Breast Cancer

Women with breast cancer who are taking adjuvant endocrine therapy to reduce the risk for recurrence often report that the side effects of dampening down estrogen, such as hot flashes and vaginal dryness, spoil their quality of life, and these side effects can lead to discontinuation of therapy.

But medical measures to address these side effects carry risks, as shown in the results of a new study from Denmark.

The use of vaginal estrogen therapy (VET) increased the risk for breast cancer recurrence by 39% in women with early estrogen receptor–positive breast cancer who were taking aromatase inhibitors (AIs).

There was no increase in the risk for recurrence in women who were using VET and taking tamoxifen or in women who were using VET and not taking any adjuvant endocrine therapy.

The finding was published in the Journal of the National Cancer Institute.

“Patients who are taking aromatase inhibitors should try alternative strategies for management of genitourinary symptoms because (VET) will likely increase their risk for breast cancer recurrence,” warn the authors of an accompanying editorial, Elizabeth J. Cathcart-Rake, MD, and Kathryn J. Ruddy, MD, oncologists at the Mayo Clinic, Rochester, Minn.

The use of oral estrogen treatment, known as menopausal hormone therapy (MHT), is also not recommended in breast cancer survivors being treated with AIs, the editorialists added.

The study did not find an increase in the risk for recurrence with MHT added onto AIs, but that finding comes from a very small subgroup of only 37 women.

“The absence of an obvious detrimental impact of MHT on breast cancer recurrence or mortality” in this study “is not particularly reassuring,” especially given higher systemic estrogen levels seen with MHT, Dr. Cathcart-Rake and Dr. Ruddy commented.
 

Differences between endocrine therapies

“Our study is, to our knowledge, the first to report a potential increased risk of recurrence in patients receiving AIs treated with VET,” say the investigators, led by Søren Cold, MD, an oncology researcher at Odense University Hospital, Denmark.

They suggest that women who are taking VET and AIs should be switched to tamoxifen after 2-3 years.

Speculating as to the apparent safety differences between the two endocrine therapies, Dr. Cold and colleagues explained that “AIs lower or nearly eliminate estrogen. As such, even a modest increase in circulating estrogens may” increase recurrence risk.

Tamoxifen, on the other hand, competes for estrogen receptor binding, so “a modest elevation of the very low serum estrogen levels” with hormone therapy “is not assumed to counteract the receptor blockade,” they said.
 

Study details

Study participants, obtained from a nationwide registry in Denmark, were diagnosed with early-stage, invasive, estrogen receptor–positive breast cancer from 1997 to 2004. Upfront treatment included surgery plus, in the majority of women, radiation.

The review identified 8,461 such women. After initial treatment for breast cancer, 2,410 went on to adjuvant endocrine therapy, including 2,007 with tamoxifen and 403 with an AI.

Across the entire study population, nearly 2,000 women took VET and 133 women took MHT, as assessed by having redeemed at least two prescriptions. The hormone therapies were used in women who were both on and those who were not on endocrine therapy.

Overall, breast cancer recurred in 1,333 women (16%) over a median follow-up of 9.8 years.

The investigators then analyzed the risk for recurrence in various subgroups.

The 39% higher risk for recurrence was found among the 822 women who used VET while taking an AI, compared with 2,520 women who received AIs alone.

Findings in the study were adjusted for numerous potential confounders, including age, tumor biology, and comorbidities.

Women were a median of 61 years of age (range, 35-91 years). Seventy-seven percent had invasive ductal carcinoma, and 43% were node-positive. Women on hormone therapy tended to be younger, have smaller tumors, and be less likely to have lymph node metastases.

The investigators excluded women who had taken hormone replacement before their breast cancer diagnosis.

The work was funded by the Danish Cancer Society. Dr. Cold reports no disclosures, but some co-authors reported relationships with Samsung, Novartis, Pfizer, and other companies. Dr. Cathcart-Rake and Dr. Ruddy report no disclosures.

A version of this article first appeared on Medscape.com.

Women with breast cancer who are taking adjuvant endocrine therapy to reduce the risk for recurrence often report that the side effects of dampening down estrogen, such as hot flashes and vaginal dryness, spoil their quality of life, and these side effects can lead to discontinuation of therapy.

But medical measures to address these side effects carry risks, as shown in the results of a new study from Denmark.

The use of vaginal estrogen therapy (VET) increased the risk for breast cancer recurrence by 39% in women with early estrogen receptor–positive breast cancer who were taking aromatase inhibitors (AIs).

There was no increase in the risk for recurrence in women who were using VET and taking tamoxifen or in women who were using VET and not taking any adjuvant endocrine therapy.

The finding was published in the Journal of the National Cancer Institute.

“Patients who are taking aromatase inhibitors should try alternative strategies for management of genitourinary symptoms because (VET) will likely increase their risk for breast cancer recurrence,” warn the authors of an accompanying editorial, Elizabeth J. Cathcart-Rake, MD, and Kathryn J. Ruddy, MD, oncologists at the Mayo Clinic, Rochester, Minn.

The use of oral estrogen treatment, known as menopausal hormone therapy (MHT), is also not recommended in breast cancer survivors being treated with AIs, the editorialists added.

The study did not find an increase in the risk for recurrence with MHT added onto AIs, but that finding comes from a very small subgroup of only 37 women.

“The absence of an obvious detrimental impact of MHT on breast cancer recurrence or mortality” in this study “is not particularly reassuring,” especially given higher systemic estrogen levels seen with MHT, Dr. Cathcart-Rake and Dr. Ruddy commented.
 

Differences between endocrine therapies

“Our study is, to our knowledge, the first to report a potential increased risk of recurrence in patients receiving AIs treated with VET,” say the investigators, led by Søren Cold, MD, an oncology researcher at Odense University Hospital, Denmark.

They suggest that women who are taking VET and AIs should be switched to tamoxifen after 2-3 years.

Speculating as to the apparent safety differences between the two endocrine therapies, Dr. Cold and colleagues explained that “AIs lower or nearly eliminate estrogen. As such, even a modest increase in circulating estrogens may” increase recurrence risk.

Tamoxifen, on the other hand, competes for estrogen receptor binding, so “a modest elevation of the very low serum estrogen levels” with hormone therapy “is not assumed to counteract the receptor blockade,” they said.
 

Study details

Study participants, obtained from a nationwide registry in Denmark, were diagnosed with early-stage, invasive, estrogen receptor–positive breast cancer from 1997 to 2004. Upfront treatment included surgery plus, in the majority of women, radiation.

The review identified 8,461 such women. After initial treatment for breast cancer, 2,410 went on to adjuvant endocrine therapy, including 2,007 with tamoxifen and 403 with an AI.

Across the entire study population, nearly 2,000 women took VET and 133 women took MHT, as assessed by having redeemed at least two prescriptions. The hormone therapies were used in women who were both on and those who were not on endocrine therapy.

Overall, breast cancer recurred in 1,333 women (16%) over a median follow-up of 9.8 years.

The investigators then analyzed the risk for recurrence in various subgroups.

The 39% higher risk for recurrence was found among the 822 women who used VET while taking an AI, compared with 2,520 women who received AIs alone.

Findings in the study were adjusted for numerous potential confounders, including age, tumor biology, and comorbidities.

Women were a median of 61 years of age (range, 35-91 years). Seventy-seven percent had invasive ductal carcinoma, and 43% were node-positive. Women on hormone therapy tended to be younger, have smaller tumors, and be less likely to have lymph node metastases.

The investigators excluded women who had taken hormone replacement before their breast cancer diagnosis.

The work was funded by the Danish Cancer Society. Dr. Cold reports no disclosures, but some co-authors reported relationships with Samsung, Novartis, Pfizer, and other companies. Dr. Cathcart-Rake and Dr. Ruddy report no disclosures.

A version of this article first appeared on Medscape.com.

Women with breast cancer who are taking adjuvant endocrine therapy to reduce the risk for recurrence often report that the side effects of dampening down estrogen, such as hot flashes and vaginal dryness, spoil their quality of life, and these side effects can lead to discontinuation of therapy.

But medical measures to address these side effects carry risks, as shown in the results of a new study from Denmark.

The use of vaginal estrogen therapy (VET) increased the risk for breast cancer recurrence by 39% in women with early estrogen receptor–positive breast cancer who were taking aromatase inhibitors (AIs).

There was no increase in the risk for recurrence in women who were using VET and taking tamoxifen or in women who were using VET and not taking any adjuvant endocrine therapy.

The finding was published in the Journal of the National Cancer Institute.

“Patients who are taking aromatase inhibitors should try alternative strategies for management of genitourinary symptoms because (VET) will likely increase their risk for breast cancer recurrence,” warn the authors of an accompanying editorial, Elizabeth J. Cathcart-Rake, MD, and Kathryn J. Ruddy, MD, oncologists at the Mayo Clinic, Rochester, Minn.

The use of oral estrogen treatment, known as menopausal hormone therapy (MHT), is also not recommended in breast cancer survivors being treated with AIs, the editorialists added.

The study did not find an increase in the risk for recurrence with MHT added onto AIs, but that finding comes from a very small subgroup of only 37 women.

“The absence of an obvious detrimental impact of MHT on breast cancer recurrence or mortality” in this study “is not particularly reassuring,” especially given higher systemic estrogen levels seen with MHT, Dr. Cathcart-Rake and Dr. Ruddy commented.
 

Differences between endocrine therapies

“Our study is, to our knowledge, the first to report a potential increased risk of recurrence in patients receiving AIs treated with VET,” say the investigators, led by Søren Cold, MD, an oncology researcher at Odense University Hospital, Denmark.

They suggest that women who are taking VET and AIs should be switched to tamoxifen after 2-3 years.

Speculating as to the apparent safety differences between the two endocrine therapies, Dr. Cold and colleagues explained that “AIs lower or nearly eliminate estrogen. As such, even a modest increase in circulating estrogens may” increase recurrence risk.

Tamoxifen, on the other hand, competes for estrogen receptor binding, so “a modest elevation of the very low serum estrogen levels” with hormone therapy “is not assumed to counteract the receptor blockade,” they said.
 

Study details

Study participants, obtained from a nationwide registry in Denmark, were diagnosed with early-stage, invasive, estrogen receptor–positive breast cancer from 1997 to 2004. Upfront treatment included surgery plus, in the majority of women, radiation.

The review identified 8,461 such women. After initial treatment for breast cancer, 2,410 went on to adjuvant endocrine therapy, including 2,007 with tamoxifen and 403 with an AI.

Across the entire study population, nearly 2,000 women took VET and 133 women took MHT, as assessed by having redeemed at least two prescriptions. The hormone therapies were used in women who were both on and those who were not on endocrine therapy.

Overall, breast cancer recurred in 1,333 women (16%) over a median follow-up of 9.8 years.

The investigators then analyzed the risk for recurrence in various subgroups.

The 39% higher risk for recurrence was found among the 822 women who used VET while taking an AI, compared with 2,520 women who received AIs alone.

Findings in the study were adjusted for numerous potential confounders, including age, tumor biology, and comorbidities.

Women were a median of 61 years of age (range, 35-91 years). Seventy-seven percent had invasive ductal carcinoma, and 43% were node-positive. Women on hormone therapy tended to be younger, have smaller tumors, and be less likely to have lymph node metastases.

The investigators excluded women who had taken hormone replacement before their breast cancer diagnosis.

The work was funded by the Danish Cancer Society. Dr. Cold reports no disclosures, but some co-authors reported relationships with Samsung, Novartis, Pfizer, and other companies. Dr. Cathcart-Rake and Dr. Ruddy report no disclosures.

A version of this article first appeared on Medscape.com.

Key clinical point: In clinically fit older women with breast cancer (BC), high interleukin-6 (IL-6) and C-reactive protein (CRP) levels before chemotherapy treatment may predict chemotherapy-induced deterioration in frailty status.

Major finding: Overall, 25.8% of patients experienced a decline in frailty status due to chemotherapy. Higher vs lower prechemotherapy levels of both IL-6 and CRP were associated with increased odds of decline in frailty status (odds ratio 3.52; P = .003).

Study details: Findings are from a prospective study, The Hurria Older Patients with BC Study, including 295 robust women with stage I-III BC who received chemotherapy.

Disclosures: This study was supported by the National Institute on Aging and other sources. Three authors declared receiving research funding or royalties, owning patents, or holding stock options in pharmaceutical companies. The other authors declared no conflicts of interest.

Source: Ji J, Sun C-L, et al. Inflammation and clinical decline after adjuvant chemotherapy in older adults with breast cancer: Results from The Hurria Older Patients prospective study. J Clin Oncol. 2022 (Sep 20). Doi: 10.1200/JCO.22.01217

Key clinical point: In clinically fit older women with breast cancer (BC), high interleukin-6 (IL-6) and C-reactive protein (CRP) levels before chemotherapy treatment may predict chemotherapy-induced deterioration in frailty status.

Major finding: Overall, 25.8% of patients experienced a decline in frailty status due to chemotherapy. Higher vs lower prechemotherapy levels of both IL-6 and CRP were associated with increased odds of decline in frailty status (odds ratio 3.52; P = .003).

Study details: Findings are from a prospective study, The Hurria Older Patients with BC Study, including 295 robust women with stage I-III BC who received chemotherapy.

Disclosures: This study was supported by the National Institute on Aging and other sources. Three authors declared receiving research funding or royalties, owning patents, or holding stock options in pharmaceutical companies. The other authors declared no conflicts of interest.

Source: Ji J, Sun C-L, et al. Inflammation and clinical decline after adjuvant chemotherapy in older adults with breast cancer: Results from The Hurria Older Patients prospective study. J Clin Oncol. 2022 (Sep 20). Doi: 10.1200/JCO.22.01217

Key clinical point: In clinically fit older women with breast cancer (BC), high interleukin-6 (IL-6) and C-reactive protein (CRP) levels before chemotherapy treatment may predict chemotherapy-induced deterioration in frailty status.

Major finding: Overall, 25.8% of patients experienced a decline in frailty status due to chemotherapy. Higher vs lower prechemotherapy levels of both IL-6 and CRP were associated with increased odds of decline in frailty status (odds ratio 3.52; P = .003).

Study details: Findings are from a prospective study, The Hurria Older Patients with BC Study, including 295 robust women with stage I-III BC who received chemotherapy.

Disclosures: This study was supported by the National Institute on Aging and other sources. Three authors declared receiving research funding or royalties, owning patents, or holding stock options in pharmaceutical companies. The other authors declared no conflicts of interest.

Source: Ji J, Sun C-L, et al. Inflammation and clinical decline after adjuvant chemotherapy in older adults with breast cancer: Results from The Hurria Older Patients prospective study. J Clin Oncol. 2022 (Sep 20). Doi: 10.1200/JCO.22.01217

Key clinical point: A considerable number of patients with breast cancer (BC) who received sedative-hypnotic medications during adjuvant chemotherapy turned into new, persistent users of those medications even after chemotherapy.

Major finding: Overall, a substantial proportion of benzodiazepine-naive (15.6%)/Z-drug (zolpidem, zaleplon, and eszopiclone, the active stereoisomer of zopiclone)-naive (27.3%) patients who filled ≥1 prescription of benzodiazepine/Z-drug became persistent users. A shorter duration (<4 months) of chemotherapy and receipt of opioid prescriptions during chemotherapy were associated with new persistent sedative-hypnotic use in both benzodiazepine-naive and Z-drug-naive patients (both P ≤ .01).

Study details: Findings are from a study including patients with BC who were naive to benzodiazepine (n = 22,039) or Z-drug (n = 23,816) and received adjuvant chemotherapy.

Disclosures: This work was supported by the Breast Cancer Research Foundation and American Cancer Society. JD Wright declared receiving research support and royalties from some sources.

Source: Cogan JC et al. New and persistent sedative-hypnotic use after adjuvant chemotherapy for breast cancer. J Natl Cancer Inst. 2022 (Sep 20). Doi: 10.1093/jnci/djac170

Key clinical point: A considerable number of patients with breast cancer (BC) who received sedative-hypnotic medications during adjuvant chemotherapy turned into new, persistent users of those medications even after chemotherapy.

Major finding: Overall, a substantial proportion of benzodiazepine-naive (15.6%)/Z-drug (zolpidem, zaleplon, and eszopiclone, the active stereoisomer of zopiclone)-naive (27.3%) patients who filled ≥1 prescription of benzodiazepine/Z-drug became persistent users. A shorter duration (<4 months) of chemotherapy and receipt of opioid prescriptions during chemotherapy were associated with new persistent sedative-hypnotic use in both benzodiazepine-naive and Z-drug-naive patients (both P ≤ .01).

Study details: Findings are from a study including patients with BC who were naive to benzodiazepine (n = 22,039) or Z-drug (n = 23,816) and received adjuvant chemotherapy.

Disclosures: This work was supported by the Breast Cancer Research Foundation and American Cancer Society. JD Wright declared receiving research support and royalties from some sources.

Source: Cogan JC et al. New and persistent sedative-hypnotic use after adjuvant chemotherapy for breast cancer. J Natl Cancer Inst. 2022 (Sep 20). Doi: 10.1093/jnci/djac170

Key clinical point: A considerable number of patients with breast cancer (BC) who received sedative-hypnotic medications during adjuvant chemotherapy turned into new, persistent users of those medications even after chemotherapy.

Major finding: Overall, a substantial proportion of benzodiazepine-naive (15.6%)/Z-drug (zolpidem, zaleplon, and eszopiclone, the active stereoisomer of zopiclone)-naive (27.3%) patients who filled ≥1 prescription of benzodiazepine/Z-drug became persistent users. A shorter duration (<4 months) of chemotherapy and receipt of opioid prescriptions during chemotherapy were associated with new persistent sedative-hypnotic use in both benzodiazepine-naive and Z-drug-naive patients (both P ≤ .01).

Study details: Findings are from a study including patients with BC who were naive to benzodiazepine (n = 22,039) or Z-drug (n = 23,816) and received adjuvant chemotherapy.

Disclosures: This work was supported by the Breast Cancer Research Foundation and American Cancer Society. JD Wright declared receiving research support and royalties from some sources.

Source: Cogan JC et al. New and persistent sedative-hypnotic use after adjuvant chemotherapy for breast cancer. J Natl Cancer Inst. 2022 (Sep 20). Doi: 10.1093/jnci/djac170

Key clinical point: One of the key factors influencing contraceptive use in premenopausal women with early breast cancer (BC) is the use of contraception at the time of diagnosis.

Major finding: At diagnosis, 54.2% of patients reported using contraceptives, mostly hormonal (62.7%); however, the use of contraception decreased significantly to 38.9% and 41.2% at the first and second year, respectively (P < .001). The use of contraception at diagnosis was associated with higher odds of contraceptive use at years 1 (adjusted odds ratio [aOR] 4.02; 95% CI 3.15-5.14) and 2 (aOR 3.12; 95% CI 2.36-4.14) after diagnosis.

Study details: Findings are from an analysis of the prospective, Cancer Toxicity (CANTO) study including 2900 premenopausal women with early BC.

Disclosures: The CANTO study is supported by the Investment for the Future program of the National Research Agency of France. The authors declared serving as advisors, owning stocks, or receiving grants, personal fees, or royalties from several sources.

Source: Lambertini M et al. Contraceptive use in premenopausal women with early breast cancer. JAMA Netw Open. 2022;5(9):e2233137 (Sep 23). Doi: 10.1001/jamanetworkopen.2022.33137

Key clinical point: One of the key factors influencing contraceptive use in premenopausal women with early breast cancer (BC) is the use of contraception at the time of diagnosis.

Major finding: At diagnosis, 54.2% of patients reported using contraceptives, mostly hormonal (62.7%); however, the use of contraception decreased significantly to 38.9% and 41.2% at the first and second year, respectively (P < .001). The use of contraception at diagnosis was associated with higher odds of contraceptive use at years 1 (adjusted odds ratio [aOR] 4.02; 95% CI 3.15-5.14) and 2 (aOR 3.12; 95% CI 2.36-4.14) after diagnosis.

Study details: Findings are from an analysis of the prospective, Cancer Toxicity (CANTO) study including 2900 premenopausal women with early BC.

Disclosures: The CANTO study is supported by the Investment for the Future program of the National Research Agency of France. The authors declared serving as advisors, owning stocks, or receiving grants, personal fees, or royalties from several sources.

Source: Lambertini M et al. Contraceptive use in premenopausal women with early breast cancer. JAMA Netw Open. 2022;5(9):e2233137 (Sep 23). Doi: 10.1001/jamanetworkopen.2022.33137

Key clinical point: One of the key factors influencing contraceptive use in premenopausal women with early breast cancer (BC) is the use of contraception at the time of diagnosis.

Major finding: At diagnosis, 54.2% of patients reported using contraceptives, mostly hormonal (62.7%); however, the use of contraception decreased significantly to 38.9% and 41.2% at the first and second year, respectively (P < .001). The use of contraception at diagnosis was associated with higher odds of contraceptive use at years 1 (adjusted odds ratio [aOR] 4.02; 95% CI 3.15-5.14) and 2 (aOR 3.12; 95% CI 2.36-4.14) after diagnosis.

Study details: Findings are from an analysis of the prospective, Cancer Toxicity (CANTO) study including 2900 premenopausal women with early BC.

Disclosures: The CANTO study is supported by the Investment for the Future program of the National Research Agency of France. The authors declared serving as advisors, owning stocks, or receiving grants, personal fees, or royalties from several sources.

Source: Lambertini M et al. Contraceptive use in premenopausal women with early breast cancer. JAMA Netw Open. 2022;5(9):e2233137 (Sep 23). Doi: 10.1001/jamanetworkopen.2022.33137

Key clinical point: Male patients who survived breast cancer (BC) were more likely to develop second primary cancers (SPC), such as colorectal, pancreatic, and thyroid cancers.

Major finding: Standardized incidence ratio (SIR) of any SPC was estimated to be 1.27 (95% CI 1.03-1.56), with the risk being elevated in the case of a second primary colorectal cancer (SIR 1.29; 95% CI 1.03-1.61), pancreatic cancer (SIR 1.64; 95% CI 1.05-2.55), and thyroid cancer (SIR 5.58; 95% CI 1.04-30.05).

Study details: Findings are from a meta-analysis of eight retrospective cohort studies including male BC survivors.

Disclosures: This study was funded by the Cancer Research UK Catalyst Award CanGene-CanVar. The authors declared no conflicts of interest.

Source: Allen I et al. Risk of developing a second primary cancer in male breast cancer survivors: A systematic review and meta-analysis. Br J Cancer. 2022;127:1660–1669 (Sep 17). Doi: 10.1038/s41416-022-01940-1

Key clinical point: Male patients who survived breast cancer (BC) were more likely to develop second primary cancers (SPC), such as colorectal, pancreatic, and thyroid cancers.

Major finding: Standardized incidence ratio (SIR) of any SPC was estimated to be 1.27 (95% CI 1.03-1.56), with the risk being elevated in the case of a second primary colorectal cancer (SIR 1.29; 95% CI 1.03-1.61), pancreatic cancer (SIR 1.64; 95% CI 1.05-2.55), and thyroid cancer (SIR 5.58; 95% CI 1.04-30.05).

Study details: Findings are from a meta-analysis of eight retrospective cohort studies including male BC survivors.

Disclosures: This study was funded by the Cancer Research UK Catalyst Award CanGene-CanVar. The authors declared no conflicts of interest.

Source: Allen I et al. Risk of developing a second primary cancer in male breast cancer survivors: A systematic review and meta-analysis. Br J Cancer. 2022;127:1660–1669 (Sep 17). Doi: 10.1038/s41416-022-01940-1

Key clinical point: Male patients who survived breast cancer (BC) were more likely to develop second primary cancers (SPC), such as colorectal, pancreatic, and thyroid cancers.

Major finding: Standardized incidence ratio (SIR) of any SPC was estimated to be 1.27 (95% CI 1.03-1.56), with the risk being elevated in the case of a second primary colorectal cancer (SIR 1.29; 95% CI 1.03-1.61), pancreatic cancer (SIR 1.64; 95% CI 1.05-2.55), and thyroid cancer (SIR 5.58; 95% CI 1.04-30.05).

Study details: Findings are from a meta-analysis of eight retrospective cohort studies including male BC survivors.

Disclosures: This study was funded by the Cancer Research UK Catalyst Award CanGene-CanVar. The authors declared no conflicts of interest.

Source: Allen I et al. Risk of developing a second primary cancer in male breast cancer survivors: A systematic review and meta-analysis. Br J Cancer. 2022;127:1660–1669 (Sep 17). Doi: 10.1038/s41416-022-01940-1

Key clinical point: Endocrine therapy (ET) improved survival outcomes in all patients with small pT1a-b, estrogen receptor-positive (ER+) breast cancer (BC), especially in patients with grade 2-3 tumors.

Major finding: No adjuvant ET vs adjuvant ET was associated with decreased disease-free survival (DFS) in the overall cohort of patients with pT1a-bN0 ER+ BC (hazard ratio [HR] 1.275; P = .047) and in those with grade 2-3 tumors (HR 1.502; P = .049); however, ET did not affect DFS outcomes in grade 1 pT1a-bN0 ER+ BC.

Study details: Findings are from a retrospective, observational study including 5545 patients with pT1a-b ER+ BC, of which the majority (80.3%) received adjuvant ET.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Houvenaeghel G et al. Contribution of endocrine therapy in oestrogen receptor-positive pT1a-b breast cancer: Results of a retrospective study. Eur J Cancer. 2022;176:58-69 (Oct 1). Doi: 10.1016/j.ejca.2022.08.027

Key clinical point: Endocrine therapy (ET) improved survival outcomes in all patients with small pT1a-b, estrogen receptor-positive (ER+) breast cancer (BC), especially in patients with grade 2-3 tumors.

Major finding: No adjuvant ET vs adjuvant ET was associated with decreased disease-free survival (DFS) in the overall cohort of patients with pT1a-bN0 ER+ BC (hazard ratio [HR] 1.275; P = .047) and in those with grade 2-3 tumors (HR 1.502; P = .049); however, ET did not affect DFS outcomes in grade 1 pT1a-bN0 ER+ BC.

Study details: Findings are from a retrospective, observational study including 5545 patients with pT1a-b ER+ BC, of which the majority (80.3%) received adjuvant ET.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Houvenaeghel G et al. Contribution of endocrine therapy in oestrogen receptor-positive pT1a-b breast cancer: Results of a retrospective study. Eur J Cancer. 2022;176:58-69 (Oct 1). Doi: 10.1016/j.ejca.2022.08.027

Key clinical point: Endocrine therapy (ET) improved survival outcomes in all patients with small pT1a-b, estrogen receptor-positive (ER+) breast cancer (BC), especially in patients with grade 2-3 tumors.

Major finding: No adjuvant ET vs adjuvant ET was associated with decreased disease-free survival (DFS) in the overall cohort of patients with pT1a-bN0 ER+ BC (hazard ratio [HR] 1.275; P = .047) and in those with grade 2-3 tumors (HR 1.502; P = .049); however, ET did not affect DFS outcomes in grade 1 pT1a-bN0 ER+ BC.

Study details: Findings are from a retrospective, observational study including 5545 patients with pT1a-b ER+ BC, of which the majority (80.3%) received adjuvant ET.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Houvenaeghel G et al. Contribution of endocrine therapy in oestrogen receptor-positive pT1a-b breast cancer: Results of a retrospective study. Eur J Cancer. 2022;176:58-69 (Oct 1). Doi: 10.1016/j.ejca.2022.08.027

Key clinical point: Repeat breast-conserving surgery (re-BCS) worsened survival outcomes in patients with small ipsilateral breast tumor recurrence (IBTR), especially in those with estrogen receptor-negative (ER−) IBTR and those who omitted radiation after re-BCS.

Major finding: Compared with mastectomy, re-BCS was associated with worse overall survival (OS; hazard ratio [HR] 1.342; 95% CI 1.084-1.663) and breast cancer-specific survival (BCSS; HR 1.454; 95% CI 1.004-2.105). After re-BCS, the omission of radiation worsened OS (overall re-BCS without radiation: HR 1.384; 95% CI 1.110-1.724; and negative IBTR ER re-BCS without radiation: HR 1.972; 95% CI 1.191-3.265, respectively) and BCSS (overall re-BCS without radiation: HR 1.577; 95% CI 1.075-2.314; and negative IBTR ER re-BCS without radiation: HR 2.097; 95% CI 1.053-4.178, respectively).

Study details: Findings are from a population-based cohort study including 3648 patients with small IBTR, of which 22.4% of patients underwent re-BCS and the remaining patients underwent mastectomy.

Disclosures: This study did not report any funding source. The authors declared no conflicts of interest.

Source: Li Y et al. Is repeat breast conservation possible for small ipsilateral breast cancer recurrence? Cancer. 2022 (Sep 20). Doi: 10.1002/cncr.34468

Key clinical point: Repeat breast-conserving surgery (re-BCS) worsened survival outcomes in patients with small ipsilateral breast tumor recurrence (IBTR), especially in those with estrogen receptor-negative (ER−) IBTR and those who omitted radiation after re-BCS.

Major finding: Compared with mastectomy, re-BCS was associated with worse overall survival (OS; hazard ratio [HR] 1.342; 95% CI 1.084-1.663) and breast cancer-specific survival (BCSS; HR 1.454; 95% CI 1.004-2.105). After re-BCS, the omission of radiation worsened OS (overall re-BCS without radiation: HR 1.384; 95% CI 1.110-1.724; and negative IBTR ER re-BCS without radiation: HR 1.972; 95% CI 1.191-3.265, respectively) and BCSS (overall re-BCS without radiation: HR 1.577; 95% CI 1.075-2.314; and negative IBTR ER re-BCS without radiation: HR 2.097; 95% CI 1.053-4.178, respectively).

Study details: Findings are from a population-based cohort study including 3648 patients with small IBTR, of which 22.4% of patients underwent re-BCS and the remaining patients underwent mastectomy.

Disclosures: This study did not report any funding source. The authors declared no conflicts of interest.

Source: Li Y et al. Is repeat breast conservation possible for small ipsilateral breast cancer recurrence? Cancer. 2022 (Sep 20). Doi: 10.1002/cncr.34468

Key clinical point: Repeat breast-conserving surgery (re-BCS) worsened survival outcomes in patients with small ipsilateral breast tumor recurrence (IBTR), especially in those with estrogen receptor-negative (ER−) IBTR and those who omitted radiation after re-BCS.

Major finding: Compared with mastectomy, re-BCS was associated with worse overall survival (OS; hazard ratio [HR] 1.342; 95% CI 1.084-1.663) and breast cancer-specific survival (BCSS; HR 1.454; 95% CI 1.004-2.105). After re-BCS, the omission of radiation worsened OS (overall re-BCS without radiation: HR 1.384; 95% CI 1.110-1.724; and negative IBTR ER re-BCS without radiation: HR 1.972; 95% CI 1.191-3.265, respectively) and BCSS (overall re-BCS without radiation: HR 1.577; 95% CI 1.075-2.314; and negative IBTR ER re-BCS without radiation: HR 2.097; 95% CI 1.053-4.178, respectively).

Study details: Findings are from a population-based cohort study including 3648 patients with small IBTR, of which 22.4% of patients underwent re-BCS and the remaining patients underwent mastectomy.

Disclosures: This study did not report any funding source. The authors declared no conflicts of interest.

Source: Li Y et al. Is repeat breast conservation possible for small ipsilateral breast cancer recurrence? Cancer. 2022 (Sep 20). Doi: 10.1002/cncr.34468

Key clinical point: In patients with metastatic breast cancer (BC), germline BRCA1/2 mutation (gBRCAm) had a differential prognostic impact for triple-negative BC (TNBC) or hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) BC.

Major finding: Compared with gBRCA wild-type (WT) BC, gBRCAm BC showed comparable overall survival (OS) and first-line progression-free survival (PFS1) outcomes in the overall cohort of patients with metastatic BC (both P > .05), better OS (hazard ratio [HR] 0.76; P = .027) and PFS1 (HR 0.69; P = .001) in the TNBC subgroup, and worse PFS1 (HR 1.23; P = .024) in the HR+/HER2− BC subgroup.

Study details: Findings are from a retrospective cohort including 20,624 patients with newly diagnosed metastatic BC, of which 325 had gBRCAm, 1138 had gBRCA WT, and 19,161 had not tested for gBRCA.

Disclosures: This study was funded by an industrial consortium. Several authors declared receiving personal fees, grants, nonfinancial support, or travel support from several sources, including some of the companies in the consortium. Seventeen authors declared no conflicts of interest.

Source: Mailliez A et al. Survival outcomes of metastatic breast cancer patients by germline BRCA1/2 status in a large multicenter real-world database. Int J Cancer. 2022 (Sep 26). Doi: 10.1002/ijc.34304

Key clinical point: In patients with metastatic breast cancer (BC), germline BRCA1/2 mutation (gBRCAm) had a differential prognostic impact for triple-negative BC (TNBC) or hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) BC.

Major finding: Compared with gBRCA wild-type (WT) BC, gBRCAm BC showed comparable overall survival (OS) and first-line progression-free survival (PFS1) outcomes in the overall cohort of patients with metastatic BC (both P > .05), better OS (hazard ratio [HR] 0.76; P = .027) and PFS1 (HR 0.69; P = .001) in the TNBC subgroup, and worse PFS1 (HR 1.23; P = .024) in the HR+/HER2− BC subgroup.

Study details: Findings are from a retrospective cohort including 20,624 patients with newly diagnosed metastatic BC, of which 325 had gBRCAm, 1138 had gBRCA WT, and 19,161 had not tested for gBRCA.

Disclosures: This study was funded by an industrial consortium. Several authors declared receiving personal fees, grants, nonfinancial support, or travel support from several sources, including some of the companies in the consortium. Seventeen authors declared no conflicts of interest.

Source: Mailliez A et al. Survival outcomes of metastatic breast cancer patients by germline BRCA1/2 status in a large multicenter real-world database. Int J Cancer. 2022 (Sep 26). Doi: 10.1002/ijc.34304

Key clinical point: In patients with metastatic breast cancer (BC), germline BRCA1/2 mutation (gBRCAm) had a differential prognostic impact for triple-negative BC (TNBC) or hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) BC.

Major finding: Compared with gBRCA wild-type (WT) BC, gBRCAm BC showed comparable overall survival (OS) and first-line progression-free survival (PFS1) outcomes in the overall cohort of patients with metastatic BC (both P > .05), better OS (hazard ratio [HR] 0.76; P = .027) and PFS1 (HR 0.69; P = .001) in the TNBC subgroup, and worse PFS1 (HR 1.23; P = .024) in the HR+/HER2− BC subgroup.

Study details: Findings are from a retrospective cohort including 20,624 patients with newly diagnosed metastatic BC, of which 325 had gBRCAm, 1138 had gBRCA WT, and 19,161 had not tested for gBRCA.

Disclosures: This study was funded by an industrial consortium. Several authors declared receiving personal fees, grants, nonfinancial support, or travel support from several sources, including some of the companies in the consortium. Seventeen authors declared no conflicts of interest.

Source: Mailliez A et al. Survival outcomes of metastatic breast cancer patients by germline BRCA1/2 status in a large multicenter real-world database. Int J Cancer. 2022 (Sep 26). Doi: 10.1002/ijc.34304

Key clinical point: Patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC) who relapsed after prior (neo)adjuvant trastuzumab (T) treatment benefitted from dual blockade with pertuzumab + trastuzumab (P + T) in routine clinical practice.

Major finding: The median progression-free survival was 18.8 months, with comparable outcomes observed in patients with hormone receptor (HR)-positive vs HR-negative BC (18.2 vs 19.4 months) and with visceral vs non-visceral metastasis (18.0 vs 20.5 months). No new safety signals were reported, and 6.1% of patients reported fatal serious adverse events.

Study details: Findings are from the observational, noninterventional, HELENA study including 126 patients with HER2+ metastatic BC who relapsed after prior (neo)adjuvant T treatment and received first-line P + T + chemotherapy.

Disclosures: This study was funded by Roche Pharma AG. Some authors declared receiving personal fees, grants, honoraria, or consulting fees from several sources, and one author declared being an employee and holding stocks in Roche Pharma.

Source: Thill M et al. Dual HER2 blockade with pertuzumab (P) and trastuzumab (T) in patients with HER2-positive metastatic breast cancer (mBC) relapsing after adjuvant treatment with T: Results from a German non-interventional study (NIS) HELENA (NCT01777958). Breast Cancer Res Treat. 2022 (Sep 12). Doi: 10.1007/s10549-022-06710-4

Key clinical point: Patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC) who relapsed after prior (neo)adjuvant trastuzumab (T) treatment benefitted from dual blockade with pertuzumab + trastuzumab (P + T) in routine clinical practice.

Major finding: The median progression-free survival was 18.8 months, with comparable outcomes observed in patients with hormone receptor (HR)-positive vs HR-negative BC (18.2 vs 19.4 months) and with visceral vs non-visceral metastasis (18.0 vs 20.5 months). No new safety signals were reported, and 6.1% of patients reported fatal serious adverse events.

Study details: Findings are from the observational, noninterventional, HELENA study including 126 patients with HER2+ metastatic BC who relapsed after prior (neo)adjuvant T treatment and received first-line P + T + chemotherapy.

Disclosures: This study was funded by Roche Pharma AG. Some authors declared receiving personal fees, grants, honoraria, or consulting fees from several sources, and one author declared being an employee and holding stocks in Roche Pharma.

Source: Thill M et al. Dual HER2 blockade with pertuzumab (P) and trastuzumab (T) in patients with HER2-positive metastatic breast cancer (mBC) relapsing after adjuvant treatment with T: Results from a German non-interventional study (NIS) HELENA (NCT01777958). Breast Cancer Res Treat. 2022 (Sep 12). Doi: 10.1007/s10549-022-06710-4

Key clinical point: Patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC) who relapsed after prior (neo)adjuvant trastuzumab (T) treatment benefitted from dual blockade with pertuzumab + trastuzumab (P + T) in routine clinical practice.

Major finding: The median progression-free survival was 18.8 months, with comparable outcomes observed in patients with hormone receptor (HR)-positive vs HR-negative BC (18.2 vs 19.4 months) and with visceral vs non-visceral metastasis (18.0 vs 20.5 months). No new safety signals were reported, and 6.1% of patients reported fatal serious adverse events.

Study details: Findings are from the observational, noninterventional, HELENA study including 126 patients with HER2+ metastatic BC who relapsed after prior (neo)adjuvant T treatment and received first-line P + T + chemotherapy.

Disclosures: This study was funded by Roche Pharma AG. Some authors declared receiving personal fees, grants, honoraria, or consulting fees from several sources, and one author declared being an employee and holding stocks in Roche Pharma.

Source: Thill M et al. Dual HER2 blockade with pertuzumab (P) and trastuzumab (T) in patients with HER2-positive metastatic breast cancer (mBC) relapsing after adjuvant treatment with T: Results from a German non-interventional study (NIS) HELENA (NCT01777958). Breast Cancer Res Treat. 2022 (Sep 12). Doi: 10.1007/s10549-022-06710-4

Key clinical point: The combination of apatinib and vinorelbine lowered the risk for disease progression and was well tolerated in patients with metastatic triple-negative breast cancer (TNBC) who had failed first or second-line treatment.

Major finding: There was a significant improvement in progression-free survival with apatinib + vinorelbine vs only vinorelbine (hazard ratio 1.82; P = .026). Leukopenia (42.4% vs 40.6%) and granulocytopenia (57.6% vs 31.3%) were the most frequent grade 3-4 hematologic adverse events in the apatinib + vinorelbine vs vinorelbine group.

Study details: Findings are from the phase 2, NAN study including 66 patients with recurrent or metastatic TNBC who had failed first or second-line treatment and were randomly assigned to receive apatinib + vinorelbine or vinorelbine.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Li DD et al. Apatinib plus vinorelbine versus vinorelbine for metastatic triple-negative breast cancer who failed first/second-line treatment: The NAN trial. NPJ Breast Cancer. 2022;8:110 (Sep 20). Doi: 10.1038/s41523-022-00462-6

Key clinical point: The combination of apatinib and vinorelbine lowered the risk for disease progression and was well tolerated in patients with metastatic triple-negative breast cancer (TNBC) who had failed first or second-line treatment.

Major finding: There was a significant improvement in progression-free survival with apatinib + vinorelbine vs only vinorelbine (hazard ratio 1.82; P = .026). Leukopenia (42.4% vs 40.6%) and granulocytopenia (57.6% vs 31.3%) were the most frequent grade 3-4 hematologic adverse events in the apatinib + vinorelbine vs vinorelbine group.

Study details: Findings are from the phase 2, NAN study including 66 patients with recurrent or metastatic TNBC who had failed first or second-line treatment and were randomly assigned to receive apatinib + vinorelbine or vinorelbine.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Li DD et al. Apatinib plus vinorelbine versus vinorelbine for metastatic triple-negative breast cancer who failed first/second-line treatment: The NAN trial. NPJ Breast Cancer. 2022;8:110 (Sep 20). Doi: 10.1038/s41523-022-00462-6

Key clinical point: The combination of apatinib and vinorelbine lowered the risk for disease progression and was well tolerated in patients with metastatic triple-negative breast cancer (TNBC) who had failed first or second-line treatment.

Major finding: There was a significant improvement in progression-free survival with apatinib + vinorelbine vs only vinorelbine (hazard ratio 1.82; P = .026). Leukopenia (42.4% vs 40.6%) and granulocytopenia (57.6% vs 31.3%) were the most frequent grade 3-4 hematologic adverse events in the apatinib + vinorelbine vs vinorelbine group.

Study details: Findings are from the phase 2, NAN study including 66 patients with recurrent or metastatic TNBC who had failed first or second-line treatment and were randomly assigned to receive apatinib + vinorelbine or vinorelbine.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Li DD et al. Apatinib plus vinorelbine versus vinorelbine for metastatic triple-negative breast cancer who failed first/second-line treatment: The NAN trial. NPJ Breast Cancer. 2022;8:110 (Sep 20). Doi: 10.1038/s41523-022-00462-6