Arm Morbidity Rates in Young Breast Cancer Survivors
With the move away from axillary node dissection among breast cancer patients in recent years, the incidence of arm morbidity in this population would be expected to decrease. To confirm whether this hypothesis is accurate among young patients, researchers examined the incidence of patient-reported arm swelling or decreased range of motion (ROM) 1 year after diagnosis among women aged 40 or younger who had stage 0-4 breast cancer. Among 1,037 patients, 13% reported arm swelling and 40% reported decreased ROM in the ipsilateral arm at 1 year. Among patients who underwent sentinel lymph node biopsy (SLNB) without radiation therapy (RT), the incidence of arm swelling was 4%, compared with 8% among those who underwent SLNB with RT, 20% in those who underwent axillary lymph node dissection (ALND) without RT, and 24% in those who underwent ALND with RT. Incidence rates for decreased ROM were 21% in patients who underwent SLNB without RT, 34% in those who underwent SLNB with RT, 33% in those who underwent ALND without RT, and 44% in those who underwent ALND with RT.
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Circulating Tumor Cells Prognostic of Late Recurrence
Biomarkers that are prognostic for late breast cancer recurrence may aid in accurately identifying patients who could benefit from extended adjuvant endocrine therapy or novel strategies for reducing late recurrence risk. For a study, researchers assessed circulating tumor cell (CTC) counts in patients without clinical evidence of recurrence between 4.5 and 7.5 years after an initial diagnosis of HER2-negative stage II-III breast cancer. At a median of 5.2 years, CTC assay results were positive in 4.9% of patients overall. Recurrence rates per person-year were 19.6% in patients with positive CTC assay results and 1.1% in those with negative results.
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Disparities in Early Breast Cancer Outcomes
Data are lacking that evaluate outcomes in different subtypes of very early breast cancer at the national level. Treatment outcomes and prognostic factors for both disease-specific and overall survival were evaluated among patients with stage I T1aN0M0 and T1bN0M0 breast cancer. Disease-specific and overall survival rates for patients with stage T1aN0 or T1bN0 disease were 98.7% and 93.7%, respectively. Estrogen receptor (ER)-positive tumors were associated with improved 5-year disease-specific survival (99% vs 96%) and overall survival (94% vs 92%) when compared with ER-negative tumors. Caucasian patients had 5-year disease-specific and overall survival rates of 98.8% and 93.7%, respectively, compared with rates of 94.0% and 91.5%, respectively, in African-American patients and 99.0% and 96.3%, respectively, in Asian or Pacific Islander patients. Tumor subtype was not associated with significant differences in outcomes.
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CDK 4/6 Inhibitors in Older Women
The safety and efficacy of cyclin-dependent kinases 4 and 6 (CDK 4/6) inhibitors in postmenopausal women with hormone receptor-positive metastatic breast cancer (MBC) is not fully understood. For a study, data from two prospective randomized controlled studies of different CDK 4/6 inhibitors in combination with an aromatase inhibitor for the initial treatment of postmenopausal patients with hormone-receptor positive MBC were pooled and analyzed. The estimated progression free survival (PFS) of 25.1 months was not reached for patients aged 70 or older who were treated with a CDK 4/6 inhibitor in combination with an aromatase inhibitor. Those treated only with an aromatase inhibitor, however, had an estimated PFS of 18 months. Patients younger than 70 who were treated with a CDK 4/6 inhibitor had an estimated PFS of 23.5 months, compared with 13.8 months for those treated only with an aromatase inhibitor. However, about 66% of women younger than 65 experienced serious adverse events, compared with 80% of those aged 65 or older and 82% of those aged 70 or older.
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Acupuncture Improves Joint Pain & Stiffness
Previous studies suggest that joint pain and stiffness are the most common side effects of aromatase inhibitors and a major cause of treatment noncompliance. Measures to reduce these side effects may allow more patients to reap the benefits of this drug class. Women with early-stage breast cancer who were taking aromatase inhibitors were randomized to receive no treatment for their joint pain and stiffness, acupuncture, or sham acupuncture. Patients who received true acupuncture twice weekly for 6 weeks experienced statistically significant reductions in “worst pain” scores at 6 weeks when compared with those in the other two groups. Mean worst pain scores at 6 weeks were 0.92 points lower in the true acupuncture group when compared with the sham group, and 0.96 points lower than in the no-treatment group. Of patients in the true acupuncture group, 58% experienced clinically meaningful reductions in worst pain scores, compared with about 30% in both the sham and no-treatment groups.
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The Benefits of Dose-Dense Chemotherapy
Large meta-analyses to support dose-intensification strategies for the treatment of breast cancer have been lacking. Study investigators performed a meta-analysis of 25 trials in which more than 34,000 patients with early-stage breast cancer were treated with some form of dose-intensification strategy. Administering patients the same drugs but for a shorter interval was shown to reduce the absolute risk for breast cancer recurrence by 4.3% at 10 years when compared with standard 3-week regimens, according to trials involving more than 10,000 women. Dose-dense regimens were also associated with 2.8% lower breast cancer-specific mortality rates at 10 years when compared with standard chemotherapy. Among more than 11,000 women, 28.1% of those treated with sequential therapy experienced disease recurrence, compared with 31.25% of those treated concurrently. Those treated sequentially had a 1.9% lower rate of 10-year mortality. Among more than 6,500 women, absolute recurrence rates at 10 years were 4.5% lower for those who received sequential therapy every 2 weeks when compared with those who received concurrent chemotherapy every 3 weeks. In these women, 10-year mortality rates were 3.9% lower in those who underwent dose intensification.
