2-negative metastatic breast cancer, highlighting data on the safety and efficacy of oral therapies, including endocrine therapy alone or in combination with cyclin-dependent kinase (CDK)  4/6 inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, and mammalian target of rapamycin (mTOR) inhibitors. In addition, we note the significant underrepresentation of older and frail adults in these studies. Current and future directions in research for this special population, in order to address significant knowledge gaps, include the need to improve long-term adherence to hormonal and targeted therapy, prospective clinical trials that capture clinical and biological aging end...
Source: Drugs and Aging - Category: Geriatrics Source Type: research

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Adjuvant therapy with S-1, an oral fluoropyrimidine-based drug, plus endocrine therapy postoperatively significantly increased invasive disease-free survival (IDFS) in patients with HR-positive, HER2-negative breast cancer.
Source: CancerNetwork - Category: Cancer & Oncology Authors: Source Type: news
ConclusionsThe oral SERD G1T48 is well tolerated with no DLTs reported to date in patients with ER+/HER2- ABC. Early efficacy, safety, PK, and FES-PET data are encouraging, and support continued dose escalation followed by expansion. Updated safety, anti-tumor activity, and cfDNA data will be presented (NCT#03455270).Clinical trial identificationNCT03455270.Legal entity responsible for the studyG1 Therapeutics, Inc.FundingG1 Therapeutics.DisclosureE.C. Dees: Research grant / Funding (institution): G1 Therapeutics; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Merck; Research grant ...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsThis subgroup analysis from CompLEEment-1 supports the safety and efficacy of RIB + LET in pts with CNS metastasis. Additional patient follow-up is ongoing.Clinical trial identificationNCT02941926.Editorial acknowledgementMedical editorial assistance was provided by Heyuan Sun, PhD, of Healthcare Consultancy Group, LLC, and funded by Novartis Pharmaceuticals Corporation.Legal entity responsible for the studyNovartis.FundingNovartis Pharmaceuticals.DisclosureM. De Laurentiis: Honoraria (self), Advisory / Consultancy: Pfizer; Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consulta...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsSafety and efficacy outcomes in this post hoc analysis support the use of RIB + LET in pts with VM and BOM. Pts with BOM were less likely to have an objective tumor response but more likely to be progression free at 12 months, consistent with the more favorable prognosis of BOM compared with non-osseous metastases.Clinical trial identificationNCT02941926.Editorial acknowledgementMedical editorial assistance was provided by Joe Hodgson of Healthcare Consultancy Group, LLC, and funded by Novartis Pharmaceuticals Corporation.Legal entity responsible for the studyNovartis.FundingNovartis Pharmaceuticals.DisclosureM....
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsThe first comparative analysis of a CDK4/6 inhibitor in combination with endocrine therapy compared to endocrine therapy alone provides real-world evidence confirming the findings of PFS benefit demonstrated in clinical trial data for palbociclib in diverse clinical practices. Table:329P Patient characteristics and real-world progressionfree survival (rwPFS)VariablePB+LE (N  = 453)LE alone (N = 453) Median age (years)68.068.0 White (%)69.870.6 Median number of metastatic sites (n)2.02.0 Bone only disease (%)26.932.2 Visceral disease (%)49.749.7 Median rwP...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundEfficacy and quality of life (QoL) are key factors when selecting therapies for metastatic breast cancer (MBC) patients. The addition of targeted oral agents such as CDK4/6 inhibitors to endocrine therapy is the new standard for HR+ HER2- MBC and substantially prolongs progression-free survival. However more complex oral medication in oncology might require substantial improvement of patient management. Despite several advantages of oral treatments, patients become increasingly self-responsible and physician-patient contact is reduced. Adherence, maintaining patients ’ satisfaction and early detecti...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
A UCLA-led study has found that using a drug called ribociclib in combination with a common hormone therapy may help premenopausal women with the most common type of breast cancer live longer than if they only receive the hormone therapy.Ribociclib is considered a cyclin-dependent kinase inhibitor that works by blocking the activity of proteins called cyclin-dependent kinase 4/6 enzymes, which promote cell division and cancer growth.The study involved 672 women aged 25 to 59 when the study began who had advanced hormone-receptor positive/HER2- breast cancer. Seventy percent of the women who took the combination therapy wer...
Source: UCLA Newsroom: Health Sciences - Category: Universities & Medical Training Source Type: news
In conclusion, e-As4S4 holds great potential for an alternative therapeutics in the treatment of breast cancer, due to its unique function of correcting the aggressive microenvironment. Introduction Metastasis is the leading cause of breast cancer mortality, which has been one major challenge in clinical treatment (1). In particular, triple-negative breast cancer (TNBC) is characterized by the absence of estrogen receptors (ER), progesterone receptors (PR) and HER2 receptors, which is one of the most aggressive types of breast cancers, marked by high rates of relapse, visceral metastases and early death (2, 3). The...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
AbstractPurpose of ReviewMost women with hormone receptor (HR)-positive, HER2-negative (HR+/HER2 −) breast cancer will ultimately develop endocrine-resistant disease, either primary or acquired. This review will discuss the proposed mechanisms underlying endocrine resistance and key advances in the treatment of endocrine-resistant breast cancer.Recent FindingsEstrogen receptor 1 mutations (ESR1) occur in the majority of patients with HR+/HER2 − metastatic breast cancer after prolonged exposure to aromatase inhibitors. Data from the SoFEA trial showed that patients had improved progression-free survival (PFS) af...
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research
Authors: Le D, Gelmon KA Abstract Introduction Germline BRCA mutations (gBRCAm) are diagnosed in approximately 5% of unselected breast cancer patients. Olaparib is a new treatment option for patients with a gBRCAm who have metastatic HER2-negative breast cancer. Areas Covered Olaparib is an oral poly (ADP-ribose) polymerase inhibitor that has been shown in phase I-III clinical trials to have single-agent efficacy in breast cancer patients with gBRCAm. The recent phase III OlympiAD study demonstrated a statistically significant progression free survival benefit compared to the chemotherapy control arm, although an o...
Source: Expert Review of Clinical Pharmacology - Category: Drugs & Pharmacology Tags: Expert Rev Clin Pharmacol Source Type: research
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