Highlights from the San Antonio Breast Cancer Symposium 2009: An Update

A recap of the 2008 San Antonio Breast Cancer Symposium. 

Many women develop breast tumors that are sensitive to estrogen—a female hormone that can feed a tumor’s growth and development. So for the past 15 years, researchers have experimented with hormonal drugs to figure out which drugs work best, how they should be sequenced (if giving more than one hormonal agent), and how long they should be taken.

In February 2008, Avastin (bevacizumab) received approval for metastatic breast cancer, despite the fact that an advisory panel for the FDA said the drug did not offer enough benefit (specifically in survival) to justify its use. Hoping to more clearly define the potential and the limits of the drug, researchers have continued testing Avastin in breast cancer, including as second-line therapy.

New data from the RIBBON-2 trial involved 684 women with HER2-negative metastatic breast cancer who had already received one course of chemotherapy. The women received another session of chemotherapy with or without Avastin.

The results: Adding Avastin to chemotherapy as a second-line treatment increased progression-free survival—the length of time the disease did not worsen—by approximately two months (from 5.1 months to 7.2 months). Furthermore, the RIBBON-2 study has not found an improvement in overall survival with the addition of Avastin, but 43 percent of women in the study were still alive.

In July, an FDA advisory panel met and recommended revoking the approval due to the disappointing results from RIBBON-2 and other more recent Avastin trials. A previous study had shown progression-free survival increase of about five months—data on which the FDA had originally based its accelerated approval decision. The FDA is expected to make a decision on Avastin by Dec. 17.

Read the full article here.

Scientists at the 2009 San Antonio Breast Cancer Symposium reported on women who initially started on the aromatase inhibitor Aromasin (exemestane) did no better than the women who switched to Aromasin later from tamoxifen. Regarding the likelihood of cancer recurring or a difference in survival, researcher Daniel Rea, MD, of the University of Birmingham said, "There is no difference whatsoever."

Another study examined whether being premenopausal at diagnosis made a difference in outcomes. All women were menopausal during the study, either naturally, because of surgical removal of the ovaries or because of chemotherapy treatment. Premenopausal women who took tamoxifen for five years, followed by another aromatase inhibitor called Femara (letrozole), were less likely to have a recurrence than women who took only tamoxifen for the initial five years. 

Read the full article here.

Taking Herceptin (trastuzumab) with, as opposed to after, chemotherapy helped more women live longer without a recurrence, new research found.

Investigators randomly assigned roughly 3,000 patients with stage 1 to stage 3 HER2-positive breast cancer who had already undergone surgery to receive either chemotherapy alone (Adriamycin [doxorubicin] and cyclophosphamide followed by Taxol [paclitaxel]), chemotherapy followed by Herceptin or chemotherapy given with Herceptin (paired with Taxol).

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