Breast Cancer

Efficacy of immunotherapy also depends on breast cancer subtype. Triple-negative and HER2-positive tumors have higher TMB and TILs compared to luminal subtype. A phase 2 study in 88 patients with metastatic HR-positive, ERBB2-negative breast cancer demonstrated no difference in PFS or ORR with pembrolizumab/eribulin versus eribulin alone, including the PD-L1 positive population. There was a trend towards greater immunotherapy benefit in the high TMB subgroup which is encouraging. Future research with novel agents that may augment immune response and/or alter tumor microenvironment are intriguing concepts. 

First-line endocrine therapy plus CDK 4/6 inhibitor is considered standard of care for HR-positive metastatic breast cancer. A retrospective chart review evaluating everolimus plus endocrine therapy post-CDK 4/6 inhibitor demonstrated PFS of 4.2 months and ORR of 17%. Although benefit appears modest, mTOR inhibitor combinations remain a valuable treatment option for select patients. Chemotherapy is often reserved for rapidly progressive disease or visceral crisis, however, it is crucial to evaluate for endocrine resistance. Furthermore, additional research is warranted to determine interactions between PI3K/Akt/mTOR and downstream Cyclin D/CDK 4/6/Rb pathways and implications on treatment sequencing. 

Trastuzumab therapy for 1 year is standard of care for early-stage HER2-positive breast cancer. A meta-analysis of 5 trials with 11,376 patients showed noninferiority of shorter duration trastuzumab compared to 1 year for DFS and OS and lower congestive heart failure rates with the former. Trastuzumab is well-tolerated, and although cardiac toxicity is often reversible, it can carry more severe consequences in patients with cardiac conditions. Shorter duration may be an option in patients with clinically lower risk disease (ER-positive, node-negative tumors) and significant cardiac risk factors, and represents a method of therapy de-escalation for the appropriate patient.

The COVID-19 pandemic has impacted oncology healthcare delivery models and cancer patients have poorer outcomes from COVID-19. A survey study of Brazilian breast cancer specialists demonstrated changing practices for early-stage breast cancer as the pandemic progressed. For HR-positive tumors with low ki-67, 48% would recommend NET for postmenopausal women, while 34% would recommend NET for those with high ki-67. There is limited data regarding NET for pre-menopausal women. Genomic assays may have an evolving role to identify patients who may be appropriate candidates for neoadjuvant therapy versus upfront surgery. Strategies to decrease treatment complications and effectively utilize resources are essential during the COVID-19 pandemic. 

Erin Roesch, MD
The Cleveland Clinic

References:
Zhu L, Narloch, JL, Onkar S, et al. Metastatic breast cancers have reduced immune cell recruitment but harbor increased macrophages relative to their matched primary tumors. J Immunother Cancer 2019; 7:265. 

Nanda R, Liu MC, Yau C, et al. Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer: An analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial. JAMA Oncol. 2020; 6(5):676–684.

Schmid P, Adams S, Rugo HS, et al. IMpassion130: updated overall survival (OS) from a global, randomized, double-blind, placebo-controlled, Phase III study of atezolizumab (atezo) + nab-paclitaxel (nP) in previously untreated locally advanced or metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2019; 37S:ASCO #1003. 

Cortes J, Cescon DW, Rugo HS, et al. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol 2020;38S:ASCO #1000. 

Martinello R, Becco P, Vici P, et al. Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity. Breast J 2019; 25(3):444-449.

Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21(3):335-337.

Efficacy of immunotherapy also depends on breast cancer subtype. Triple-negative and HER2-positive tumors have higher TMB and TILs compared to luminal subtype. A phase 2 study in 88 patients with metastatic HR-positive, ERBB2-negative breast cancer demonstrated no difference in PFS or ORR with pembrolizumab/eribulin versus eribulin alone, including the PD-L1 positive population. There was a trend towards greater immunotherapy benefit in the high TMB subgroup which is encouraging. Future research with novel agents that may augment immune response and/or alter tumor microenvironment are intriguing concepts. 

First-line endocrine therapy plus CDK 4/6 inhibitor is considered standard of care for HR-positive metastatic breast cancer. A retrospective chart review evaluating everolimus plus endocrine therapy post-CDK 4/6 inhibitor demonstrated PFS of 4.2 months and ORR of 17%. Although benefit appears modest, mTOR inhibitor combinations remain a valuable treatment option for select patients. Chemotherapy is often reserved for rapidly progressive disease or visceral crisis, however, it is crucial to evaluate for endocrine resistance. Furthermore, additional research is warranted to determine interactions between PI3K/Akt/mTOR and downstream Cyclin D/CDK 4/6/Rb pathways and implications on treatment sequencing. 

Trastuzumab therapy for 1 year is standard of care for early-stage HER2-positive breast cancer. A meta-analysis of 5 trials with 11,376 patients showed noninferiority of shorter duration trastuzumab compared to 1 year for DFS and OS and lower congestive heart failure rates with the former. Trastuzumab is well-tolerated, and although cardiac toxicity is often reversible, it can carry more severe consequences in patients with cardiac conditions. Shorter duration may be an option in patients with clinically lower risk disease (ER-positive, node-negative tumors) and significant cardiac risk factors, and represents a method of therapy de-escalation for the appropriate patient.

The COVID-19 pandemic has impacted oncology healthcare delivery models and cancer patients have poorer outcomes from COVID-19. A survey study of Brazilian breast cancer specialists demonstrated changing practices for early-stage breast cancer as the pandemic progressed. For HR-positive tumors with low ki-67, 48% would recommend NET for postmenopausal women, while 34% would recommend NET for those with high ki-67. There is limited data regarding NET for pre-menopausal women. Genomic assays may have an evolving role to identify patients who may be appropriate candidates for neoadjuvant therapy versus upfront surgery. Strategies to decrease treatment complications and effectively utilize resources are essential during the COVID-19 pandemic. 

Erin Roesch, MD
The Cleveland Clinic

References:
Zhu L, Narloch, JL, Onkar S, et al. Metastatic breast cancers have reduced immune cell recruitment but harbor increased macrophages relative to their matched primary tumors. J Immunother Cancer 2019; 7:265. 

Nanda R, Liu MC, Yau C, et al. Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer: An analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial. JAMA Oncol. 2020; 6(5):676–684.

Schmid P, Adams S, Rugo HS, et al. IMpassion130: updated overall survival (OS) from a global, randomized, double-blind, placebo-controlled, Phase III study of atezolizumab (atezo) + nab-paclitaxel (nP) in previously untreated locally advanced or metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2019; 37S:ASCO #1003. 

Cortes J, Cescon DW, Rugo HS, et al. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol 2020;38S:ASCO #1000. 

Martinello R, Becco P, Vici P, et al. Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity. Breast J 2019; 25(3):444-449.

Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21(3):335-337.

Efficacy of immunotherapy also depends on breast cancer subtype. Triple-negative and HER2-positive tumors have higher TMB and TILs compared to luminal subtype. A phase 2 study in 88 patients with metastatic HR-positive, ERBB2-negative breast cancer demonstrated no difference in PFS or ORR with pembrolizumab/eribulin versus eribulin alone, including the PD-L1 positive population. There was a trend towards greater immunotherapy benefit in the high TMB subgroup which is encouraging. Future research with novel agents that may augment immune response and/or alter tumor microenvironment are intriguing concepts. 

First-line endocrine therapy plus CDK 4/6 inhibitor is considered standard of care for HR-positive metastatic breast cancer. A retrospective chart review evaluating everolimus plus endocrine therapy post-CDK 4/6 inhibitor demonstrated PFS of 4.2 months and ORR of 17%. Although benefit appears modest, mTOR inhibitor combinations remain a valuable treatment option for select patients. Chemotherapy is often reserved for rapidly progressive disease or visceral crisis, however, it is crucial to evaluate for endocrine resistance. Furthermore, additional research is warranted to determine interactions between PI3K/Akt/mTOR and downstream Cyclin D/CDK 4/6/Rb pathways and implications on treatment sequencing. 

Trastuzumab therapy for 1 year is standard of care for early-stage HER2-positive breast cancer. A meta-analysis of 5 trials with 11,376 patients showed noninferiority of shorter duration trastuzumab compared to 1 year for DFS and OS and lower congestive heart failure rates with the former. Trastuzumab is well-tolerated, and although cardiac toxicity is often reversible, it can carry more severe consequences in patients with cardiac conditions. Shorter duration may be an option in patients with clinically lower risk disease (ER-positive, node-negative tumors) and significant cardiac risk factors, and represents a method of therapy de-escalation for the appropriate patient.

The COVID-19 pandemic has impacted oncology healthcare delivery models and cancer patients have poorer outcomes from COVID-19. A survey study of Brazilian breast cancer specialists demonstrated changing practices for early-stage breast cancer as the pandemic progressed. For HR-positive tumors with low ki-67, 48% would recommend NET for postmenopausal women, while 34% would recommend NET for those with high ki-67. There is limited data regarding NET for pre-menopausal women. Genomic assays may have an evolving role to identify patients who may be appropriate candidates for neoadjuvant therapy versus upfront surgery. Strategies to decrease treatment complications and effectively utilize resources are essential during the COVID-19 pandemic. 

Erin Roesch, MD
The Cleveland Clinic

References:
Zhu L, Narloch, JL, Onkar S, et al. Metastatic breast cancers have reduced immune cell recruitment but harbor increased macrophages relative to their matched primary tumors. J Immunother Cancer 2019; 7:265. 

Nanda R, Liu MC, Yau C, et al. Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer: An analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial. JAMA Oncol. 2020; 6(5):676–684.

Schmid P, Adams S, Rugo HS, et al. IMpassion130: updated overall survival (OS) from a global, randomized, double-blind, placebo-controlled, Phase III study of atezolizumab (atezo) + nab-paclitaxel (nP) in previously untreated locally advanced or metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2019; 37S:ASCO #1003. 

Cortes J, Cescon DW, Rugo HS, et al. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol 2020;38S:ASCO #1000. 

Martinello R, Becco P, Vici P, et al. Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity. Breast J 2019; 25(3):444-449.

Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21(3):335-337.

Key clinical point: Sarcoidosis can develop after breast cancer and requires histologic confirmation.

Major finding: Twenty of 429 (4.9%) women with sarcoidosis had breast cancer, which usually was diagnosed first. Sarcoidosis was diagnosed at a median age of 53.9 years, most often involved the lungs and central lymph nodes, and was asymptomatic in half of cases.

Study details: Single-center retrospective study of 1,000 sarcoidosis cases.

Disclosures: The study was not funded. The investigators reported having no conflicts.

Citation: Papanikolaou IC et al. Resp Med Case Rep. 2020 Aug 13.  doi: 10.1016/j.rmcr.2020.101190

Key clinical point: Sarcoidosis can develop after breast cancer and requires histologic confirmation.

Major finding: Twenty of 429 (4.9%) women with sarcoidosis had breast cancer, which usually was diagnosed first. Sarcoidosis was diagnosed at a median age of 53.9 years, most often involved the lungs and central lymph nodes, and was asymptomatic in half of cases.

Study details: Single-center retrospective study of 1,000 sarcoidosis cases.

Disclosures: The study was not funded. The investigators reported having no conflicts.

Citation: Papanikolaou IC et al. Resp Med Case Rep. 2020 Aug 13.  doi: 10.1016/j.rmcr.2020.101190

Key clinical point: Sarcoidosis can develop after breast cancer and requires histologic confirmation.

Major finding: Twenty of 429 (4.9%) women with sarcoidosis had breast cancer, which usually was diagnosed first. Sarcoidosis was diagnosed at a median age of 53.9 years, most often involved the lungs and central lymph nodes, and was asymptomatic in half of cases.

Study details: Single-center retrospective study of 1,000 sarcoidosis cases.

Disclosures: The study was not funded. The investigators reported having no conflicts.

Citation: Papanikolaou IC et al. Resp Med Case Rep. 2020 Aug 13.  doi: 10.1016/j.rmcr.2020.101190

Key clinical point: The mTOR inhibitor everolimus performed modestly when sequenced after palbociclib in metastatic HR+ HER2- breast cancer.

Major finding: Median PFS on everolimus was 4.2 months. ORR was 17.1% (all partial responses).

Study details: Two-center retrospective chart review of 41 patients who received everolimus combinations after their metastatic HR+ HER2- breast cancer progressed on palbociclib.

Disclosures: The National Cancer Institute provided funding. Four of the investigators disclosed ties to Novartis, Pfizer, and other pharmaceutical companies.

Citation: Dhakal A et al. Breast Cancer (Auckl). 2020 Jul 23. doi: 10.1177/1178223420944864

Key clinical point: The mTOR inhibitor everolimus performed modestly when sequenced after palbociclib in metastatic HR+ HER2- breast cancer.

Major finding: Median PFS on everolimus was 4.2 months. ORR was 17.1% (all partial responses).

Study details: Two-center retrospective chart review of 41 patients who received everolimus combinations after their metastatic HR+ HER2- breast cancer progressed on palbociclib.

Disclosures: The National Cancer Institute provided funding. Four of the investigators disclosed ties to Novartis, Pfizer, and other pharmaceutical companies.

Citation: Dhakal A et al. Breast Cancer (Auckl). 2020 Jul 23. doi: 10.1177/1178223420944864

Key clinical point: The mTOR inhibitor everolimus performed modestly when sequenced after palbociclib in metastatic HR+ HER2- breast cancer.

Major finding: Median PFS on everolimus was 4.2 months. ORR was 17.1% (all partial responses).

Study details: Two-center retrospective chart review of 41 patients who received everolimus combinations after their metastatic HR+ HER2- breast cancer progressed on palbociclib.

Disclosures: The National Cancer Institute provided funding. Four of the investigators disclosed ties to Novartis, Pfizer, and other pharmaceutical companies.

Citation: Dhakal A et al. Breast Cancer (Auckl). 2020 Jul 23. doi: 10.1177/1178223420944864

Key clinical point: In Brazil, the COVID-19 pandemic changed how specialists managed early breast cancer, especially HR-positive tumors.

Major finding: Nearly 70% of breast cancer specialists reported changing their management of early breast cancer. For more proliferative HR-positive tumors (Ki-67 >30%), 34% recommended neoadjuvant endocrine therapy (NET) for postmenopausal patients, while 10.9% recommended NET for premenopausal patients.

Study details: Survey of 503 breast cancer specialists in Brazil.

Disclosures: The study was not funded. The researchers reported having no conflicts.

Citation: Cavalcante FP et al. Breast Cancer Res Treat. 2020 Aug 16. doi: 10.1007/s10549-020-05877-y

Key clinical point: In Brazil, the COVID-19 pandemic changed how specialists managed early breast cancer, especially HR-positive tumors.

Major finding: Nearly 70% of breast cancer specialists reported changing their management of early breast cancer. For more proliferative HR-positive tumors (Ki-67 >30%), 34% recommended neoadjuvant endocrine therapy (NET) for postmenopausal patients, while 10.9% recommended NET for premenopausal patients.

Study details: Survey of 503 breast cancer specialists in Brazil.

Disclosures: The study was not funded. The researchers reported having no conflicts.

Citation: Cavalcante FP et al. Breast Cancer Res Treat. 2020 Aug 16. doi: 10.1007/s10549-020-05877-y

Key clinical point: In Brazil, the COVID-19 pandemic changed how specialists managed early breast cancer, especially HR-positive tumors.

Major finding: Nearly 70% of breast cancer specialists reported changing their management of early breast cancer. For more proliferative HR-positive tumors (Ki-67 >30%), 34% recommended neoadjuvant endocrine therapy (NET) for postmenopausal patients, while 10.9% recommended NET for premenopausal patients.

Study details: Survey of 503 breast cancer specialists in Brazil.

Disclosures: The study was not funded. The researchers reported having no conflicts.

Citation: Cavalcante FP et al. Breast Cancer Res Treat. 2020 Aug 16. doi: 10.1007/s10549-020-05877-y

Key clinical point: For patients with early breast cancer, ≤ 6 months of adjuvant trastuzumab was noninferior to a 1-year course and appeared to be less cardiotoxic.

Major finding: 5-year DFS rates were 85.4% vs. 87.1%, respectively. Rates of congestive heart failure were 3.9% vs. 6.9%, respectively.

Study details: Meta-analysis of 5 randomized trials (11,376 patients).

Disclosures: Funding sources were not reported. Two coinvestigators disclosed ties to Roche, Eisai, Novartis, Sanofi, Kendle India, and several other pharmaceutical companies.

Citation: Gulia S et al. 2020 Aug 24. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.11777

Key clinical point: For patients with early breast cancer, ≤ 6 months of adjuvant trastuzumab was noninferior to a 1-year course and appeared to be less cardiotoxic.

Major finding: 5-year DFS rates were 85.4% vs. 87.1%, respectively. Rates of congestive heart failure were 3.9% vs. 6.9%, respectively.

Study details: Meta-analysis of 5 randomized trials (11,376 patients).

Disclosures: Funding sources were not reported. Two coinvestigators disclosed ties to Roche, Eisai, Novartis, Sanofi, Kendle India, and several other pharmaceutical companies.

Citation: Gulia S et al. 2020 Aug 24. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.11777

Key clinical point: For patients with early breast cancer, ≤ 6 months of adjuvant trastuzumab was noninferior to a 1-year course and appeared to be less cardiotoxic.

Major finding: 5-year DFS rates were 85.4% vs. 87.1%, respectively. Rates of congestive heart failure were 3.9% vs. 6.9%, respectively.

Study details: Meta-analysis of 5 randomized trials (11,376 patients).

Disclosures: Funding sources were not reported. Two coinvestigators disclosed ties to Roche, Eisai, Novartis, Sanofi, Kendle India, and several other pharmaceutical companies.

Citation: Gulia S et al. 2020 Aug 24. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.11777

Key clinical point: Despite showing efficacy in specific subgroups, immune checkpoint inhibitors (ICIs) are unlikely to benefit most women with metastatic breast cancer.

Major finding: Objective response rates were 19% overall, 27% in PD-L1 positive patients, 18% in PD-L1 negative patients, 28% in HER2-positive breast cancer, 23% in triple-negative breast cancer, 35% when used in the first line, 26% when combined with systemic therapy, and 9% when used as monotherapy.

Study details: Meta-analysis of 27 studies of metastatic breast cancer (1,746 patients).

Disclosures: The study was funded by the National Natural Science Foundation of China. The investigators reported having no conflicts.

Citation: Zou Y et al. Ther Adv Med Oncol. 2020 Aug 17. doi: 10.1177/1758835920940928

Key clinical point: Despite showing efficacy in specific subgroups, immune checkpoint inhibitors (ICIs) are unlikely to benefit most women with metastatic breast cancer.

Major finding: Objective response rates were 19% overall, 27% in PD-L1 positive patients, 18% in PD-L1 negative patients, 28% in HER2-positive breast cancer, 23% in triple-negative breast cancer, 35% when used in the first line, 26% when combined with systemic therapy, and 9% when used as monotherapy.

Study details: Meta-analysis of 27 studies of metastatic breast cancer (1,746 patients).

Disclosures: The study was funded by the National Natural Science Foundation of China. The investigators reported having no conflicts.

Citation: Zou Y et al. Ther Adv Med Oncol. 2020 Aug 17. doi: 10.1177/1758835920940928

Key clinical point: Despite showing efficacy in specific subgroups, immune checkpoint inhibitors (ICIs) are unlikely to benefit most women with metastatic breast cancer.

Major finding: Objective response rates were 19% overall, 27% in PD-L1 positive patients, 18% in PD-L1 negative patients, 28% in HER2-positive breast cancer, 23% in triple-negative breast cancer, 35% when used in the first line, 26% when combined with systemic therapy, and 9% when used as monotherapy.

Study details: Meta-analysis of 27 studies of metastatic breast cancer (1,746 patients).

Disclosures: The study was funded by the National Natural Science Foundation of China. The investigators reported having no conflicts.

Citation: Zou Y et al. Ther Adv Med Oncol. 2020 Aug 17. doi: 10.1177/1758835920940928

Key clinical point: Later uptake and less extensive use of screening mammography might explain a relatively high rate of deaths from breast cancer among older women in Germany.

Major finding: Women aged ≥ 70 years in Germany had a 19% lower incidence but a 45% higher rate of mortality from breast cancer compared with their peers in the United States.

Study details: Population-based study of the Surveillance, Epidemiology, and End Results (SEER) 9 registry in the United States, and the Saarland Cancer Registry and the German Centre for Cancer Registry Data in Germany. 

Disclosures: German Cancer Aid funded the study. The investigators reported having no conflicts.

Citation: Jansen L et al. Cancers (Basel). 2020 Aug 26. doi: 10.3390/cancers12092419

Key clinical point: Later uptake and less extensive use of screening mammography might explain a relatively high rate of deaths from breast cancer among older women in Germany.

Major finding: Women aged ≥ 70 years in Germany had a 19% lower incidence but a 45% higher rate of mortality from breast cancer compared with their peers in the United States.

Study details: Population-based study of the Surveillance, Epidemiology, and End Results (SEER) 9 registry in the United States, and the Saarland Cancer Registry and the German Centre for Cancer Registry Data in Germany. 

Disclosures: German Cancer Aid funded the study. The investigators reported having no conflicts.

Citation: Jansen L et al. Cancers (Basel). 2020 Aug 26. doi: 10.3390/cancers12092419

Key clinical point: Later uptake and less extensive use of screening mammography might explain a relatively high rate of deaths from breast cancer among older women in Germany.

Major finding: Women aged ≥ 70 years in Germany had a 19% lower incidence but a 45% higher rate of mortality from breast cancer compared with their peers in the United States.

Study details: Population-based study of the Surveillance, Epidemiology, and End Results (SEER) 9 registry in the United States, and the Saarland Cancer Registry and the German Centre for Cancer Registry Data in Germany. 

Disclosures: German Cancer Aid funded the study. The investigators reported having no conflicts.

Citation: Jansen L et al. Cancers (Basel). 2020 Aug 26. doi: 10.3390/cancers12092419

Key clinical point: Prior use of conjugated equine estrogen in women who had a hysterectomy was associated with lower breast cancer incidence and mortality.

Major finding: Conjugated equine estrogen alone was associated with lower mortality (30 deaths, annualized mortality rate 0.031%), compared with placebo (46 deaths, annualized mortality rate 0.046%); HR 0.60; 95% CI, 0.37-0.97; P = .04.

Study details: This was a long-term follow-up study of two Women’s Health Initiative clinical trials of postmenopausal women with no prior breast cancer.

Disclosures: The Women’s Health Initiative is supported by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the Department of Health and Human Services. The authors reported numerous potential conflicts of interest, including receiving personal fees and grants from various government organizations, foundations, and pharmaceutical companies.

Citation: Chlebowski RT et al. JAMA. 2020 Jul 28. doi: 10.1001/jama.2020.9482.

Key clinical point: Prior use of conjugated equine estrogen in women who had a hysterectomy was associated with lower breast cancer incidence and mortality.

Major finding: Conjugated equine estrogen alone was associated with lower mortality (30 deaths, annualized mortality rate 0.031%), compared with placebo (46 deaths, annualized mortality rate 0.046%); HR 0.60; 95% CI, 0.37-0.97; P = .04.

Study details: This was a long-term follow-up study of two Women’s Health Initiative clinical trials of postmenopausal women with no prior breast cancer.

Disclosures: The Women’s Health Initiative is supported by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the Department of Health and Human Services. The authors reported numerous potential conflicts of interest, including receiving personal fees and grants from various government organizations, foundations, and pharmaceutical companies.

Citation: Chlebowski RT et al. JAMA. 2020 Jul 28. doi: 10.1001/jama.2020.9482.

Key clinical point: Prior use of conjugated equine estrogen in women who had a hysterectomy was associated with lower breast cancer incidence and mortality.

Major finding: Conjugated equine estrogen alone was associated with lower mortality (30 deaths, annualized mortality rate 0.031%), compared with placebo (46 deaths, annualized mortality rate 0.046%); HR 0.60; 95% CI, 0.37-0.97; P = .04.

Study details: This was a long-term follow-up study of two Women’s Health Initiative clinical trials of postmenopausal women with no prior breast cancer.

Disclosures: The Women’s Health Initiative is supported by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the Department of Health and Human Services. The authors reported numerous potential conflicts of interest, including receiving personal fees and grants from various government organizations, foundations, and pharmaceutical companies.

Citation: Chlebowski RT et al. JAMA. 2020 Jul 28. doi: 10.1001/jama.2020.9482.

Key clinical point: An automated image cytometry system called CytoPAN provides rapid cancer profiling and requires “scant” cellular specimens, according to researchers.

Major finding: In preclinical experiments, CytoPAN detected cancer in 1 hour using as few as 50 cells. In a patient cohort, CytoPAN detected breast cancer with 100% accuracy.

Study details: Preclinical research and a prospective study of 68 breast cancer patients.

Disclosures: The authors received funding from the National Institutes of Health, the MGH Scholar Fund, and Robert Wood Johnson Foundation. Some authors disclosed relationships with Akili, Accure Health, ModeRNA, Tarveda, Lumicell, and Noul.

Citation: Min J et al. Sci Transl Med. 2020 Aug 5. doi: 10.1126/scitranslmed.aaz9746.

Key clinical point: An automated image cytometry system called CytoPAN provides rapid cancer profiling and requires “scant” cellular specimens, according to researchers.

Major finding: In preclinical experiments, CytoPAN detected cancer in 1 hour using as few as 50 cells. In a patient cohort, CytoPAN detected breast cancer with 100% accuracy.

Study details: Preclinical research and a prospective study of 68 breast cancer patients.

Disclosures: The authors received funding from the National Institutes of Health, the MGH Scholar Fund, and Robert Wood Johnson Foundation. Some authors disclosed relationships with Akili, Accure Health, ModeRNA, Tarveda, Lumicell, and Noul.

Citation: Min J et al. Sci Transl Med. 2020 Aug 5. doi: 10.1126/scitranslmed.aaz9746.

Key clinical point: An automated image cytometry system called CytoPAN provides rapid cancer profiling and requires “scant” cellular specimens, according to researchers.

Major finding: In preclinical experiments, CytoPAN detected cancer in 1 hour using as few as 50 cells. In a patient cohort, CytoPAN detected breast cancer with 100% accuracy.

Study details: Preclinical research and a prospective study of 68 breast cancer patients.

Disclosures: The authors received funding from the National Institutes of Health, the MGH Scholar Fund, and Robert Wood Johnson Foundation. Some authors disclosed relationships with Akili, Accure Health, ModeRNA, Tarveda, Lumicell, and Noul.

Citation: Min J et al. Sci Transl Med. 2020 Aug 5. doi: 10.1126/scitranslmed.aaz9746.

An international survey provides new insights into how COVID-19 has affected, and may continue to affect, the field of oncology.

The survey showed that “COVID-19 has had a major impact on the organization of patient care, on the well-being of caregivers, on continued medical education, and on clinical trial activities in oncology,” stated Guy Jerusalem, MD, PhD, of Centre Hospitalier Universitaire de Liège (Belgium).

Dr. Jerusalem presented these findings at the European Society for Medical Oncology Virtual Congress 2020.

The survey was distributed by 20 oncologists from 10 of the countries most affected by COVID-19. Responses were obtained from 109 oncologists representing centers in 18 countries. The responses were recorded between June 17 and July 14, 2020.

The survey consisted of 95 items intended to evaluate the impact of COVID-19 on the organization of oncologic care. Questions encompassed the capacity and service offered at each center, the magnitude of COVID-19–based care interruptions and the reasons for them, the ensuing challenges faced, interventions implemented, and the estimated harms to patients during the pandemic.

The 109 oncologists surveyed had a median of 20 years of oncology experience. A majority of respondents were men (61.5%), and the median age was 48.5 years.

The respondents had worked predominantly (62.4%) at academic hospitals, with 29.6% at community hospitals. Most respondents worked at general hospitals with an oncology unit (66.1%) rather than a specialized separate cancer center (32.1%).

The most common specialty was breast cancer (60.6%), followed by gastrointestinal cancer (10.1%), urogenital cancer (9.2%), and lung cancer (8.3%).
 

Impact on treatment

The treatment modalities affected by the pandemic – through cancellations or delays in more than 10% of patients – included surgery (in 34% of centers), chemotherapy (22%), radiotherapy (13.7%), checkpoint inhibitor therapy (9.1%), monoclonal antibodies (9%), and oral targeted therapy (3.7%).

Among oncologists treating breast cancer, cancellations/delays in more than 10% of patients were reported for everolimus (18%), CDK4/6 inhibitors (8.9%), and endocrine therapy (2.2%).

Overall, 34.8% of respondents reported increased use of granulocyte colony–stimulating factor, and 6.4% reported increased use of erythropoietin.

On the other hand, 11.1% of respondents reported a decrease in the use of double immunotherapy, and 21.9% reported decreased use of corticosteroids.

Not only can the immunosuppressive effects of steroid use increase infection risks, Dr. Jerusalem noted, fever suppression can lead to a delayed diagnosis of COVID-19.

“To circumvent potential higher infection risks or greater disease severity, we use lower doses of steroids, but this is not based on studies,” he said.

“Previous exposure to steroids or being on steroids at the time of COVID-19 infection is a detrimental factor for complications and mortality,” commented ESMO President Solange Peters, MD, PhD, of Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland.

Frontline Medical News

Dr. Peters noted that the observation was based on lung cancer registry findings. Furthermore, because data from smaller outbreaks of other coronavirus infections suggested worse prognosis and increased mortality, steroid use was already feared in the very early days of the COVID-19 pandemic.

Lastly, earlier cessation of palliative treatment was observed in 32.1% of centers, and 64.2% of respondents agreed that undertreatment because of COVID-19 is a major concern.

Dr. Jerusalem noted that the survey data do not explain the early cessation of palliative treatment. “I suspect that many patients died at home rather than alone in institutions because it was the only way they could die with their families around them.”
 

Telehealth, meetings, and trials

The survey also revealed rationales for the use of teleconsultation, including follow-up (94.5%), oral therapy (92.7%), immunotherapy (57.8%), and chemotherapy (55%).

Most respondents reported more frequent use of virtual meetings for continuing medical education (94%), oncologic team meetings (92%), and tumor boards (82%).

While about 82% of respondents said they were likely to continue the use of telemedicine, 45% said virtual conferences are not an acceptable alternative to live international conferences such as ESMO, Dr. Jerusalem said.

Finally, nearly three-quarters of respondents (72.5%) said all clinical trial activities are or will soon be activated, or never stopped, at their centers. On the other hand, 27.5% of respondents reported that their centers had major protocol violations or deviations, and 37% of respondents said they expect significant reductions in clinical trial activities this year.

Dr. Jerusalem concluded that COVID-19 is having a major, long-term impact on the organization of patient care, caregivers, continued medical education, and clinical trial activities in oncology.

He cautioned that “the risk of a delayed diagnosis of new cancers and economic consequences of COVID-19 on access to health care and cancer treatments have to be carefully evaluated.”

This research was funded by Fondation Léon Fredericq. Dr. Jerusalem disclosed relationships with Novartis, Roche, Lilly, Pfizer, Amgen, Bristol-Myers Squibb, AstraZeneca, Daiichi Sankyo, AbbVie, MedImmune, and Merck. Dr. Peters disclosed relationships with AbbVie, Amgen, AstraZeneca, and many other companies.

SOURCE: Jerusalem G et al. ESMO 2020, Abstract LBA76.

An international survey provides new insights into how COVID-19 has affected, and may continue to affect, the field of oncology.

The survey showed that “COVID-19 has had a major impact on the organization of patient care, on the well-being of caregivers, on continued medical education, and on clinical trial activities in oncology,” stated Guy Jerusalem, MD, PhD, of Centre Hospitalier Universitaire de Liège (Belgium).

Dr. Jerusalem presented these findings at the European Society for Medical Oncology Virtual Congress 2020.

The survey was distributed by 20 oncologists from 10 of the countries most affected by COVID-19. Responses were obtained from 109 oncologists representing centers in 18 countries. The responses were recorded between June 17 and July 14, 2020.

The survey consisted of 95 items intended to evaluate the impact of COVID-19 on the organization of oncologic care. Questions encompassed the capacity and service offered at each center, the magnitude of COVID-19–based care interruptions and the reasons for them, the ensuing challenges faced, interventions implemented, and the estimated harms to patients during the pandemic.

The 109 oncologists surveyed had a median of 20 years of oncology experience. A majority of respondents were men (61.5%), and the median age was 48.5 years.

The respondents had worked predominantly (62.4%) at academic hospitals, with 29.6% at community hospitals. Most respondents worked at general hospitals with an oncology unit (66.1%) rather than a specialized separate cancer center (32.1%).

The most common specialty was breast cancer (60.6%), followed by gastrointestinal cancer (10.1%), urogenital cancer (9.2%), and lung cancer (8.3%).
 

Impact on treatment

The treatment modalities affected by the pandemic – through cancellations or delays in more than 10% of patients – included surgery (in 34% of centers), chemotherapy (22%), radiotherapy (13.7%), checkpoint inhibitor therapy (9.1%), monoclonal antibodies (9%), and oral targeted therapy (3.7%).

Among oncologists treating breast cancer, cancellations/delays in more than 10% of patients were reported for everolimus (18%), CDK4/6 inhibitors (8.9%), and endocrine therapy (2.2%).

Overall, 34.8% of respondents reported increased use of granulocyte colony–stimulating factor, and 6.4% reported increased use of erythropoietin.

On the other hand, 11.1% of respondents reported a decrease in the use of double immunotherapy, and 21.9% reported decreased use of corticosteroids.

Not only can the immunosuppressive effects of steroid use increase infection risks, Dr. Jerusalem noted, fever suppression can lead to a delayed diagnosis of COVID-19.

“To circumvent potential higher infection risks or greater disease severity, we use lower doses of steroids, but this is not based on studies,” he said.

“Previous exposure to steroids or being on steroids at the time of COVID-19 infection is a detrimental factor for complications and mortality,” commented ESMO President Solange Peters, MD, PhD, of Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland.

Frontline Medical News

Dr. Peters noted that the observation was based on lung cancer registry findings. Furthermore, because data from smaller outbreaks of other coronavirus infections suggested worse prognosis and increased mortality, steroid use was already feared in the very early days of the COVID-19 pandemic.

Lastly, earlier cessation of palliative treatment was observed in 32.1% of centers, and 64.2% of respondents agreed that undertreatment because of COVID-19 is a major concern.

Dr. Jerusalem noted that the survey data do not explain the early cessation of palliative treatment. “I suspect that many patients died at home rather than alone in institutions because it was the only way they could die with their families around them.”
 

Telehealth, meetings, and trials

The survey also revealed rationales for the use of teleconsultation, including follow-up (94.5%), oral therapy (92.7%), immunotherapy (57.8%), and chemotherapy (55%).

Most respondents reported more frequent use of virtual meetings for continuing medical education (94%), oncologic team meetings (92%), and tumor boards (82%).

While about 82% of respondents said they were likely to continue the use of telemedicine, 45% said virtual conferences are not an acceptable alternative to live international conferences such as ESMO, Dr. Jerusalem said.

Finally, nearly three-quarters of respondents (72.5%) said all clinical trial activities are or will soon be activated, or never stopped, at their centers. On the other hand, 27.5% of respondents reported that their centers had major protocol violations or deviations, and 37% of respondents said they expect significant reductions in clinical trial activities this year.

Dr. Jerusalem concluded that COVID-19 is having a major, long-term impact on the organization of patient care, caregivers, continued medical education, and clinical trial activities in oncology.

He cautioned that “the risk of a delayed diagnosis of new cancers and economic consequences of COVID-19 on access to health care and cancer treatments have to be carefully evaluated.”

This research was funded by Fondation Léon Fredericq. Dr. Jerusalem disclosed relationships with Novartis, Roche, Lilly, Pfizer, Amgen, Bristol-Myers Squibb, AstraZeneca, Daiichi Sankyo, AbbVie, MedImmune, and Merck. Dr. Peters disclosed relationships with AbbVie, Amgen, AstraZeneca, and many other companies.

SOURCE: Jerusalem G et al. ESMO 2020, Abstract LBA76.

An international survey provides new insights into how COVID-19 has affected, and may continue to affect, the field of oncology.

The survey showed that “COVID-19 has had a major impact on the organization of patient care, on the well-being of caregivers, on continued medical education, and on clinical trial activities in oncology,” stated Guy Jerusalem, MD, PhD, of Centre Hospitalier Universitaire de Liège (Belgium).

Dr. Jerusalem presented these findings at the European Society for Medical Oncology Virtual Congress 2020.

The survey was distributed by 20 oncologists from 10 of the countries most affected by COVID-19. Responses were obtained from 109 oncologists representing centers in 18 countries. The responses were recorded between June 17 and July 14, 2020.

The survey consisted of 95 items intended to evaluate the impact of COVID-19 on the organization of oncologic care. Questions encompassed the capacity and service offered at each center, the magnitude of COVID-19–based care interruptions and the reasons for them, the ensuing challenges faced, interventions implemented, and the estimated harms to patients during the pandemic.

The 109 oncologists surveyed had a median of 20 years of oncology experience. A majority of respondents were men (61.5%), and the median age was 48.5 years.

The respondents had worked predominantly (62.4%) at academic hospitals, with 29.6% at community hospitals. Most respondents worked at general hospitals with an oncology unit (66.1%) rather than a specialized separate cancer center (32.1%).

The most common specialty was breast cancer (60.6%), followed by gastrointestinal cancer (10.1%), urogenital cancer (9.2%), and lung cancer (8.3%).
 

Impact on treatment

The treatment modalities affected by the pandemic – through cancellations or delays in more than 10% of patients – included surgery (in 34% of centers), chemotherapy (22%), radiotherapy (13.7%), checkpoint inhibitor therapy (9.1%), monoclonal antibodies (9%), and oral targeted therapy (3.7%).

Among oncologists treating breast cancer, cancellations/delays in more than 10% of patients were reported for everolimus (18%), CDK4/6 inhibitors (8.9%), and endocrine therapy (2.2%).

Overall, 34.8% of respondents reported increased use of granulocyte colony–stimulating factor, and 6.4% reported increased use of erythropoietin.

On the other hand, 11.1% of respondents reported a decrease in the use of double immunotherapy, and 21.9% reported decreased use of corticosteroids.

Not only can the immunosuppressive effects of steroid use increase infection risks, Dr. Jerusalem noted, fever suppression can lead to a delayed diagnosis of COVID-19.

“To circumvent potential higher infection risks or greater disease severity, we use lower doses of steroids, but this is not based on studies,” he said.

“Previous exposure to steroids or being on steroids at the time of COVID-19 infection is a detrimental factor for complications and mortality,” commented ESMO President Solange Peters, MD, PhD, of Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland.

Frontline Medical News

Dr. Peters noted that the observation was based on lung cancer registry findings. Furthermore, because data from smaller outbreaks of other coronavirus infections suggested worse prognosis and increased mortality, steroid use was already feared in the very early days of the COVID-19 pandemic.

Lastly, earlier cessation of palliative treatment was observed in 32.1% of centers, and 64.2% of respondents agreed that undertreatment because of COVID-19 is a major concern.

Dr. Jerusalem noted that the survey data do not explain the early cessation of palliative treatment. “I suspect that many patients died at home rather than alone in institutions because it was the only way they could die with their families around them.”
 

Telehealth, meetings, and trials

The survey also revealed rationales for the use of teleconsultation, including follow-up (94.5%), oral therapy (92.7%), immunotherapy (57.8%), and chemotherapy (55%).

Most respondents reported more frequent use of virtual meetings for continuing medical education (94%), oncologic team meetings (92%), and tumor boards (82%).

While about 82% of respondents said they were likely to continue the use of telemedicine, 45% said virtual conferences are not an acceptable alternative to live international conferences such as ESMO, Dr. Jerusalem said.

Finally, nearly three-quarters of respondents (72.5%) said all clinical trial activities are or will soon be activated, or never stopped, at their centers. On the other hand, 27.5% of respondents reported that their centers had major protocol violations or deviations, and 37% of respondents said they expect significant reductions in clinical trial activities this year.

Dr. Jerusalem concluded that COVID-19 is having a major, long-term impact on the organization of patient care, caregivers, continued medical education, and clinical trial activities in oncology.

He cautioned that “the risk of a delayed diagnosis of new cancers and economic consequences of COVID-19 on access to health care and cancer treatments have to be carefully evaluated.”

This research was funded by Fondation Léon Fredericq. Dr. Jerusalem disclosed relationships with Novartis, Roche, Lilly, Pfizer, Amgen, Bristol-Myers Squibb, AstraZeneca, Daiichi Sankyo, AbbVie, MedImmune, and Merck. Dr. Peters disclosed relationships with AbbVie, Amgen, AstraZeneca, and many other companies.

SOURCE: Jerusalem G et al. ESMO 2020, Abstract LBA76.