What to look for at this year's SABCS breast cancer meeting

This year's Annual San Antonio Breast Cancer Symposium has several presentations that could have immediate impacts on breast cancer care. Many of the details of results of clinical trials and other studies will not be fully disclosed until the time of the actual presentations, but the titles that have been posted offer some hints. Several studies examining the effects of bisphosphonates on preventing recurrences of breast cancer will be presented for the first time or updated from previous presentations. So far, studies have yielded mixed results and these drugs are currently not recommended as adjuvant therapy - it is not clear yet if new information will tilt us toward new recommendations.Also, the first large scale trial to be reported testing Tykerb (lapatinib) as adjuvant therapy for early stage HER2+ breast cancer will be revealed. While this may not change standards in the U.S., where Herceptin (trastuzumab) is the treatment of choice, there is also interest in combining the two drugs even though the combination study results are still pending. Combining two hormonal therapies in metastatic breast cancer has not received much attention, so we are eager to see the results of a trial combining Arimidex (anastrozole) and Faslodex (fulvestrant) compared with Arimidex alone. In a similar vein, drugs that affect growth signaling have been shown to augment the effects of hormonal therapy, and updated results of the BOLERO II trial, showing improvements with the addition of the mTOR inhibitor Afinitor (everolimus) to exemestane for metastatic breast cancer will be presented. This strategy could very well be in practice soon as submission for FDA approval is planned. On the heels of the FDA's withdrawal of Avastin (bevacizumab) for metastatic breast cancer, two studies – one in combination with Herceptin in metastatic and one for patients on neoadjuvant (pre-operative) chemotherapy who are not responding will be presented, reminding us that the final chapter on this drug is still ahead.On the diagnostic front, new information on molecular profiling to assess the risk of local recurrence of ductal carcinoma in situ (DCIS) may be helpful in planning surgery and radiation for this type of pre-invasive cancer that is being picked up more frequently with screening mammograms – a disease that rarely spreads and kills, but can recur in the breast and sometimes as a more dangerous invasive cancer. New information on markers that could help predict benefit from Herceptin and other biological drugs will also be presented. Many advances in basic biology can be anticipated – the ones that are generating much interest (though still some way from clinical application) are further understanding of breast cancer stem cells and how they can be targeted therapeutically, new insights from full genome sequencing of breast cancers, and more details of growth factor receptor signaling pathways and how they vary among cancer cases, providing clues to vulnerabilities of cancer cells that can be exploited. Overall, the agenda is very robust and we plan to continue our updates as soon as the news breaks.Note: For full SABCS coverage, go to curetoday.com/sabcs2011.