Breast Cancer

Key clinical point: In older women with stage I hormone receptor (HR)-positive breast cancer, radiation without endocrine therapy does not increase the risk for second breast cancer events (SBCE).

Major finding: Compared with endocrine therapy plus radiotherapy, radiotherapy alone was not associated with a higher risk for SBCE (P = .137), whereas no therapy (standardized hazard ratio [SHR], 3.7; P less than .001) or endocrine therapy (SHR, 2.2; P = .008) alone was associated with higher risk for SBCE.

Study details: A retrospective study of 13,321 women aged 66 years and older with stage I HR-positive breast cancer who underwent breast-conserving surgery between 2007 and 2012.

Disclosures: The study received funding from the Department of Radiation Oncology, NYU School of Medicine. Dr. Deb received personal fees from the NYU School of Medicine. The other authors did not disclose any conflicts of interest.

Source: Gerber NK et al. Int J Radiat Oncol Biol Phys. 2021 May 8. doi: 10.1016/j.ijrobp.2021.04.030.

Key clinical point: In older women with stage I hormone receptor (HR)-positive breast cancer, radiation without endocrine therapy does not increase the risk for second breast cancer events (SBCE).

Major finding: Compared with endocrine therapy plus radiotherapy, radiotherapy alone was not associated with a higher risk for SBCE (P = .137), whereas no therapy (standardized hazard ratio [SHR], 3.7; P less than .001) or endocrine therapy (SHR, 2.2; P = .008) alone was associated with higher risk for SBCE.

Study details: A retrospective study of 13,321 women aged 66 years and older with stage I HR-positive breast cancer who underwent breast-conserving surgery between 2007 and 2012.

Disclosures: The study received funding from the Department of Radiation Oncology, NYU School of Medicine. Dr. Deb received personal fees from the NYU School of Medicine. The other authors did not disclose any conflicts of interest.

Source: Gerber NK et al. Int J Radiat Oncol Biol Phys. 2021 May 8. doi: 10.1016/j.ijrobp.2021.04.030.

Key clinical point: In older women with stage I hormone receptor (HR)-positive breast cancer, radiation without endocrine therapy does not increase the risk for second breast cancer events (SBCE).

Major finding: Compared with endocrine therapy plus radiotherapy, radiotherapy alone was not associated with a higher risk for SBCE (P = .137), whereas no therapy (standardized hazard ratio [SHR], 3.7; P less than .001) or endocrine therapy (SHR, 2.2; P = .008) alone was associated with higher risk for SBCE.

Study details: A retrospective study of 13,321 women aged 66 years and older with stage I HR-positive breast cancer who underwent breast-conserving surgery between 2007 and 2012.

Disclosures: The study received funding from the Department of Radiation Oncology, NYU School of Medicine. Dr. Deb received personal fees from the NYU School of Medicine. The other authors did not disclose any conflicts of interest.

Source: Gerber NK et al. Int J Radiat Oncol Biol Phys. 2021 May 8. doi: 10.1016/j.ijrobp.2021.04.030.

Key clinical point: In patients with locally advanced or metastatic human epidermal growth factor receptor 2 (HER2)-negative, BRCA germline-mutated breast cancer, poly (ADP-ribose) polymerase (PARP) inhibitors improve progression-free survival (PFS), overall survival (OS), and tumor response rate.

Major findings: A PARP-containing regimen showed a small advantage in OS (hazard ratio, 0.87; 95% confidence interval, 0.76-1.00) vs. non-PARP regimen. PARP inhibitors improved PFS (hazard ratio, 0.63; P less than .00001) and tumor response rate (66.9% vs. 48.9%). The rate of grade 3 or higher adverse events was not significantly different in the PARP-containing vs. non-PARP regimen.

Study details: A meta-analysis of 5 randomized controlled trials comparing PARP-containing and non-PARP regimens in patients with locally advanced or metastatic breast cancer.

Disclosures: The funding source for this meta-analysis was not identified. Some of the authors received honoraria, research funding, compensation, financial support, consulting fees, and/or grants outside this work. Dr. Redfern is the Principal Investigator on the Brightness trial and served on the advisory board of AstraZeneca and Pfizer.

Source: Taylor AM. Cochrane Database Syst Rev. 2021 Apr 22. doi: 10.1002/14651858.CD011395.pub2.

Key clinical point: In patients with locally advanced or metastatic human epidermal growth factor receptor 2 (HER2)-negative, BRCA germline-mutated breast cancer, poly (ADP-ribose) polymerase (PARP) inhibitors improve progression-free survival (PFS), overall survival (OS), and tumor response rate.

Major findings: A PARP-containing regimen showed a small advantage in OS (hazard ratio, 0.87; 95% confidence interval, 0.76-1.00) vs. non-PARP regimen. PARP inhibitors improved PFS (hazard ratio, 0.63; P less than .00001) and tumor response rate (66.9% vs. 48.9%). The rate of grade 3 or higher adverse events was not significantly different in the PARP-containing vs. non-PARP regimen.

Study details: A meta-analysis of 5 randomized controlled trials comparing PARP-containing and non-PARP regimens in patients with locally advanced or metastatic breast cancer.

Disclosures: The funding source for this meta-analysis was not identified. Some of the authors received honoraria, research funding, compensation, financial support, consulting fees, and/or grants outside this work. Dr. Redfern is the Principal Investigator on the Brightness trial and served on the advisory board of AstraZeneca and Pfizer.

Source: Taylor AM. Cochrane Database Syst Rev. 2021 Apr 22. doi: 10.1002/14651858.CD011395.pub2.

Key clinical point: In patients with locally advanced or metastatic human epidermal growth factor receptor 2 (HER2)-negative, BRCA germline-mutated breast cancer, poly (ADP-ribose) polymerase (PARP) inhibitors improve progression-free survival (PFS), overall survival (OS), and tumor response rate.

Major findings: A PARP-containing regimen showed a small advantage in OS (hazard ratio, 0.87; 95% confidence interval, 0.76-1.00) vs. non-PARP regimen. PARP inhibitors improved PFS (hazard ratio, 0.63; P less than .00001) and tumor response rate (66.9% vs. 48.9%). The rate of grade 3 or higher adverse events was not significantly different in the PARP-containing vs. non-PARP regimen.

Study details: A meta-analysis of 5 randomized controlled trials comparing PARP-containing and non-PARP regimens in patients with locally advanced or metastatic breast cancer.

Disclosures: The funding source for this meta-analysis was not identified. Some of the authors received honoraria, research funding, compensation, financial support, consulting fees, and/or grants outside this work. Dr. Redfern is the Principal Investigator on the Brightness trial and served on the advisory board of AstraZeneca and Pfizer.

Source: Taylor AM. Cochrane Database Syst Rev. 2021 Apr 22. doi: 10.1002/14651858.CD011395.pub2.

Key clinical point: Fertility concerns affect adjuvant endocrine therapy (ET) decisions in one-third of young breast cancer survivors.

Major finding: Within 2 years after diagnosis, fertility concerns affected ET decisions in 33.12% of women. Parity at diagnosis showed a significant association with fertility concerns. The women who reported that fertility concerns affected their ET decisions showed a higher rate of noninitiation/nonpersistence with ET vs. those without fertility concerns (40% vs. 20%; P less than .0001).

Study details: An analysis of 643 hormone receptor-positive women (mean age, 36 years) who completed a survey from the Young Women’s Breast Cancer Study.

Disclosures: This study was funded by Susan G. Komen and the Breast Cancer Research Foundation. Dr. Rosenberg received a grant from the Agency for Healthcare Research and Quality. Dr. Sella was supported by the Pinchas Borenstein Talpiot Medical Leadership Program at Sheba Medical Center and the American Physicians Fellowship for Medicine in Israel. The authors reported receiving honorarium/research funding/consultancy fees/personal fees outside this study work. Dr. Peppercorn reported employment by/stocks in GlaxoSmithKline.

Source: Sella T. Cancer. 2021 Apr 22. doi: 10.1002/cncr.33596.

Key clinical point: Fertility concerns affect adjuvant endocrine therapy (ET) decisions in one-third of young breast cancer survivors.

Major finding: Within 2 years after diagnosis, fertility concerns affected ET decisions in 33.12% of women. Parity at diagnosis showed a significant association with fertility concerns. The women who reported that fertility concerns affected their ET decisions showed a higher rate of noninitiation/nonpersistence with ET vs. those without fertility concerns (40% vs. 20%; P less than .0001).

Study details: An analysis of 643 hormone receptor-positive women (mean age, 36 years) who completed a survey from the Young Women’s Breast Cancer Study.

Disclosures: This study was funded by Susan G. Komen and the Breast Cancer Research Foundation. Dr. Rosenberg received a grant from the Agency for Healthcare Research and Quality. Dr. Sella was supported by the Pinchas Borenstein Talpiot Medical Leadership Program at Sheba Medical Center and the American Physicians Fellowship for Medicine in Israel. The authors reported receiving honorarium/research funding/consultancy fees/personal fees outside this study work. Dr. Peppercorn reported employment by/stocks in GlaxoSmithKline.

Source: Sella T. Cancer. 2021 Apr 22. doi: 10.1002/cncr.33596.

Key clinical point: Fertility concerns affect adjuvant endocrine therapy (ET) decisions in one-third of young breast cancer survivors.

Major finding: Within 2 years after diagnosis, fertility concerns affected ET decisions in 33.12% of women. Parity at diagnosis showed a significant association with fertility concerns. The women who reported that fertility concerns affected their ET decisions showed a higher rate of noninitiation/nonpersistence with ET vs. those without fertility concerns (40% vs. 20%; P less than .0001).

Study details: An analysis of 643 hormone receptor-positive women (mean age, 36 years) who completed a survey from the Young Women’s Breast Cancer Study.

Disclosures: This study was funded by Susan G. Komen and the Breast Cancer Research Foundation. Dr. Rosenberg received a grant from the Agency for Healthcare Research and Quality. Dr. Sella was supported by the Pinchas Borenstein Talpiot Medical Leadership Program at Sheba Medical Center and the American Physicians Fellowship for Medicine in Israel. The authors reported receiving honorarium/research funding/consultancy fees/personal fees outside this study work. Dr. Peppercorn reported employment by/stocks in GlaxoSmithKline.

Source: Sella T. Cancer. 2021 Apr 22. doi: 10.1002/cncr.33596.

Key clinical point: The risk for breast cancer-specific mortality (BCSM) remains high beyond 5 years. The BCSM rate is significantly higher in hormone receptor (HR)-positive vs. HR-negative women.

Major finding: The overall BCSM rate was 14.9%. Of all BCSM, 54.2% of deaths occurred after 5 years and were significantly higher in HR-positive vs. HR-negative patients (P less than .001). Among patients with HR-positive and HR-negative breast cancer, independent risk factors for BCSM conditional on having survived 5 years were tumor size, nodal status, age, and year of diagnosis. Among patients with HR-positive status, tumor grade, marital status, and race were also independently associated with the risk for BCSM.

Study details: An observational study of 202,080 women with breast cancer with known HR status diagnosed between 1990 and 2005.

Disclosures: The study did not receive any funding. Some authors received research funding and/or advisory/consulting fees from various sources.

Source: Leone JP. Breast Cancer Res Treat. 2021 Apr 24. doi: 10.1007/s10549-021-06233-4.

Key clinical point: The risk for breast cancer-specific mortality (BCSM) remains high beyond 5 years. The BCSM rate is significantly higher in hormone receptor (HR)-positive vs. HR-negative women.

Major finding: The overall BCSM rate was 14.9%. Of all BCSM, 54.2% of deaths occurred after 5 years and were significantly higher in HR-positive vs. HR-negative patients (P less than .001). Among patients with HR-positive and HR-negative breast cancer, independent risk factors for BCSM conditional on having survived 5 years were tumor size, nodal status, age, and year of diagnosis. Among patients with HR-positive status, tumor grade, marital status, and race were also independently associated with the risk for BCSM.

Study details: An observational study of 202,080 women with breast cancer with known HR status diagnosed between 1990 and 2005.

Disclosures: The study did not receive any funding. Some authors received research funding and/or advisory/consulting fees from various sources.

Source: Leone JP. Breast Cancer Res Treat. 2021 Apr 24. doi: 10.1007/s10549-021-06233-4.

Key clinical point: The risk for breast cancer-specific mortality (BCSM) remains high beyond 5 years. The BCSM rate is significantly higher in hormone receptor (HR)-positive vs. HR-negative women.

Major finding: The overall BCSM rate was 14.9%. Of all BCSM, 54.2% of deaths occurred after 5 years and were significantly higher in HR-positive vs. HR-negative patients (P less than .001). Among patients with HR-positive and HR-negative breast cancer, independent risk factors for BCSM conditional on having survived 5 years were tumor size, nodal status, age, and year of diagnosis. Among patients with HR-positive status, tumor grade, marital status, and race were also independently associated with the risk for BCSM.

Study details: An observational study of 202,080 women with breast cancer with known HR status diagnosed between 1990 and 2005.

Disclosures: The study did not receive any funding. Some authors received research funding and/or advisory/consulting fees from various sources.

Source: Leone JP. Breast Cancer Res Treat. 2021 Apr 24. doi: 10.1007/s10549-021-06233-4.

Key clinical point: In patients with human epidermal growth factor 2 (HER2)-positive early breast cancer, trastuzumab emtansine vs. trastuzumab is associated with longer invasive disease-free survival (DFS) regardless of the type of neoadjuvant chemotherapy (NACT) received.

Major finding: Trastuzumab emtansine was associated with longer invasive DFS vs. trastuzumab in high-risk patients (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.39-0.64), in patients who received anthracycline-based NACT (HR, 0.51; 95% CI, 0.38-0.67), and in those who received nonanthracycline-based NACT (HR, 0.43; 95% CI, 0.22-0.82).

Study details: This is a subgroup analysis of the KATHERINE trial comparing trastuzumab emtansine with trastuzumab in 1,486 HER2-positive patients with early breast cancer.

Disclosure: This study was funded by F. Hoffmann-La Roche Ltd. The authors received consulting fees, speaker bureau fees, honoraria, educational support, research funding, travel expenses, royalties from, and/or owned stocks in various organizations outside this work. Dr. Boulet was an employee of Parexel International GmbH contracted by F. Hoffmann-La Roche Ltd. Dr. Liu, Dr. Tesarowski, Dr. Lam, Dr. Song, and Dr. Smitt were/are employees of Genetech and/or owned stocks in Roche. All other authors declared no conflicts of interest.

Source: Mamounas EP et al. Ann Oncol. 2021 Apr 28. doi: 10.1016/j.annonc.2021.04.011.

Key clinical point: In patients with human epidermal growth factor 2 (HER2)-positive early breast cancer, trastuzumab emtansine vs. trastuzumab is associated with longer invasive disease-free survival (DFS) regardless of the type of neoadjuvant chemotherapy (NACT) received.

Major finding: Trastuzumab emtansine was associated with longer invasive DFS vs. trastuzumab in high-risk patients (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.39-0.64), in patients who received anthracycline-based NACT (HR, 0.51; 95% CI, 0.38-0.67), and in those who received nonanthracycline-based NACT (HR, 0.43; 95% CI, 0.22-0.82).

Study details: This is a subgroup analysis of the KATHERINE trial comparing trastuzumab emtansine with trastuzumab in 1,486 HER2-positive patients with early breast cancer.

Disclosure: This study was funded by F. Hoffmann-La Roche Ltd. The authors received consulting fees, speaker bureau fees, honoraria, educational support, research funding, travel expenses, royalties from, and/or owned stocks in various organizations outside this work. Dr. Boulet was an employee of Parexel International GmbH contracted by F. Hoffmann-La Roche Ltd. Dr. Liu, Dr. Tesarowski, Dr. Lam, Dr. Song, and Dr. Smitt were/are employees of Genetech and/or owned stocks in Roche. All other authors declared no conflicts of interest.

Source: Mamounas EP et al. Ann Oncol. 2021 Apr 28. doi: 10.1016/j.annonc.2021.04.011.

Key clinical point: In patients with human epidermal growth factor 2 (HER2)-positive early breast cancer, trastuzumab emtansine vs. trastuzumab is associated with longer invasive disease-free survival (DFS) regardless of the type of neoadjuvant chemotherapy (NACT) received.

Major finding: Trastuzumab emtansine was associated with longer invasive DFS vs. trastuzumab in high-risk patients (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.39-0.64), in patients who received anthracycline-based NACT (HR, 0.51; 95% CI, 0.38-0.67), and in those who received nonanthracycline-based NACT (HR, 0.43; 95% CI, 0.22-0.82).

Study details: This is a subgroup analysis of the KATHERINE trial comparing trastuzumab emtansine with trastuzumab in 1,486 HER2-positive patients with early breast cancer.

Disclosure: This study was funded by F. Hoffmann-La Roche Ltd. The authors received consulting fees, speaker bureau fees, honoraria, educational support, research funding, travel expenses, royalties from, and/or owned stocks in various organizations outside this work. Dr. Boulet was an employee of Parexel International GmbH contracted by F. Hoffmann-La Roche Ltd. Dr. Liu, Dr. Tesarowski, Dr. Lam, Dr. Song, and Dr. Smitt were/are employees of Genetech and/or owned stocks in Roche. All other authors declared no conflicts of interest.

Source: Mamounas EP et al. Ann Oncol. 2021 Apr 28. doi: 10.1016/j.annonc.2021.04.011.

Key clinical point: In patients with human epidermal growth factor 2 (HER2)-positive metastatic breast cancer and progressive brain metastases despite radiotherapy, pertuzumab in combination with high-dose trastuzumab shows modest central nervous system (CNS) response and good clinical benefit.

Major finding: The confirmed CNS objective response rate was 11% with all partial responses. The clinical benefit rate at 4 months was 68% and at 6 months was 51%. The grade 3-4 adverse event rate was 44%. There were no new safety signals.

Study details: A phase 2 PATRICIA study evaluated pertuzumab in combination with high-dose trastuzumab in 39 patients with HER2-positive metastatic breast cancer and progressive brain metastases despite radiotherapy.

Disclosures: The study was sponsored by F. Hoffmann-La Roche/ Genentech. The authors received consulting/advisory fees, research funding, royalties, and travel/accommodation expenses from various sources. Dr. Fung, Dr. Cheng, and Dr. Kirschbrown reported employment by, stocks, and other ownership interests in Genentech/Roche.

Source: Lin NU et al. J Clin Oncol. 2021 May 4. doi: 10.1200/JCO.20.02822.

Key clinical point: In patients with human epidermal growth factor 2 (HER2)-positive metastatic breast cancer and progressive brain metastases despite radiotherapy, pertuzumab in combination with high-dose trastuzumab shows modest central nervous system (CNS) response and good clinical benefit.

Major finding: The confirmed CNS objective response rate was 11% with all partial responses. The clinical benefit rate at 4 months was 68% and at 6 months was 51%. The grade 3-4 adverse event rate was 44%. There were no new safety signals.

Study details: A phase 2 PATRICIA study evaluated pertuzumab in combination with high-dose trastuzumab in 39 patients with HER2-positive metastatic breast cancer and progressive brain metastases despite radiotherapy.

Disclosures: The study was sponsored by F. Hoffmann-La Roche/ Genentech. The authors received consulting/advisory fees, research funding, royalties, and travel/accommodation expenses from various sources. Dr. Fung, Dr. Cheng, and Dr. Kirschbrown reported employment by, stocks, and other ownership interests in Genentech/Roche.

Source: Lin NU et al. J Clin Oncol. 2021 May 4. doi: 10.1200/JCO.20.02822.

Key clinical point: In patients with human epidermal growth factor 2 (HER2)-positive metastatic breast cancer and progressive brain metastases despite radiotherapy, pertuzumab in combination with high-dose trastuzumab shows modest central nervous system (CNS) response and good clinical benefit.

Major finding: The confirmed CNS objective response rate was 11% with all partial responses. The clinical benefit rate at 4 months was 68% and at 6 months was 51%. The grade 3-4 adverse event rate was 44%. There were no new safety signals.

Study details: A phase 2 PATRICIA study evaluated pertuzumab in combination with high-dose trastuzumab in 39 patients with HER2-positive metastatic breast cancer and progressive brain metastases despite radiotherapy.

Disclosures: The study was sponsored by F. Hoffmann-La Roche/ Genentech. The authors received consulting/advisory fees, research funding, royalties, and travel/accommodation expenses from various sources. Dr. Fung, Dr. Cheng, and Dr. Kirschbrown reported employment by, stocks, and other ownership interests in Genentech/Roche.

Source: Lin NU et al. J Clin Oncol. 2021 May 4. doi: 10.1200/JCO.20.02822.

Key clinical point: Immediate reconstruction after neoadjuvant chemotherapy in women with T4 breast cancer is associated with higher odds for complication resulting in unplanned reoperations and a longer time to postmastectomy radiotherapy.

Major finding: Unplanned reoperations for complications were more common after immediate vs. delayed and no reconstruction (22% vs. 7.3% and 4.4%, respectively; P less than .001). The median time to initiation of postmastectomy radiotherapy was longer after immediate reconstruction vs. delayed and no reconstruction (60 days vs. 42 days and 49 days, respectively; P less than .001). The median time to the first recurrence was 18 months and was not significantly different between the groups (P = .13).

Study details: A retrospective study of 269 consecutive women with stage T4 breast cancer treated with surgery, chemotherapy, and radiotherapy between 2007 and 2019.

Disclosure: This study was supported in part by the National Institutes of Health. Dr. Morrow received speaking honoraria from Roche. The other authors did not disclose any conflicts of interest.

Source: Pawloski KR et al. J Am Coll Surg. 2021 Apr 24. doi: 10.1016/j.jamcollsurg.2021.04.016.

Key clinical point: Immediate reconstruction after neoadjuvant chemotherapy in women with T4 breast cancer is associated with higher odds for complication resulting in unplanned reoperations and a longer time to postmastectomy radiotherapy.

Major finding: Unplanned reoperations for complications were more common after immediate vs. delayed and no reconstruction (22% vs. 7.3% and 4.4%, respectively; P less than .001). The median time to initiation of postmastectomy radiotherapy was longer after immediate reconstruction vs. delayed and no reconstruction (60 days vs. 42 days and 49 days, respectively; P less than .001). The median time to the first recurrence was 18 months and was not significantly different between the groups (P = .13).

Study details: A retrospective study of 269 consecutive women with stage T4 breast cancer treated with surgery, chemotherapy, and radiotherapy between 2007 and 2019.

Disclosure: This study was supported in part by the National Institutes of Health. Dr. Morrow received speaking honoraria from Roche. The other authors did not disclose any conflicts of interest.

Source: Pawloski KR et al. J Am Coll Surg. 2021 Apr 24. doi: 10.1016/j.jamcollsurg.2021.04.016.

Key clinical point: Immediate reconstruction after neoadjuvant chemotherapy in women with T4 breast cancer is associated with higher odds for complication resulting in unplanned reoperations and a longer time to postmastectomy radiotherapy.

Major finding: Unplanned reoperations for complications were more common after immediate vs. delayed and no reconstruction (22% vs. 7.3% and 4.4%, respectively; P less than .001). The median time to initiation of postmastectomy radiotherapy was longer after immediate reconstruction vs. delayed and no reconstruction (60 days vs. 42 days and 49 days, respectively; P less than .001). The median time to the first recurrence was 18 months and was not significantly different between the groups (P = .13).

Study details: A retrospective study of 269 consecutive women with stage T4 breast cancer treated with surgery, chemotherapy, and radiotherapy between 2007 and 2019.

Disclosure: This study was supported in part by the National Institutes of Health. Dr. Morrow received speaking honoraria from Roche. The other authors did not disclose any conflicts of interest.

Source: Pawloski KR et al. J Am Coll Surg. 2021 Apr 24. doi: 10.1016/j.jamcollsurg.2021.04.016.

Key clinical point: The presence and extent of coronary artery calcium (CAC), as automatically quantified on routinely performed computed tomography scans, are associated with cardiovascular and coronary artery diseases.

Major finding: The risk for cardiovascular disease increased with a higher CAC score (adjusted hazard ratio, 1.8, 2.1, and 3.4 for CAC scores 11-100, 101-400, and greater than 400, respectively). The risk for coronary artery disease also increased with an increase in CAC score (adjusted hazard ratio, 2.8, 4.3, and 7.8 for CAC scores 11-100, 101-400, and greater than 400, respectively).

Study details: A multicenter cohort study of 15,915 patients with breast cancer who received radiotherapy between 2005 and 2016. The CAC scores were automatically extracted from computed tomography scans using a deep learning algorithm.

Disclosure: This study was funded by the Dutch Cancer Society. The authors received grants, lecture fees, and research support from various sources. Dr. Leiner and Dr. Isgum owned shares of Quantib-U BV and/or a patent with royalties planned. No other conflicts of interest were reported.

Source: Gal R et al. JAMA Oncol. 2021 May 6. doi: 10.1001/jamaoncol.2021.1144.

Key clinical point: The presence and extent of coronary artery calcium (CAC), as automatically quantified on routinely performed computed tomography scans, are associated with cardiovascular and coronary artery diseases.

Major finding: The risk for cardiovascular disease increased with a higher CAC score (adjusted hazard ratio, 1.8, 2.1, and 3.4 for CAC scores 11-100, 101-400, and greater than 400, respectively). The risk for coronary artery disease also increased with an increase in CAC score (adjusted hazard ratio, 2.8, 4.3, and 7.8 for CAC scores 11-100, 101-400, and greater than 400, respectively).

Study details: A multicenter cohort study of 15,915 patients with breast cancer who received radiotherapy between 2005 and 2016. The CAC scores were automatically extracted from computed tomography scans using a deep learning algorithm.

Disclosure: This study was funded by the Dutch Cancer Society. The authors received grants, lecture fees, and research support from various sources. Dr. Leiner and Dr. Isgum owned shares of Quantib-U BV and/or a patent with royalties planned. No other conflicts of interest were reported.

Source: Gal R et al. JAMA Oncol. 2021 May 6. doi: 10.1001/jamaoncol.2021.1144.

Key clinical point: The presence and extent of coronary artery calcium (CAC), as automatically quantified on routinely performed computed tomography scans, are associated with cardiovascular and coronary artery diseases.

Major finding: The risk for cardiovascular disease increased with a higher CAC score (adjusted hazard ratio, 1.8, 2.1, and 3.4 for CAC scores 11-100, 101-400, and greater than 400, respectively). The risk for coronary artery disease also increased with an increase in CAC score (adjusted hazard ratio, 2.8, 4.3, and 7.8 for CAC scores 11-100, 101-400, and greater than 400, respectively).

Study details: A multicenter cohort study of 15,915 patients with breast cancer who received radiotherapy between 2005 and 2016. The CAC scores were automatically extracted from computed tomography scans using a deep learning algorithm.

Disclosure: This study was funded by the Dutch Cancer Society. The authors received grants, lecture fees, and research support from various sources. Dr. Leiner and Dr. Isgum owned shares of Quantib-U BV and/or a patent with royalties planned. No other conflicts of interest were reported.

Source: Gal R et al. JAMA Oncol. 2021 May 6. doi: 10.1001/jamaoncol.2021.1144.

Key clinical point: Breast-conserving surgery (BCS) with radiotherapy yields superior survival vs. mastectomy in patients with early-stage breast cancer.

Major finding: At a median follow-up of 6.28 years, mastectomy without radiotherapy vs. BCS with radiotherapy was associated with worse overall survival (OS; hazard ratio [HR], 1.79; P less than .001) and breast cancer-specific survival (BCSS; HR, 1.66; P less than .001). Mastectomy with radiotherapy also showed lower OS (HR, 1.24; P less than .001) and BCSS (HR, 1.28; P=.001) vs. BCS and radiotherapy.

Study details: A cohort study of 48,986 patients with primary invasive T1-2 N0-2 breast cancer who underwent breast surgery between 2008 and 2017.

Disclosure: This work was funded by the Swedish Breast Cancer Association. Dr de Boniface was supported by an investigator award from the Swedish Cancer Society, and Ms Johansson was supported by a research grant from the Swedish Research Council. The authors did not declare any conflict of interest.

Source: de Boniface J et al. JAMA Surg. 2021 May 5. doi: 10.1001/jamasurg.2021.1438.

Key clinical point: Breast-conserving surgery (BCS) with radiotherapy yields superior survival vs. mastectomy in patients with early-stage breast cancer.

Major finding: At a median follow-up of 6.28 years, mastectomy without radiotherapy vs. BCS with radiotherapy was associated with worse overall survival (OS; hazard ratio [HR], 1.79; P less than .001) and breast cancer-specific survival (BCSS; HR, 1.66; P less than .001). Mastectomy with radiotherapy also showed lower OS (HR, 1.24; P less than .001) and BCSS (HR, 1.28; P=.001) vs. BCS and radiotherapy.

Study details: A cohort study of 48,986 patients with primary invasive T1-2 N0-2 breast cancer who underwent breast surgery between 2008 and 2017.

Disclosure: This work was funded by the Swedish Breast Cancer Association. Dr de Boniface was supported by an investigator award from the Swedish Cancer Society, and Ms Johansson was supported by a research grant from the Swedish Research Council. The authors did not declare any conflict of interest.

Source: de Boniface J et al. JAMA Surg. 2021 May 5. doi: 10.1001/jamasurg.2021.1438.

Key clinical point: Breast-conserving surgery (BCS) with radiotherapy yields superior survival vs. mastectomy in patients with early-stage breast cancer.

Major finding: At a median follow-up of 6.28 years, mastectomy without radiotherapy vs. BCS with radiotherapy was associated with worse overall survival (OS; hazard ratio [HR], 1.79; P less than .001) and breast cancer-specific survival (BCSS; HR, 1.66; P less than .001). Mastectomy with radiotherapy also showed lower OS (HR, 1.24; P less than .001) and BCSS (HR, 1.28; P=.001) vs. BCS and radiotherapy.

Study details: A cohort study of 48,986 patients with primary invasive T1-2 N0-2 breast cancer who underwent breast surgery between 2008 and 2017.

Disclosure: This work was funded by the Swedish Breast Cancer Association. Dr de Boniface was supported by an investigator award from the Swedish Cancer Society, and Ms Johansson was supported by a research grant from the Swedish Research Council. The authors did not declare any conflict of interest.

Source: de Boniface J et al. JAMA Surg. 2021 May 5. doi: 10.1001/jamasurg.2021.1438.

Adjuvant T-DM1 is recommended for patients with HER2-positive early breast cancer with residual disease after neoadjuvant therapy based on phase 3 results. The KATHERINE study found a significant reduction for the risk of recurrence and death with adjuvant T-DM1 vs trastuzumab. Subgroup analyses from KATHERINE showed similar benefits with T-DM1 irrespective of type of neoadjuvant regimen. Furthermore, T-DM1 appeared to benefit small node-negative tumors and particularly those tumors considered high-risk (Mamounas). In the phase 3 TRAIN-2 study, similar pCR rates (68% vs 67%), as well as 3 year event-free (94% vs 93%) and overall (98% vs 98%) survival, were observed for non-anthracycline and anthracycline-containing regimens. These findings highlight the broad applicability of T-DM1 in the adjuvant setting, the rationale to support de-escalation and omission of anthracyclines for HER2-positive tumors, and the importance of tailoring therapy based on response.

Brain metastases occur in up to 50% of patients with HER2-positive metastatic breast cancer (MBC). Effective therapies for this population represent an unmet clinical need. The phase 2 PATRICIA study demonstrated activity of pertuzumab plus high-dose trastuzumab (6mg/kg weekly) for patients with HER2-positive MBC and central nervous system (CNS) progression after radiotherapy. In 37 patients evaluable for efficacy, the CNS objective response rate was 11%, clinical benefit rate at 4 and 6 months was 68% and 51%, respectively, and 2 patients had stable disease for over 2 years (Lin). Data supports the role of other HER2-targeted therapies for CNS disease including T-DM1, neratinib, and tucatinib. Among 291 patients with brain metastases in HER2CLIMB, the combination of tucatinib, capecitabine, and trastuzumab improved median overall survival (18 vs 12 months) and CNS progression-free survival (9.9 vs 4.2 months), compared with capecitabine plus trastuzumab. Further investigation exploring other novel therapy combinations and biomarkers will help further improve outcomes for these patients.

Adjuvant endocrine therapy decreases the risk for recurrence and improves survival for women diagnosed with HR-positive breast cancer. For young women, endocrine therapy options include tamoxifen, as well as ovarian suppression plus tamoxifen, or an aromatase inhibitor. Recommended duration of therapy is at least 5 years and can extend to 10 years. These treatments and duration may present challenges related to childbearing attempts and raise fertility concerns among young women.  In the Young Women’s Breast Cancer Study, among 643 women aged 40 years or younger and diagnosed with early stage HR-positive breast cancer, one-third reported fertility concerns impacting endocrine therapy decisions. Those who reported fertility concerns were more likely to exhibit non-initiation or non-persistence to endocrine therapy (40% vs 20%). Among women with fertility concerns, 7% did not initiate endocrine therapy, and 33% were non-persistent over 5 years (Sella). It is essential to integrate early oncofertility dialogue to help achieve optimal endocrine therapy and address family planning goals.

Studies have shown sugar-sweetened beverages (SSB) increase the risk for insulin resistance, diabetes, and heart disease. In a subsample of Women’s Health Initiative participants, higher levels of insulin resistance were shown to be linked to an increased incidence of breast cancer and all-cause mortality after breast cancer. Researchers found that among 8,863 women diagnosed with early breast cancer, those who consumed SSB after diagnosis had higher breast cancer-specific mortality and all-cause mortality. Additionally, replacing SSB with coffee, tea or water was linked to a decrease in mortality (Farvid). These findings support discussion of lifestyle and dietary behaviors in the survivorship setting, as these modifiable risk factors can potentially have significant health implications.

References:

van der Voort A, van Ramshorst MS, van Werkhoven ED, et al. Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2-blockade for HER2-positive breast cancer (TRAIN-2): A randomized phase III trial. J Clin Oncol. 2020;38S:ASCO #501.

Lin NU, Borges V, Anders C, et al. Intracranial efficacy and survival with tucatinib plus trastuzumab and capecitabine for previously treated HER2-positive breast cancer with brain metastases in the HER2CLIMB trial. J Clin Oncol. 2020;38(23):2610-2619.

Pan K, Chlebowski RT, Mortimer JE, et al. Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women's Health Initiative. Cancer. 2020;126(16):3638-3647.

Adjuvant T-DM1 is recommended for patients with HER2-positive early breast cancer with residual disease after neoadjuvant therapy based on phase 3 results. The KATHERINE study found a significant reduction for the risk of recurrence and death with adjuvant T-DM1 vs trastuzumab. Subgroup analyses from KATHERINE showed similar benefits with T-DM1 irrespective of type of neoadjuvant regimen. Furthermore, T-DM1 appeared to benefit small node-negative tumors and particularly those tumors considered high-risk (Mamounas). In the phase 3 TRAIN-2 study, similar pCR rates (68% vs 67%), as well as 3 year event-free (94% vs 93%) and overall (98% vs 98%) survival, were observed for non-anthracycline and anthracycline-containing regimens. These findings highlight the broad applicability of T-DM1 in the adjuvant setting, the rationale to support de-escalation and omission of anthracyclines for HER2-positive tumors, and the importance of tailoring therapy based on response.

Brain metastases occur in up to 50% of patients with HER2-positive metastatic breast cancer (MBC). Effective therapies for this population represent an unmet clinical need. The phase 2 PATRICIA study demonstrated activity of pertuzumab plus high-dose trastuzumab (6mg/kg weekly) for patients with HER2-positive MBC and central nervous system (CNS) progression after radiotherapy. In 37 patients evaluable for efficacy, the CNS objective response rate was 11%, clinical benefit rate at 4 and 6 months was 68% and 51%, respectively, and 2 patients had stable disease for over 2 years (Lin). Data supports the role of other HER2-targeted therapies for CNS disease including T-DM1, neratinib, and tucatinib. Among 291 patients with brain metastases in HER2CLIMB, the combination of tucatinib, capecitabine, and trastuzumab improved median overall survival (18 vs 12 months) and CNS progression-free survival (9.9 vs 4.2 months), compared with capecitabine plus trastuzumab. Further investigation exploring other novel therapy combinations and biomarkers will help further improve outcomes for these patients.

Adjuvant endocrine therapy decreases the risk for recurrence and improves survival for women diagnosed with HR-positive breast cancer. For young women, endocrine therapy options include tamoxifen, as well as ovarian suppression plus tamoxifen, or an aromatase inhibitor. Recommended duration of therapy is at least 5 years and can extend to 10 years. These treatments and duration may present challenges related to childbearing attempts and raise fertility concerns among young women.  In the Young Women’s Breast Cancer Study, among 643 women aged 40 years or younger and diagnosed with early stage HR-positive breast cancer, one-third reported fertility concerns impacting endocrine therapy decisions. Those who reported fertility concerns were more likely to exhibit non-initiation or non-persistence to endocrine therapy (40% vs 20%). Among women with fertility concerns, 7% did not initiate endocrine therapy, and 33% were non-persistent over 5 years (Sella). It is essential to integrate early oncofertility dialogue to help achieve optimal endocrine therapy and address family planning goals.

Studies have shown sugar-sweetened beverages (SSB) increase the risk for insulin resistance, diabetes, and heart disease. In a subsample of Women’s Health Initiative participants, higher levels of insulin resistance were shown to be linked to an increased incidence of breast cancer and all-cause mortality after breast cancer. Researchers found that among 8,863 women diagnosed with early breast cancer, those who consumed SSB after diagnosis had higher breast cancer-specific mortality and all-cause mortality. Additionally, replacing SSB with coffee, tea or water was linked to a decrease in mortality (Farvid). These findings support discussion of lifestyle and dietary behaviors in the survivorship setting, as these modifiable risk factors can potentially have significant health implications.

References:

van der Voort A, van Ramshorst MS, van Werkhoven ED, et al. Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2-blockade for HER2-positive breast cancer (TRAIN-2): A randomized phase III trial. J Clin Oncol. 2020;38S:ASCO #501.

Lin NU, Borges V, Anders C, et al. Intracranial efficacy and survival with tucatinib plus trastuzumab and capecitabine for previously treated HER2-positive breast cancer with brain metastases in the HER2CLIMB trial. J Clin Oncol. 2020;38(23):2610-2619.

Pan K, Chlebowski RT, Mortimer JE, et al. Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women's Health Initiative. Cancer. 2020;126(16):3638-3647.

Adjuvant T-DM1 is recommended for patients with HER2-positive early breast cancer with residual disease after neoadjuvant therapy based on phase 3 results. The KATHERINE study found a significant reduction for the risk of recurrence and death with adjuvant T-DM1 vs trastuzumab. Subgroup analyses from KATHERINE showed similar benefits with T-DM1 irrespective of type of neoadjuvant regimen. Furthermore, T-DM1 appeared to benefit small node-negative tumors and particularly those tumors considered high-risk (Mamounas). In the phase 3 TRAIN-2 study, similar pCR rates (68% vs 67%), as well as 3 year event-free (94% vs 93%) and overall (98% vs 98%) survival, were observed for non-anthracycline and anthracycline-containing regimens. These findings highlight the broad applicability of T-DM1 in the adjuvant setting, the rationale to support de-escalation and omission of anthracyclines for HER2-positive tumors, and the importance of tailoring therapy based on response.

Brain metastases occur in up to 50% of patients with HER2-positive metastatic breast cancer (MBC). Effective therapies for this population represent an unmet clinical need. The phase 2 PATRICIA study demonstrated activity of pertuzumab plus high-dose trastuzumab (6mg/kg weekly) for patients with HER2-positive MBC and central nervous system (CNS) progression after radiotherapy. In 37 patients evaluable for efficacy, the CNS objective response rate was 11%, clinical benefit rate at 4 and 6 months was 68% and 51%, respectively, and 2 patients had stable disease for over 2 years (Lin). Data supports the role of other HER2-targeted therapies for CNS disease including T-DM1, neratinib, and tucatinib. Among 291 patients with brain metastases in HER2CLIMB, the combination of tucatinib, capecitabine, and trastuzumab improved median overall survival (18 vs 12 months) and CNS progression-free survival (9.9 vs 4.2 months), compared with capecitabine plus trastuzumab. Further investigation exploring other novel therapy combinations and biomarkers will help further improve outcomes for these patients.

Adjuvant endocrine therapy decreases the risk for recurrence and improves survival for women diagnosed with HR-positive breast cancer. For young women, endocrine therapy options include tamoxifen, as well as ovarian suppression plus tamoxifen, or an aromatase inhibitor. Recommended duration of therapy is at least 5 years and can extend to 10 years. These treatments and duration may present challenges related to childbearing attempts and raise fertility concerns among young women.  In the Young Women’s Breast Cancer Study, among 643 women aged 40 years or younger and diagnosed with early stage HR-positive breast cancer, one-third reported fertility concerns impacting endocrine therapy decisions. Those who reported fertility concerns were more likely to exhibit non-initiation or non-persistence to endocrine therapy (40% vs 20%). Among women with fertility concerns, 7% did not initiate endocrine therapy, and 33% were non-persistent over 5 years (Sella). It is essential to integrate early oncofertility dialogue to help achieve optimal endocrine therapy and address family planning goals.

Studies have shown sugar-sweetened beverages (SSB) increase the risk for insulin resistance, diabetes, and heart disease. In a subsample of Women’s Health Initiative participants, higher levels of insulin resistance were shown to be linked to an increased incidence of breast cancer and all-cause mortality after breast cancer. Researchers found that among 8,863 women diagnosed with early breast cancer, those who consumed SSB after diagnosis had higher breast cancer-specific mortality and all-cause mortality. Additionally, replacing SSB with coffee, tea or water was linked to a decrease in mortality (Farvid). These findings support discussion of lifestyle and dietary behaviors in the survivorship setting, as these modifiable risk factors can potentially have significant health implications.

References:

van der Voort A, van Ramshorst MS, van Werkhoven ED, et al. Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2-blockade for HER2-positive breast cancer (TRAIN-2): A randomized phase III trial. J Clin Oncol. 2020;38S:ASCO #501.

Lin NU, Borges V, Anders C, et al. Intracranial efficacy and survival with tucatinib plus trastuzumab and capecitabine for previously treated HER2-positive breast cancer with brain metastases in the HER2CLIMB trial. J Clin Oncol. 2020;38(23):2610-2619.

Pan K, Chlebowski RT, Mortimer JE, et al. Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women's Health Initiative. Cancer. 2020;126(16):3638-3647.