Microscopic evaluation of a dermoscopy-guided skin scraping revealed that this was a case of scabies.

Classically, patients with scabies have many excoriated papules or plaques on their hands, genitals, and trunk with itching so intense that their sleep is interrupted. However, scabies can also be diagnosed in patients who complain of itching but also have very subtle skin findings, such as a small dry patch or fissure (as in this case). Such subtle findings can be easily mistaken for mild hand dermatitis.

In the elderly, itching without a significant rash can arise from many causes. A short list includes dry skin, medications, kidney disease, liver disease, and of course, various dermatologic conditions. Dermoscopy is a sensitive and specific tool for investigating itching and areas of suspected infestation with mites.¹ A mite appears as an oval on dermoscopy, but the most recognizable part is the head and front legs, which appear as a single gray triangle. The photo shows that the most erythematous area around a burrow (black arrows) is an excellent place to start when looking through the dermatoscope. In this case, an area of broken skin was connected to a haphazard tunnel that ultimately led to the mite (white arrows).

Scabies may be effectively treated with topical permethrin 5% applied over every inch of the body from the top of the neck to the tips of the toes.

This topical treatment is left on for at least 8 hours and reapplied a week later. Also, remember to take a careful history of close contacts so that others who are affected may receive treatment.

This patient was treated with permethrin, as was her adult son who lived at home with her and had similar itching. Permethrin comes in 60 g tubes, which is enough to treat 1 adult twice. After 6 weeks, all itching symptoms in the patient had cleared.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

Microscopic evaluation of a dermoscopy-guided skin scraping revealed that this was a case of scabies.

Classically, patients with scabies have many excoriated papules or plaques on their hands, genitals, and trunk with itching so intense that their sleep is interrupted. However, scabies can also be diagnosed in patients who complain of itching but also have very subtle skin findings, such as a small dry patch or fissure (as in this case). Such subtle findings can be easily mistaken for mild hand dermatitis.

In the elderly, itching without a significant rash can arise from many causes. A short list includes dry skin, medications, kidney disease, liver disease, and of course, various dermatologic conditions. Dermoscopy is a sensitive and specific tool for investigating itching and areas of suspected infestation with mites.¹ A mite appears as an oval on dermoscopy, but the most recognizable part is the head and front legs, which appear as a single gray triangle. The photo shows that the most erythematous area around a burrow (black arrows) is an excellent place to start when looking through the dermatoscope. In this case, an area of broken skin was connected to a haphazard tunnel that ultimately led to the mite (white arrows).

Scabies may be effectively treated with topical permethrin 5% applied over every inch of the body from the top of the neck to the tips of the toes.

This topical treatment is left on for at least 8 hours and reapplied a week later. Also, remember to take a careful history of close contacts so that others who are affected may receive treatment.

This patient was treated with permethrin, as was her adult son who lived at home with her and had similar itching. Permethrin comes in 60 g tubes, which is enough to treat 1 adult twice. After 6 weeks, all itching symptoms in the patient had cleared.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

Microscopic evaluation of a dermoscopy-guided skin scraping revealed that this was a case of scabies.

Classically, patients with scabies have many excoriated papules or plaques on their hands, genitals, and trunk with itching so intense that their sleep is interrupted. However, scabies can also be diagnosed in patients who complain of itching but also have very subtle skin findings, such as a small dry patch or fissure (as in this case). Such subtle findings can be easily mistaken for mild hand dermatitis.

In the elderly, itching without a significant rash can arise from many causes. A short list includes dry skin, medications, kidney disease, liver disease, and of course, various dermatologic conditions. Dermoscopy is a sensitive and specific tool for investigating itching and areas of suspected infestation with mites.¹ A mite appears as an oval on dermoscopy, but the most recognizable part is the head and front legs, which appear as a single gray triangle. The photo shows that the most erythematous area around a burrow (black arrows) is an excellent place to start when looking through the dermatoscope. In this case, an area of broken skin was connected to a haphazard tunnel that ultimately led to the mite (white arrows).

Scabies may be effectively treated with topical permethrin 5% applied over every inch of the body from the top of the neck to the tips of the toes.

This topical treatment is left on for at least 8 hours and reapplied a week later. Also, remember to take a careful history of close contacts so that others who are affected may receive treatment.

This patient was treated with permethrin, as was her adult son who lived at home with her and had similar itching. Permethrin comes in 60 g tubes, which is enough to treat 1 adult twice. After 6 weeks, all itching symptoms in the patient had cleared.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

Key clinical point: Patients with left-sided breast cancer (BC) who received radiation doses to the left anterior descending artery (LAD) experienced an elevated risk for adverse cardiac outcomes.

Major finding: Mean dose to LAD was associated with an increased risk for any cardiac event (hazard ratio [HR] 1.09; P = .006) and major cardiac events (HR 1.08; P = .022). Receiver operating characteristics analysis identified 2.8 Gy (area under the curve 0.69) as the mean LAD dose threshold, above which the risk for any cardiac event was higher (P = .001).

Study details: Findings are from a retrospective study of 375 consecutively treated female patients with nonmetastatic, left-sided BC who received breast-conserving surgery/mastectomy and adjuvant radiation therapy.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Zureick AH et al. Dose to the left anterior descending artery correlates with cardiac events following irradiation for breast cancer. Int J Radiat Oncol Biol Phys. 2022 (Apr 24). Doi: 10.1016/j.ijrobp.2022.04.019

Key clinical point: Patients with left-sided breast cancer (BC) who received radiation doses to the left anterior descending artery (LAD) experienced an elevated risk for adverse cardiac outcomes.

Major finding: Mean dose to LAD was associated with an increased risk for any cardiac event (hazard ratio [HR] 1.09; P = .006) and major cardiac events (HR 1.08; P = .022). Receiver operating characteristics analysis identified 2.8 Gy (area under the curve 0.69) as the mean LAD dose threshold, above which the risk for any cardiac event was higher (P = .001).

Study details: Findings are from a retrospective study of 375 consecutively treated female patients with nonmetastatic, left-sided BC who received breast-conserving surgery/mastectomy and adjuvant radiation therapy.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Zureick AH et al. Dose to the left anterior descending artery correlates with cardiac events following irradiation for breast cancer. Int J Radiat Oncol Biol Phys. 2022 (Apr 24). Doi: 10.1016/j.ijrobp.2022.04.019

Key clinical point: Patients with left-sided breast cancer (BC) who received radiation doses to the left anterior descending artery (LAD) experienced an elevated risk for adverse cardiac outcomes.

Major finding: Mean dose to LAD was associated with an increased risk for any cardiac event (hazard ratio [HR] 1.09; P = .006) and major cardiac events (HR 1.08; P = .022). Receiver operating characteristics analysis identified 2.8 Gy (area under the curve 0.69) as the mean LAD dose threshold, above which the risk for any cardiac event was higher (P = .001).

Study details: Findings are from a retrospective study of 375 consecutively treated female patients with nonmetastatic, left-sided BC who received breast-conserving surgery/mastectomy and adjuvant radiation therapy.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Zureick AH et al. Dose to the left anterior descending artery correlates with cardiac events following irradiation for breast cancer. Int J Radiat Oncol Biol Phys. 2022 (Apr 24). Doi: 10.1016/j.ijrobp.2022.04.019

Key clinical point: Young age at diagnosis of human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC) was not associated with any detrimental prognostic value and had no effect on the efficacy of adjuvant dual anti-HER2 targeted therapy.

Major finding: Young age had no effect on invasive disease-free survival (adjusted hazard ratio [aHR] 1.07; 95% CI 0.84-1.35), regardless of hormone receptor status (positive: aHR 1.10; 95% CI 0.82-1.44 or negative: aHR 0.99; 95% CI 0.62-1.51) and anti-HER2 treatment administered (chemotherapy+trastuzumab+pertuzumab: aHR 1.20; 95% CI 0.83-1.68 or chemotherapy+trastuzumab+placebo: aHR, 0.99; 95% CI, 0.71-1.35).

Study details: Findings are from the phase 3 APHINITY trial including 768 patients aged ≤40 years with HER2+ early BC who were randomly assigned to receive chemotherapy+trastuzumab+placebo or chemotherapy+trastuzumab+pertuzumab.

Disclosures: The APHINITY trial was supported by F Hoffmann-La Roche Ltd/Genentech. Some authors declared receiving research funding, honoraria, grants, or nonfinancial support or serving as advisors, speakers, or consultants for several sources, including Roche/Genentech.

Source: Lambertini M et al. Impact of age on clinical outcomes and efficacy of adjuvant dual anti-HER2 targeted therapy. J Natl Cancer Inst. 2022 (May 5). Doi: 10.1093/jnci/djac096 

Key clinical point: Young age at diagnosis of human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC) was not associated with any detrimental prognostic value and had no effect on the efficacy of adjuvant dual anti-HER2 targeted therapy.

Major finding: Young age had no effect on invasive disease-free survival (adjusted hazard ratio [aHR] 1.07; 95% CI 0.84-1.35), regardless of hormone receptor status (positive: aHR 1.10; 95% CI 0.82-1.44 or negative: aHR 0.99; 95% CI 0.62-1.51) and anti-HER2 treatment administered (chemotherapy+trastuzumab+pertuzumab: aHR 1.20; 95% CI 0.83-1.68 or chemotherapy+trastuzumab+placebo: aHR, 0.99; 95% CI, 0.71-1.35).

Study details: Findings are from the phase 3 APHINITY trial including 768 patients aged ≤40 years with HER2+ early BC who were randomly assigned to receive chemotherapy+trastuzumab+placebo or chemotherapy+trastuzumab+pertuzumab.

Disclosures: The APHINITY trial was supported by F Hoffmann-La Roche Ltd/Genentech. Some authors declared receiving research funding, honoraria, grants, or nonfinancial support or serving as advisors, speakers, or consultants for several sources, including Roche/Genentech.

Source: Lambertini M et al. Impact of age on clinical outcomes and efficacy of adjuvant dual anti-HER2 targeted therapy. J Natl Cancer Inst. 2022 (May 5). Doi: 10.1093/jnci/djac096 

Key clinical point: Young age at diagnosis of human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC) was not associated with any detrimental prognostic value and had no effect on the efficacy of adjuvant dual anti-HER2 targeted therapy.

Major finding: Young age had no effect on invasive disease-free survival (adjusted hazard ratio [aHR] 1.07; 95% CI 0.84-1.35), regardless of hormone receptor status (positive: aHR 1.10; 95% CI 0.82-1.44 or negative: aHR 0.99; 95% CI 0.62-1.51) and anti-HER2 treatment administered (chemotherapy+trastuzumab+pertuzumab: aHR 1.20; 95% CI 0.83-1.68 or chemotherapy+trastuzumab+placebo: aHR, 0.99; 95% CI, 0.71-1.35).

Study details: Findings are from the phase 3 APHINITY trial including 768 patients aged ≤40 years with HER2+ early BC who were randomly assigned to receive chemotherapy+trastuzumab+placebo or chemotherapy+trastuzumab+pertuzumab.

Disclosures: The APHINITY trial was supported by F Hoffmann-La Roche Ltd/Genentech. Some authors declared receiving research funding, honoraria, grants, or nonfinancial support or serving as advisors, speakers, or consultants for several sources, including Roche/Genentech.

Source: Lambertini M et al. Impact of age on clinical outcomes and efficacy of adjuvant dual anti-HER2 targeted therapy. J Natl Cancer Inst. 2022 (May 5). Doi: 10.1093/jnci/djac096 

Key clinical point: Age, tumor subtype, surgery, and brain metastasis are independent risk factors for survival in male patients with breast cancer (BC) and bone metastases and should be considered when devising a treatment strategy.

Major finding: Overall survival (OS) and cancer-specific survival (CSS) were significantly lower in patients aged >60 years (hazard ratio [HR] 1.671; P = .014 and HR 1.806; P = .009, respectively), with triple-negative BC (HR 3.029; P = .003 and HR 3.025; P = .004, respectively), and without surgery (HR 1.764; P = .012 and HR 1.734; P = .023, respectively), and with brain metastasis worsening OS (HR 2.045; P = .028) but not CSS (P = .056).

Study details: Findings are from a retrospective study including 207 male patients with BC and bone metastases.

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

Source: Zhou X et al. Survival analysis in male breast cancer with bone metastasis based on the SEER database. Front Oncol. 2022;12:659812 (Apr 13). Doi: 10.3389/fonc.2022.659812 

Key clinical point: Age, tumor subtype, surgery, and brain metastasis are independent risk factors for survival in male patients with breast cancer (BC) and bone metastases and should be considered when devising a treatment strategy.

Major finding: Overall survival (OS) and cancer-specific survival (CSS) were significantly lower in patients aged >60 years (hazard ratio [HR] 1.671; P = .014 and HR 1.806; P = .009, respectively), with triple-negative BC (HR 3.029; P = .003 and HR 3.025; P = .004, respectively), and without surgery (HR 1.764; P = .012 and HR 1.734; P = .023, respectively), and with brain metastasis worsening OS (HR 2.045; P = .028) but not CSS (P = .056).

Study details: Findings are from a retrospective study including 207 male patients with BC and bone metastases.

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

Source: Zhou X et al. Survival analysis in male breast cancer with bone metastasis based on the SEER database. Front Oncol. 2022;12:659812 (Apr 13). Doi: 10.3389/fonc.2022.659812 

Key clinical point: Age, tumor subtype, surgery, and brain metastasis are independent risk factors for survival in male patients with breast cancer (BC) and bone metastases and should be considered when devising a treatment strategy.

Major finding: Overall survival (OS) and cancer-specific survival (CSS) were significantly lower in patients aged >60 years (hazard ratio [HR] 1.671; P = .014 and HR 1.806; P = .009, respectively), with triple-negative BC (HR 3.029; P = .003 and HR 3.025; P = .004, respectively), and without surgery (HR 1.764; P = .012 and HR 1.734; P = .023, respectively), and with brain metastasis worsening OS (HR 2.045; P = .028) but not CSS (P = .056).

Study details: Findings are from a retrospective study including 207 male patients with BC and bone metastases.

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

Source: Zhou X et al. Survival analysis in male breast cancer with bone metastasis based on the SEER database. Front Oncol. 2022;12:659812 (Apr 13). Doi: 10.3389/fonc.2022.659812 

Key clinical point: A breast cancer (BC) diagnosis within 5 years of childbirth (postpartum BC [PPBC]) was associated with worse prognosis than no childbirth prior to diagnosis (nulliparous BC), with the association being strongest in young women diagnosed at the age of <35 years and in those with stage I disease.

Major finding: Women diagnosed with nulliparous BC vs. PPBC at age of <45 years had better overall survival (hazard ratio [HR] 0.61; 95% CI 0.42-0.87), with the difference being more pronounced in women with stage I tumors (HR 0.30; 95% CI 0.11-0.79) and in women diagnosed at the age of ≤35 years (HR 0.44; 95% CI 0.23-0.84).

Study details: The study evaluated a pooled dataset of 2519 women diagnosed with BC at the age of ≥18 years.

Disclosures: This study was funded by grants from the University of Colorado Cancer Center, National Institutes of Health, and other sources. The authors declared no conflict of interests.

Source: Shagisultanova E et al. Overall survival is the lowest among young women with postpartum breast cancer. Eur J Cancer. 2022;168:119-127 (May 4). Doi: 10.1016/j.ejca.2022.03.014

Key clinical point: A breast cancer (BC) diagnosis within 5 years of childbirth (postpartum BC [PPBC]) was associated with worse prognosis than no childbirth prior to diagnosis (nulliparous BC), with the association being strongest in young women diagnosed at the age of <35 years and in those with stage I disease.

Major finding: Women diagnosed with nulliparous BC vs. PPBC at age of <45 years had better overall survival (hazard ratio [HR] 0.61; 95% CI 0.42-0.87), with the difference being more pronounced in women with stage I tumors (HR 0.30; 95% CI 0.11-0.79) and in women diagnosed at the age of ≤35 years (HR 0.44; 95% CI 0.23-0.84).

Study details: The study evaluated a pooled dataset of 2519 women diagnosed with BC at the age of ≥18 years.

Disclosures: This study was funded by grants from the University of Colorado Cancer Center, National Institutes of Health, and other sources. The authors declared no conflict of interests.

Source: Shagisultanova E et al. Overall survival is the lowest among young women with postpartum breast cancer. Eur J Cancer. 2022;168:119-127 (May 4). Doi: 10.1016/j.ejca.2022.03.014

Key clinical point: A breast cancer (BC) diagnosis within 5 years of childbirth (postpartum BC [PPBC]) was associated with worse prognosis than no childbirth prior to diagnosis (nulliparous BC), with the association being strongest in young women diagnosed at the age of <35 years and in those with stage I disease.

Major finding: Women diagnosed with nulliparous BC vs. PPBC at age of <45 years had better overall survival (hazard ratio [HR] 0.61; 95% CI 0.42-0.87), with the difference being more pronounced in women with stage I tumors (HR 0.30; 95% CI 0.11-0.79) and in women diagnosed at the age of ≤35 years (HR 0.44; 95% CI 0.23-0.84).

Study details: The study evaluated a pooled dataset of 2519 women diagnosed with BC at the age of ≥18 years.

Disclosures: This study was funded by grants from the University of Colorado Cancer Center, National Institutes of Health, and other sources. The authors declared no conflict of interests.

Source: Shagisultanova E et al. Overall survival is the lowest among young women with postpartum breast cancer. Eur J Cancer. 2022;168:119-127 (May 4). Doi: 10.1016/j.ejca.2022.03.014

Key clinical point: The overall incidence of synchronous bilateral breast cancer (BBC) and metachronous BBC (MBBC) in patients with a history of lobular carcinoma in situ (LCIS) was 2%, with the risk for MBBC being even lower in women with hormone receptor-positive BC and those receiving endocrine therapy (ET).

Major finding: The estimated 5-year risk of developing MBBC was 6.4% (95% CI 1.9%-10.7%) among women with a remaining contralateral breast at risk, with the risk being lower among those with estrogen (hazard ratio [HR] 0.13; P = .015) or progesterone (HR 0.24; P = .047) receptor-positive BC and those who received ET (HR 0.17; P = .005).

Study details: This study included 1651 women with a history of LCIS, of which 249 women developed unilateral or bilateral BC during a median follow-up of 7 years.

Disclosures: This study was partly supported by the US National Institutes of Health/National Cancer Institute Cancer Center. TA King declared receiving speakers' honoraria and serving on advisory boards for several sources. The other authors declared no conflicts of interest.

Source: Mallory MA et al. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat. 2022 (Apr 29). Doi: 10.1007/s10549-022-06532-4 

Key clinical point: The overall incidence of synchronous bilateral breast cancer (BBC) and metachronous BBC (MBBC) in patients with a history of lobular carcinoma in situ (LCIS) was 2%, with the risk for MBBC being even lower in women with hormone receptor-positive BC and those receiving endocrine therapy (ET).

Major finding: The estimated 5-year risk of developing MBBC was 6.4% (95% CI 1.9%-10.7%) among women with a remaining contralateral breast at risk, with the risk being lower among those with estrogen (hazard ratio [HR] 0.13; P = .015) or progesterone (HR 0.24; P = .047) receptor-positive BC and those who received ET (HR 0.17; P = .005).

Study details: This study included 1651 women with a history of LCIS, of which 249 women developed unilateral or bilateral BC during a median follow-up of 7 years.

Disclosures: This study was partly supported by the US National Institutes of Health/National Cancer Institute Cancer Center. TA King declared receiving speakers' honoraria and serving on advisory boards for several sources. The other authors declared no conflicts of interest.

Source: Mallory MA et al. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat. 2022 (Apr 29). Doi: 10.1007/s10549-022-06532-4 

Key clinical point: The overall incidence of synchronous bilateral breast cancer (BBC) and metachronous BBC (MBBC) in patients with a history of lobular carcinoma in situ (LCIS) was 2%, with the risk for MBBC being even lower in women with hormone receptor-positive BC and those receiving endocrine therapy (ET).

Major finding: The estimated 5-year risk of developing MBBC was 6.4% (95% CI 1.9%-10.7%) among women with a remaining contralateral breast at risk, with the risk being lower among those with estrogen (hazard ratio [HR] 0.13; P = .015) or progesterone (HR 0.24; P = .047) receptor-positive BC and those who received ET (HR 0.17; P = .005).

Study details: This study included 1651 women with a history of LCIS, of which 249 women developed unilateral or bilateral BC during a median follow-up of 7 years.

Disclosures: This study was partly supported by the US National Institutes of Health/National Cancer Institute Cancer Center. TA King declared receiving speakers' honoraria and serving on advisory boards for several sources. The other authors declared no conflicts of interest.

Source: Mallory MA et al. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat. 2022 (Apr 29). Doi: 10.1007/s10549-022-06532-4 

Key clinical point: The combination of ibandronate and endocrine therapy (ET) failed to improve disease-free survival (DFS) compared with ET alone in postmenopausal women with estrogen receptor-positive (ER+) early breast cancer (BC).

Major finding: During a median follow-up of 8.5 years, DFS was not significantly different between the ibandronate+ET and ET treatment arms (hazard ratio [HR] 0.97; log-rank P = .811). Overall, the incidence of adverse events, particularly osteonecrosis (P = .002) and dyspepsia (P < .001), was higher in the ibandronate+ET vs. ET treatment arm.

Study details: This phase 3, TEAM-IIB trial included 1116 postmenopausal women with invasive stage I-III ER+ BC who were randomly assigned to receive ET for 5 years with or without 50 mg adjuvant oral ibandronate once daily for 3 years.

Disclosures: This study was supported by grants from Roche Nederland B.V. and Pfizer Nederland B.V. Some authors declared serving as consultants, advisors, or receiving research funding, honoraria, travel support, or accommodation expenses from several sources, including Roche and Pfizer.

Source: Vliek SB, Noordhoek I, et al. Daily oral ibandronate with adjuvant endocrine therapy in postmenopausal women with estrogen receptor–positive breast cancer (BOOG 2006-04): Randomized phase III TEAM-IIB trial. J Clin Oncol. 2022 Apr 20. doi: 10.1200/JCO.21.00311.

Key clinical point: The combination of ibandronate and endocrine therapy (ET) failed to improve disease-free survival (DFS) compared with ET alone in postmenopausal women with estrogen receptor-positive (ER+) early breast cancer (BC).

Major finding: During a median follow-up of 8.5 years, DFS was not significantly different between the ibandronate+ET and ET treatment arms (hazard ratio [HR] 0.97; log-rank P = .811). Overall, the incidence of adverse events, particularly osteonecrosis (P = .002) and dyspepsia (P < .001), was higher in the ibandronate+ET vs. ET treatment arm.

Study details: This phase 3, TEAM-IIB trial included 1116 postmenopausal women with invasive stage I-III ER+ BC who were randomly assigned to receive ET for 5 years with or without 50 mg adjuvant oral ibandronate once daily for 3 years.

Disclosures: This study was supported by grants from Roche Nederland B.V. and Pfizer Nederland B.V. Some authors declared serving as consultants, advisors, or receiving research funding, honoraria, travel support, or accommodation expenses from several sources, including Roche and Pfizer.

Source: Vliek SB, Noordhoek I, et al. Daily oral ibandronate with adjuvant endocrine therapy in postmenopausal women with estrogen receptor–positive breast cancer (BOOG 2006-04): Randomized phase III TEAM-IIB trial. J Clin Oncol. 2022 Apr 20. doi: 10.1200/JCO.21.00311.

Key clinical point: The combination of ibandronate and endocrine therapy (ET) failed to improve disease-free survival (DFS) compared with ET alone in postmenopausal women with estrogen receptor-positive (ER+) early breast cancer (BC).

Major finding: During a median follow-up of 8.5 years, DFS was not significantly different between the ibandronate+ET and ET treatment arms (hazard ratio [HR] 0.97; log-rank P = .811). Overall, the incidence of adverse events, particularly osteonecrosis (P = .002) and dyspepsia (P < .001), was higher in the ibandronate+ET vs. ET treatment arm.

Study details: This phase 3, TEAM-IIB trial included 1116 postmenopausal women with invasive stage I-III ER+ BC who were randomly assigned to receive ET for 5 years with or without 50 mg adjuvant oral ibandronate once daily for 3 years.

Disclosures: This study was supported by grants from Roche Nederland B.V. and Pfizer Nederland B.V. Some authors declared serving as consultants, advisors, or receiving research funding, honoraria, travel support, or accommodation expenses from several sources, including Roche and Pfizer.

Source: Vliek SB, Noordhoek I, et al. Daily oral ibandronate with adjuvant endocrine therapy in postmenopausal women with estrogen receptor–positive breast cancer (BOOG 2006-04): Randomized phase III TEAM-IIB trial. J Clin Oncol. 2022 Apr 20. doi: 10.1200/JCO.21.00311.

Key clinical point: Palbociclib plus endocrine therapy (ET) demonstrated no survival benefit over capecitabine in postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−), metastatic breast cancer (BC) who progressed on prior aromatase inhibitor (AI) therapy.

Major finding: The median overall survival was not significantly different between the palbociclib+ET and capecitabine groups in the overall population (adjusted hazard ratio [aHR] 1.00; P = .995) and the wild-type estrogen receptor-1 population (aHR 1.06; P = .683). No new safety signals were identified.

Study details: Findings are from the phase 3 PEARL study including 601 postmenopausal women with HR+/HER2− metastatic BC who progressed on prior AI therapy and were randomly assigned to receive capecitabine or palbociclib+ET with exemestane or fulvestrant.

Disclosures: This study was supported by Pfizer Inc. and AstraZeneca. Two authors declared being employees and having stock options in Pfizer, and the other authors reported ties with several sources, including Pfizer and AstraZeneca.

Source: Martin M et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer. 2022;168:12-24 (Apr 14). Doi: 10.1016/j.ejca.2022.03.006

Key clinical point: Palbociclib plus endocrine therapy (ET) demonstrated no survival benefit over capecitabine in postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−), metastatic breast cancer (BC) who progressed on prior aromatase inhibitor (AI) therapy.

Major finding: The median overall survival was not significantly different between the palbociclib+ET and capecitabine groups in the overall population (adjusted hazard ratio [aHR] 1.00; P = .995) and the wild-type estrogen receptor-1 population (aHR 1.06; P = .683). No new safety signals were identified.

Study details: Findings are from the phase 3 PEARL study including 601 postmenopausal women with HR+/HER2− metastatic BC who progressed on prior AI therapy and were randomly assigned to receive capecitabine or palbociclib+ET with exemestane or fulvestrant.

Disclosures: This study was supported by Pfizer Inc. and AstraZeneca. Two authors declared being employees and having stock options in Pfizer, and the other authors reported ties with several sources, including Pfizer and AstraZeneca.

Source: Martin M et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer. 2022;168:12-24 (Apr 14). Doi: 10.1016/j.ejca.2022.03.006

Key clinical point: Palbociclib plus endocrine therapy (ET) demonstrated no survival benefit over capecitabine in postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−), metastatic breast cancer (BC) who progressed on prior aromatase inhibitor (AI) therapy.

Major finding: The median overall survival was not significantly different between the palbociclib+ET and capecitabine groups in the overall population (adjusted hazard ratio [aHR] 1.00; P = .995) and the wild-type estrogen receptor-1 population (aHR 1.06; P = .683). No new safety signals were identified.

Study details: Findings are from the phase 3 PEARL study including 601 postmenopausal women with HR+/HER2− metastatic BC who progressed on prior AI therapy and were randomly assigned to receive capecitabine or palbociclib+ET with exemestane or fulvestrant.

Disclosures: This study was supported by Pfizer Inc. and AstraZeneca. Two authors declared being employees and having stock options in Pfizer, and the other authors reported ties with several sources, including Pfizer and AstraZeneca.

Source: Martin M et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer. 2022;168:12-24 (Apr 14). Doi: 10.1016/j.ejca.2022.03.006

Key clinical point: Neoadjuvant chemotherapy with paclitaxel can be safely omitted in patients with human epidermal growth factor receptor 2-positive (HER2+), hormone receptor-negative (HR−) early breast cancer (BC) who achieved pathological complete response (pCR) with only trastuzumab+pertuzumab.

Major finding: The 5-year invasive disease-free survival (iDFS; hazard ratio [HR] 0.32; P = .15) and overall survival (HR 0.41; P = .43) were achieved by a similar proportion early responders in the trastuzumab+pertuzumab without paclitaxel group and all patients in the trastuzumab+pertuzumab+paclitaxel group, irrespective of an early response, with the achievement of pCR being associated with improvement in iDFS (HR 0.14; P = .011).

Study details: Findings are from the phase 2, WSG-ADAPT-HER2+/HR− trial including 134 women with HER2+/HR− early BC who were randomly assigned to receive trastuzumab+pertuzumab with or without weekly paclitaxel for 12 weeks.

Disclosures: This study was funded by Roche and Bayer. Some authors declared serving as codirectors at the West German Study Group or on data safety monitoring boards or advisory boards or receiving research funding, consulting fees, honoraria, or travel support from several sources.

Source: Nitz U et al. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): Survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2022;23(5):625-635 (Apr 8). Doi: 10.1016/S1470-2045(22)00159-0

Key clinical point: Neoadjuvant chemotherapy with paclitaxel can be safely omitted in patients with human epidermal growth factor receptor 2-positive (HER2+), hormone receptor-negative (HR−) early breast cancer (BC) who achieved pathological complete response (pCR) with only trastuzumab+pertuzumab.

Major finding: The 5-year invasive disease-free survival (iDFS; hazard ratio [HR] 0.32; P = .15) and overall survival (HR 0.41; P = .43) were achieved by a similar proportion early responders in the trastuzumab+pertuzumab without paclitaxel group and all patients in the trastuzumab+pertuzumab+paclitaxel group, irrespective of an early response, with the achievement of pCR being associated with improvement in iDFS (HR 0.14; P = .011).

Study details: Findings are from the phase 2, WSG-ADAPT-HER2+/HR− trial including 134 women with HER2+/HR− early BC who were randomly assigned to receive trastuzumab+pertuzumab with or without weekly paclitaxel for 12 weeks.

Disclosures: This study was funded by Roche and Bayer. Some authors declared serving as codirectors at the West German Study Group or on data safety monitoring boards or advisory boards or receiving research funding, consulting fees, honoraria, or travel support from several sources.

Source: Nitz U et al. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): Survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2022;23(5):625-635 (Apr 8). Doi: 10.1016/S1470-2045(22)00159-0

Key clinical point: Neoadjuvant chemotherapy with paclitaxel can be safely omitted in patients with human epidermal growth factor receptor 2-positive (HER2+), hormone receptor-negative (HR−) early breast cancer (BC) who achieved pathological complete response (pCR) with only trastuzumab+pertuzumab.

Major finding: The 5-year invasive disease-free survival (iDFS; hazard ratio [HR] 0.32; P = .15) and overall survival (HR 0.41; P = .43) were achieved by a similar proportion early responders in the trastuzumab+pertuzumab without paclitaxel group and all patients in the trastuzumab+pertuzumab+paclitaxel group, irrespective of an early response, with the achievement of pCR being associated with improvement in iDFS (HR 0.14; P = .011).

Study details: Findings are from the phase 2, WSG-ADAPT-HER2+/HR− trial including 134 women with HER2+/HR− early BC who were randomly assigned to receive trastuzumab+pertuzumab with or without weekly paclitaxel for 12 weeks.

Disclosures: This study was funded by Roche and Bayer. Some authors declared serving as codirectors at the West German Study Group or on data safety monitoring boards or advisory boards or receiving research funding, consulting fees, honoraria, or travel support from several sources.

Source: Nitz U et al. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): Survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2022;23(5):625-635 (Apr 8). Doi: 10.1016/S1470-2045(22)00159-0

Key clinical point: Digital breast tomosynthesis plus synthesized 2-dimensional (s2D) mammography was superior to standard digital mammography for the detection of invasive breast cancer (BC).

Major finding: Detection rate of all invasive BC (odds ratio 1.48; P < .0001) was higher with digital breast tomosynthesis+s2D mammography vs digital mammography. None of the adverse events were classified as serious or related to the device used.

Study details: Findings are from the open-label, superiority TOSYMA trial including 99,689 women who were randomly assigned to undergo BC screening with digital breast tomosynthesis+s2D mammography or digital mammography.

Disclosures: This study was funded by Deutsche Forschungsgemeinschaft. Some authors declared running a third-party funded project at the University of Münster or receiving grants, honoraria, or payments from several sources.

Source: Heindel W et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): A multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022;23(5):601-611 (Apr 12). Doi: 10.1016/S1470-2045(22)00194-2

Key clinical point: Digital breast tomosynthesis plus synthesized 2-dimensional (s2D) mammography was superior to standard digital mammography for the detection of invasive breast cancer (BC).

Major finding: Detection rate of all invasive BC (odds ratio 1.48; P < .0001) was higher with digital breast tomosynthesis+s2D mammography vs digital mammography. None of the adverse events were classified as serious or related to the device used.

Study details: Findings are from the open-label, superiority TOSYMA trial including 99,689 women who were randomly assigned to undergo BC screening with digital breast tomosynthesis+s2D mammography or digital mammography.

Disclosures: This study was funded by Deutsche Forschungsgemeinschaft. Some authors declared running a third-party funded project at the University of Münster or receiving grants, honoraria, or payments from several sources.

Source: Heindel W et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): A multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022;23(5):601-611 (Apr 12). Doi: 10.1016/S1470-2045(22)00194-2

Key clinical point: Digital breast tomosynthesis plus synthesized 2-dimensional (s2D) mammography was superior to standard digital mammography for the detection of invasive breast cancer (BC).

Major finding: Detection rate of all invasive BC (odds ratio 1.48; P < .0001) was higher with digital breast tomosynthesis+s2D mammography vs digital mammography. None of the adverse events were classified as serious or related to the device used.

Study details: Findings are from the open-label, superiority TOSYMA trial including 99,689 women who were randomly assigned to undergo BC screening with digital breast tomosynthesis+s2D mammography or digital mammography.

Disclosures: This study was funded by Deutsche Forschungsgemeinschaft. Some authors declared running a third-party funded project at the University of Münster or receiving grants, honoraria, or payments from several sources.

Source: Heindel W et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): A multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022;23(5):601-611 (Apr 12). Doi: 10.1016/S1470-2045(22)00194-2