Breast Cancer

ASCO-SEP® 7th Edition, is a comprehensive resource designed to help providers assess their level of knowledge in the various areas of oncology. This chapter provides a current understanding of breast cancer, its treatment, and the supportive care needed to optimize the quality of life for people with breast cancer.

Recent Updates

MOLECULAR PROGNOSTIC AND PREDICTIVE MARKERS

  • Results from prospective evaluation of the 21-gene recurrence score assay (Oncotype DX) provided valuable information regarding the treatment of pre- and postmenopausal women with a recurrence score between 11 and 25. (Sparano JA, N Engl J Med 2018)

ADJUVANT SYSTEMIC THERAPY

  • In patients with HER2-positive, operable breast cancer, the addition of pertuzumab to trastuzumab significantly improved the rates of invasive disease-free survival (DFS), although the benefit was small. (von Minckwitz G, N Engl J Med 2017)
  • The addition of ovarian function suppression (OFS) to tamoxifen or to exemestane treatment in premenopausal women with hormone receptor (HR)-positive breast cancer resulted in an improvement in DFS and freedom from distant recurrence compared with tamoxifen alone. The addition of OFS to tamoxifen resulted in a small overall survival (OS) benefit. (Francis PA, N Engl J Med 2018)

RESIDUAL DISEASE AFTER COMPLETING NEOADJUVANT SYSTEMIC THERAPY

  • Adjuvant capecitabine improved DFS and OS in patients with HER2-negative breast cancer and residual disease after neoadjuvant chemotherapy. Patients with triple-negative breast cancer (TNBC) derived the most benefit. (Masuda et al, N Engl J Med 2017)
  • In the KATHERINE study, adjuvant ado-trastuzumab emtansine therapy, compared to trastuzumab, improved invasive DFS, including distant recurrence, in patients with residual disease after neoadjuvant chemotherapy and HER2-targeted therapy. (von Minckwitz G, N Engl J Med 2019)

RECURRENT OR METASTATIC DISEASE

  • In the randomized IMpassion130 trial, the combination of atezolizumab and nab-paclitaxel led to an improvement in progression-free survival (PFS) compared with nab-paclitaxel alone in patientswith metastatic TNBC. (Schmid P, N Engl J Med 2018)
  • In patients with advanced breast cancer and a germline BRCA1 or BRCA2 mutation who received talazoparib or standard single-agent therapy of physician’s choice, talazoparib led to a significant improvement in PFS. (Litton JK, N Engl J Med 2018)
  • An update of the MONALESSA 7 trial showed that the addition of ribociclib to endocrine therapy in pre- or perimenopausal women with HR-positive, HER2-negative advanced breast cancer resulted in significantly longer OS than endocrine therapy alone. (Im SA, N Engl J Med 2019)
  • An update of the MONARCH 2 trial showed that, regardless of menopausal status, in women with HR-positive, HER2-negative advanced breast cancer that progressed after endocrine therapy, abemaciclib plus fulvestrant resulted in a significantly longer OS compared with fulvestrant alone. (Sledge G, JAMA Oncol 2019)
  • In SOLAR-1, alpelisib and fulvestrant led to an improvement in PFS compared with placebo and fulvestrant in patients with PIK3CA-mutated, HR-positive, HER2-negative advanced breast cancer previously treated with endocrine therapy. (André F, N Engl J Med 2019)
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