The 42nd Annual CTRC-AACR San Antonio Breast Cancer Symposium
The annual meeting of the San Antonio Breast Cancer Symposium was held virtually this year from Dec. 8 to 11 and attracted participants from around the world, including medical oncologists, radiation oncologists, researchers, and other health care professionals. The conference highlighted recent advances in the risk, diagnosis, treatment, and prevention of breast cancer, with presentations focusing on emerging treatments in hard-to-treat patient populations, including patients with metastatic breast cancer.
As part of the RxPONDER study, Kevin Kalinsky, M.D., of the Glenn Family Breast Center at the Winship Cancer Institute of Emory University in Atlanta, and colleagues found that postmenopausal women with lymph node-positive early-stage breast cancer and a low recurrence score receive no additional benefit from chemotherapy.
The authors enrolled patients (women with hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer and one to three positive lymph nodes with a recurrence score of 0 to 25 performed on their breast cancer) at 632 sites in nine countries (United States, Canada, Mexico, Colombia, Ireland, France, Spain, Korea, and Saudi Arabia). A total of 5,083 such patients were randomly assigned to receive either hormone therapy alone or intravenous taxane and/or anthracycline-based chemotherapy followed by hormone therapy. The patients were monitored for a median of five years to assess invasive disease-free survival (IDFS) and overall survival (OS). The researchers found that postmenopausal women with lymph node-positive early-stage breast cancer and a low recurrence score derived no added benefit from chemotherapy, while premenopausal women saw improvements in IDFS and OS with added chemotherapy.
“For postmenopausal women with this type of breast cancer, our findings mean they’re spared the time, money, and harmful side effects that come with chemotherapy. For premenopausal women, our findings mean they can be assured that chemotherapy should, in fact, help them live longer or without their disease spreading,” Kalinsky said. “Either way, our results are great news for women diagnosed with this common type of breast cancer. We’re moving away from a one-size-fits-all treatment approach.”
Reshma Jagsi, M.D., of the University of Michigan in Ann Arbor, and colleagues found that under-recognition of adverse effects was common among patients with breast cancer treated with radiotherapy, especially among younger patients and Black patients.
The authors evaluated physician and patient reports of side effects among patients with breast cancer treated with radiation therapy across the state of Michigan to determine whether patients were reporting side effects that their physicians were not. The researchers found that physicians frequently did not recognize the severity of the symptoms patients themselves reported, and this was especially common for certain groups, including younger patients and those who were Black.
“Because physicians cannot help patients if they don’t know who is suffering, improving symptom detection appears to be a way to improve the quality of care and to reduce disparities in cancer treatment experiences and outcomes,” Jagsi said. “The findings also suggest that clinical trials should not rely on physician reports alone to evaluate the side effects of treatments; patient-reported outcomes provide an important complement to physician evaluations.”
In a retrospective cohort study, Jacob Cogan, M.D., of the New York-Presbyterian/Columbia University Irving Medical Center in New York City, and colleagues found that a substantial proportion of women undergoing mastectomy and reconstructive surgery become new persistent users of opioid and sedative-hypnotic medications.
The authors evaluated health care claims data using the MarketScan database and identified prescriptions for opioids and sedative-hypnotics in women undergoing mastectomy and reconstruction between 2008 and 2017. Women who became new persistent users of these substances postoperatively were identified. The investigators found that 13.1 percent of opioid-naïve women became new persistent opioid users, and 6.6 percent of sedative-hypnotic-naïve women became new persistent sedative-hypnotic users. When looking only at women who received prescriptions around the time of surgery (i.e., excluding those who did not receive any prescriptions perioperatively), the researchers found that the rates rose to 17.5 and 17 percent, respectively.
“We also identified several risk factors for becoming new persistent users of these substances: age greater than 65, Medicaid insurance, a diagnosis of breast cancer, and treatment with chemotherapy. The more risk factors an individual patient possessed, the higher their risk of becoming a new persistent substance user,” Cogan said. “Patients and providers should recognize the development of new persistent substance use as a potential complication of mastectomy and reconstruction, as well as the risk factors increasing an individual patient’s risk.”
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