Hot Topic: Should all Women with Breast Cancer Undergo Genetic Testing?
AbstractPurpose of ReviewPanel testing for germline mutations in cancer patients has advanced rapidly in recent years. In breast cancer, these advances have raised questions about the indications for testing, with some groups advocating testing of all patients with breast cancer.Recent FindingsStudies uniformly demonstrate that expanded scope of genetic testing will result in identification of more women with germline mutations. However, many challenges remain in interpretation of such broad panel testing, including limited information about the risks of second cancers conferred by most of these germline mutations and the ...
Source: Current Breast Cancer Reports - November 20, 2019 Category: Cancer & Oncology Source Type: research
I-SPY 2: a Neoadjuvant Adaptive Clinical Trial Designed to Improve Outcomes in High-Risk Breast Cancer
AbstractPurpose of ReviewThe I-SPY 2 trial is an adaptive clinical trial platform designed to improve outcomes in high-risk breast cancer patients by testing new drugs in the neoadjuvant setting. The intent of this review is to discuss background, study structure, innovation, and outcomes of the I-SPY 2 trial.Recent FindingsI-SPY 2 evaluates new agents combined with standard therapy with pathologic complete response (pCR) as the primary endpoint. I-SPY-2 uses clinical biomarkers to classify breast cancer into 10 subtypes, with Bayesian adaptive randomization to allow individualized patient assignment to therapy arms to max...
Source: Current Breast Cancer Reports - November 19, 2019 Category: Cancer & Oncology Source Type: research
Immunotherapy in Triple-Negative Breast Cancer: Present and Future
AbstractPurpose of ReviewImmunotherapy is emerging as an effective treatment option for metastatic triple-negative breast cancer. In this review, we summarize clinical data of immunotherapy in triple-negative breast cancer and comment on future directions in the field.Recent FindingsIMpassion130 was a phase III trial that demonstrated progression-free survival benefit, and potentially overall survival benefit, of first-line chemotherapy (nab-paclitaxel) plus anti-programmed death ligand 1 (PD-L1) atezolizumab, among PD-L1-positive metastatic triple-negative breast cancers. Studies are ongoing to evaluate other combination ...
Source: Current Breast Cancer Reports - November 19, 2019 Category: Cancer & Oncology Source Type: research
The Promise of Immunotherapy for Breast Cancer Brain Metastases
AbstractPurpose of ReviewThe goal of our review is to describe the rationale for immunotherapy in the treatment of breast cancer brain metastases (BCBM), the current landscape of clinical trials for this disease process, and possible future directions based on anticipated results.Recent FindingsImmune checkpoint inhibition has shown efficacy in the treatment of several solid tumor brain metastases (i.e., melanoma and non-small cell lung cancer), but data specific to BCBM is relatively sparse. Preclinical studies in BCBM have illustrated a lower immune content in the brain microenvironment measured by tumor-infiltrating lym...
Source: Current Breast Cancer Reports - November 19, 2019 Category: Cancer & Oncology Source Type: research
Inflammatory Breast Cancer: Diagnostic, Molecular and Therapeutic Considerations
AbstractPurpose of ReviewInflammatory breast cancer (IBC) is an aggressive type of breast cancer with poor prognosis. Treatment for non-metastatic disease is neoadjuvant chemotherapy followed by mastectomy and radiation. IBC diagnosis is primarily a clinical diagnosis, which can lead to misdiagnosis and delayed management. In addition, there are no molecular criteria for diagnosis or therapeutic regimens developed specifically for IBC. We aimed to discuss recent developments in IBC, including diagnosis, molecular mechanisms, and treatment.Recent FindingsRecently, the Union for International Cancer Control (UICC) and the Am...
Source: Current Breast Cancer Reports - November 14, 2019 Category: Cancer & Oncology Source Type: research
Immunotherapy for HER2-Positive Breast Cancer: Changing the Paradigm
AbstractPurpose of ReviewTo summarize and discuss the available evidence and ongoing efforts in order to establish the efficacy and safety of immunotherapeutic approaches in HER2-positive breast cancer.Recent FindingsThe introduction into the clinic of anti-HER2 –targeted therapies more than 15 years ago resulted in a substantial improvement in the outcome of patients with HER2-overexpressing breast cancer. However, only patients with the highest levels of HER2 expression will potentially benefit from these therapies and, unfortunately, many patients prog ress or relapse after optimal treatment. As metastatic breast canc...
Source: Current Breast Cancer Reports - November 12, 2019 Category: Cancer & Oncology Source Type: research
Biomarker Predictors for Immunotherapy Benefit in Breast: Beyond PD-L1
AbstractPurpose of ReviewImmune checkpoint blockade (ICB) has changed the clinical course of multiple cancer types and durable responses have now been observed in breast cancer (BC) patients. Most data suggest that, compared to other subtypes, triple-negative BC (TNBC) patients are more responsive to ICB, and anti-PD-L1 therapy is now approved in PD-L1+ metastatic TNBC, in combination with chemotherapy.Recent FindingsNearly 40% of PD-L1+ TNBC patients did not respond to this combination. Thus, additional biomarkers appear to be necessary to more precisely identify potential responders. A comprehensive analysis of the breas...
Source: Current Breast Cancer Reports - November 10, 2019 Category: Cancer & Oncology Source Type: research
Preoperative Radiotherapy Trials to Facilitate Immediate Breast Reconstruction after Mastectomy
AbstractPurpose of ReviewPostmastectomy radiotherapy (PMRT) is often a component of treatment algorithms for locally advanced or node-positive breast cancer. Breast reconstruction may be delayed or not performed due to negative effects of PMRT on the reconstruction. Administering radiotherapy in the preoperative setting allows for immediate breast reconstruction (IBR) to be performed in patients who have indications for PMRT and desire IBR. This review summarizes the current literature on this new concept.Recent FindingsMost prospective treatment protocols included neoadjuvant systemic therapy followed by radiotherapy (RT)...
Source: Current Breast Cancer Reports - November 6, 2019 Category: Cancer & Oncology Source Type: research
Update on Breast Implant-Associated Anaplastic Large Cell Lymphoma
AbstractPurpose of ReviewThe US Food and Drug Administration issued a recall of textured breast implants in July 2019 secondary to their association with anaplastic large cell lymphoma. This brief review serves to summarize what is actually known about breast implant associated anaplastic large cell lymphoma.Recent FindingsSince the FDA ’s first preliminary report in 2011, there have been a reported worldwide total of 573 breast implant associated anaplastic large cell lymphoma (BIA-ALCL) cases, including 33 deaths. In addition to halting the implantation of textured implants, the July recall served to increase awareness...
Source: Current Breast Cancer Reports - November 6, 2019 Category: Cancer & Oncology Source Type: research
A Radiation Oncologist ’s Guide to Axillary Management in Breast Cancer: a Walk Through the Trials
AbstractPurpose of ReviewThe axilla is the most common site for breast cancer nodal metastases. Aggressive management includes axillary lymph node dissection (ALND), radiotherapy, and systemic therapy, but carries the risks of lymphedema and “overtreatment”. We review the clinical trials that led to de-escalation of axillary management and their nuances that are often overlooked.Recent FindingsWith the rise of sentinel lymph node biopsy, several trials conclude that ALND can be omitted in specific populations. However, the subtleties in those trials, such as the role of chemotherapy and radiotherapy, have yet to be cla...
Source: Current Breast Cancer Reports - September 13, 2019 Category: Cancer & Oncology Source Type: research
Report from the Front: a Glimpse at Breast Cancer Research in Low- and Middle-Income Countries
AbstractPurpose of ReviewBreast cancer is increasingly more prevalent in low- and middle-income countries (LMICs) and its biology in these populations may differ from that in more affluent countries. Research in these settings is limited by both societal factors and the lack of resources. Our intent is to review the parameters that limit more extensive research activities in LMICs and potentially investigate options for improvement.FindingsLMIC governments have limited infrastructure to support appropriate research and the physicians are overburdened by clinical work. Even the patients fail to see the value of research in ...
Source: Current Breast Cancer Reports - September 1, 2019 Category: Cancer & Oncology Source Type: research
Combining Radiation Therapy with Immune Checkpoint Blockadein Breast Cancer
AbstractPurpose of ReviewImmune checkpoint blockade (ICB) is an emerging therapy in breast cancer. Its optimal integration with radiation therapy (RT) for breast cancer remains to be established. Herein, we review the current evidence on combining ICB and RT in breast cancer and discuss the challenges, open questions, ongoing trials, and future directions for use of this treatment combination.Recent FindingsEarly trials of ICB in breast cancer show evidence of a modest response, limited due to the low baseline immunogenicity of most breast cancers. RT, as a potent stimulator of the immune system, has been used in combinati...
Source: Current Breast Cancer Reports - August 29, 2019 Category: Cancer & Oncology Source Type: research
Bridging the Gap in Training and Clinical Practice in Sub-Saharan Africa
AbstractPurpose of ReviewAs medical knowledge and innovation reaches new heights, there is a growing gap in medical advancements between low- and middle-income countries (LMICs) and high-income countries (HICs). The former has lack of basic health care and preventive or diagnostic services for early cancer while the latter has access to novel diagnostic and therapeutic modalities.Recent FindingsKey to overcoming this disparity is finding ways to bridge this divide across distances and continental divides through innovative technology and sharing of knowledge by committed individuals and through public private partnerships....
Source: Current Breast Cancer Reports - August 18, 2019 Category: Cancer & Oncology Source Type: research
Partial-Breast Irradiation: Review of Modern Trials
AbstractPurpose of ReviewFollowing partial mastectomy, whole-breast irradiation (WBI), delivered over 3 to 6 weeks, has been the standard adjuvant radiation approach for early-stage breast cancer. A growing body of literature over the past decade has suggested that irradiation of the partial breast, including the tumor bed plus a margin, may be a suitable alternative for appropriately selected patients. The use of partial breast irradiation (PBI) has been studied in multiple prospective randomized trials, now with up to 10 years of follow-up, establishing similar safety and efficacy compared with WBI. Advantages of PBI ...
Source: Current Breast Cancer Reports - August 18, 2019 Category: Cancer & Oncology Source Type: research
Pathology Meets Biology: the New Era of Breast Cancer Staging
AbstractPurpose of ReviewBreast cancer is now recognized to be a very heterogeneous disease. This complexity was recently reflected in the newest American Joint Committee on Cancer (AJCC) breast cancer staging, implemented in 2018. Although it seems very daunting, the new staging is based on both the anatomical extent of the disease and the prognostic factors such as hormonal and HER2 status, grade of the tumor, and genomic assays providing information regarding risk of recurrence. The purpose of this review is to illustrate the reasoning for the change in previous, solely an anatomically based breast cancer staging system...
Source: Current Breast Cancer Reports - August 15, 2019 Category: Cancer & Oncology Source Type: research
