Just In... Meeting News
Key news updates and reports from the latest meetings in oncology and hematology.
Tuesday, October 06, 2015
BY LOLA BUTCHER
An overarching theme of the first Palliative Care in Oncology Symposium, held last year, was the need to provide access for cancer patients to palliative care services. For the second one, though, to be held Oct. 9 to 10 in Boston, the focus moves to how to provide palliative care.
Three abstracts presented at a presscast previewing the conference highlighted the maturation of palliative care for cancer patients from a good idea to an emerging component of standard care.
The symposium was sponsored by the American Society of Clinical Oncology, the American Academy of Hospice and Palliative Medicine, the American Society for Radiation Oncology, and the Multinational Association of Supportive Care in Cancer.
Identifying Patients Most at Risk of Early Death
The importance of end-of-life planning is becoming ever more clear, but best practices for initiating those conversations are not yet established.
“There’s no generally accepted screening tool to identify the patients who may not recover and who may be in most need of conversations about values and goals for how they want to live the rest of their lives,” said Judith Vick, a medical student at Johns Hopkins University School of Medicine (Abstract 8).
She and colleagues at Dana-Farber Cancer Institute are experimenting with the “surprise question”—“Would you be surprised if this patient died within a year?”--as a way of identifying patients who would most benefit from a conversation to clarify and articulate what matters most to them as they live the rest of their lives.
The work is being done in collaboration with Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T. H Chan School of Public Health.
In a trial, 81 clinicians--including oncologists, nurse practitioners, and physician assistants--answered the surprise question for 4,617 patients, ranging in age from 19 to 95, representing all stages and types of cancer. The finding: Clinicians were pretty good at predicting which patients would die within a year--but they were certainly not perfect:
● Of the patients for whom clinicians said, “I would be surprised if this patient died within a year,” only five percent of those patients did die within that time frame; and
● Of the patients for whom clinicians said, “I would not be surprised if this patient died within a year,” 38 percent of the patients did in fact die within the year.
“We found that the surprise question was a better predictor of death than other factors, such as patient age, type of cancer, cancer stage, or time since diagnosis alone,” Vick said, adding that use of the question is a simple and affordable way to add information about a patient’s life expectancy.
Looking at all patients together, clinicians who were asked the surprise question correctly identified about 60 percent of patients with a life expectancy of a year or less. “While that’s a good number, it certainly is not perfect, and we would like to have better tools to identify all patients who are at risk” of short life expectancy, said Rachelle Bernacki, MD, Associate Director of the Ariadne Labs’ Serious Illness Care Program and Assistant Professor of Medicine at Harvard Medical School.
She said the research team intends to analyze clinician factors such as years of practice to learn whether some clinicians accurately answered the surprise question more frequently than others. The researchers also will examine the characteristics of patients who died or lived contrary to clinician expectations to see how those patients differ from patients whose life expectancy was accurately predicted by the clinicians.
When Less Radiation is More
Another study highlighted in the presscast found that use of shorter, more efficient radiation treatments for cancer patients receiving palliative radiation for painful bone metastases resulted in shorter hospital stays--and equal or better pain relief--than standard treatment (Abstract 110).
That was demonstrated at Mount Sinai Medical Center in New York, which has had a Palliative Radiation Oncology Consult (PROC) service since 2013, which provides individualized treatment for advanced cancer patients by a radiation oncology team with a palliative care focus.
The standard approach for an advanced cancer patient being treated for painful bone metastases is about 10 radiation treatments, noted Kavita Dharmarajan, MD, Assistant Professor of Radiation Oncology and Palliative Medicine at the Icahn School of Medicine at Mount Sinai.
“Randomized clinical trial data has actually shown that as little as one fraction can be just as efficacious as 10, but the shorter courses of treatment are under-utilized by radiation oncologists today.”
PROC team members conduct whole-patient assessments and family meetings to evaluate patients’ physical symptoms; address psychosocial, spiritual, and other concerns; and discuss the goals of care, which frequently include pain relief and avoiding long hospitalizations.
Dharmarajan and her colleagues compared the medical records of 336 advanced cancer patients--175 before the PROC was started and 161 after--receiving radiation for painful bone metastases. The results showed:
● The number of patients opting for shorter courses of treatment doubled after the PROC was started--61 percent of patients served by the PROC received treatment in a single session or a short course of treatments given within one week, up from 26 percent before the PROC;
● The median hospital stay for patients served by the PROC fell by six days--from 18 days before the PROC to 12 days after;
● The rates of pain relief within one month of completing radiation were similar: Although the difference was no statistically significant, 80 percent of patients served by the PROC reported pain relief, compared with 74 percent of patients before the PROC started; and
● Nearly half the patients served by the PROC were receiving palliative care services within a month after they finished radiation therapy, up from 34 percent before the PROC was established.
“This demonstrates first-hand the practical impact incorporating palliative care can have on standard treatment,” said the moderator of the presscast, Don Dizon, MD, Chair of ASCO's Cancer Communications Committee and Clinical Co-Director of Gynecologic Oncology at Massachusetts General Hospital Cancer Center.
“It also shows that it’s possible not only to tailor our treatments for patients with bone metastases, leading to better utilization of resources and higher completion rates of therapy, but that we can do so without negatively impacting the goals of treatment in the first place.”
Primary Palliative Care Defined
In 2012, ASCO issued a formal recommendation for the early use of palliative care for any patient being treated with metastatic cancer and/or a high symptom burden (OT 3/25/12 issue). But exactly how to provide that care has not been clear.
“Not all cancer patients have access to specialist palliative medicine, and the small workforce of palliative care specialists is insufficient to meet the needs of all patients who would benefit from their services,” Kathleen Bickel, MD, Assistant Professor of Medicine at White River Junction Veterans Medical Center, said at the presscast. “Thus, alternative care models are being sought.”
ASCO and the American Academy of Hospice and Palliative Medicine recently partnered to create a consensus definition of high-quality primary palliative care to be directly delivered by oncologists and their staff in the oncology office (Abstract 108). Bickel is the lead author of a forthcoming publication that will detail this definition.
“These efforts represent an important collaboration to introduce a new concept of primary palliative care,” Dizon said. “Given the importance of addressing symptom burden for our patients, particularly with advanced malignancy, such guidelines will be helpful to delineate what palliative care services should be reasonably expected as part of usual medical oncology versus what should be referred to a specialist in palliative care.”
Bickel, who also works at the Geisel School of Medicine at Dartmouth, worked with a 31-member multidisciplinary panel that included physicians, patient advocates, social workers, nurses and nurse practitioners, to consider 966 different palliative care service items, grouped into nine domains:
Communication and shared decision-making;
Advance care planning;
Appropriate palliative care and hospice referral;
Symptom assessment and management;
Coordination and continuity of care;
Psychosocial assessment and management; and
Spiritual and cultural assessment and management.
Each of the 966 items was ranked according to its importance and feasibility and whether the services were within the scope of medical oncology practice. Items that ranked highly in all three areas—importance, feasibility, and scope—were included in the definition of high-quality primary palliative care in oncology.
“We want to improve the palliative care already being delivered by oncology practices—what we are calling primary palliative care,” Bickel said, noting that items that will be included in the definition of good primary palliative care are the following:
● Manage nausea and vomiting resistance to second-line treatment;
● Determine the patient’s and family’s understanding of prognosis; and
● Assess the need for hospice referral at the time of diagnosis of an incurable cancer.
Sunday, October 04, 2015
BY ED SUSMAN
VIENNA, Austria--Women seeking to preserve fertility after undergoing breast cancer-related chemotherapy might opt to undergo temporary ovarian suppression using luteinizing hormone-releasing hormone agonist (LHRHa) during anti-cancer treatment, according to research reported here at the European Cancer Congress (Abstract 1957),
The study, a meta-analysis of papers and reports from the medical literature, found the following:
- In studies that included 1,231 patients, about 18.5 percent of women who received LHRHa therapy eventually experienced ovarian failure compared with 33.5 percent for similar women who received standard chemotherapy only;
- In eight studies that included a total of 882 patients, the LHRHa strategy resulted in fewer women having one year of amenorrhea (31% vs. 43%);
- In five studies involving 706 women, 33 treated with LHRHa during chemotherapy subsequently became pregnant compared with 19 women of those not on the hormonal therapy; and
- In three studies that included 626 women, about 19.5 percent who had LHRHa treatment had disease recurrence compared with 18.8 percent of those not on the treatment, but the difference was not statistically significant.
Reporting the results at a news conference, Matteo Lambertini, MD, an oncology fellow at Istituto Di Ricovero e Cura a Carattere Scientifico at Azienda Ospedaliera Universitaria San Martino-IST, Institut Nazionale per la Ricerca sul Cancro in Italy, said that a strategy utilizing LHRHa gives these women a better chance of having children after completing their chemotherapy regimen.
“Temporary ovarian suppression with LHRHa in young breast cancer patients is associated with a reduced risk of chemotherapy-induced premature ovarian failure and seems to increase the pregnancy rate without apparent negative consequences on prognosis,” he said.
“The results show that pregnancy after breast cancer is safe, even in patients with endocrine-sensitive disease. With the rising trend of delaying childbearing, more breast cancer patients are diagnosed without having completed their families, and thus it is vital to provide reliable fertility-preservation methods for these young women.
“I think there is now enough data to use this strategy,” he said in an interview. “In Italy we just changed our national guidelines, and we support the use of this strategy in breast cancer patients.”
‘Seldom Talk about the Problem’
The moderator of an ECC news conference that featured the study, Peter Naredi, MD, Scientific Co-chair of the Congress from the European CanCer Organization and Professor and Chairman of Surgery at Sahlgrenska Academy of the University of Gothenburg in Sweden, said: “This is a problem that we all know about but seldom talk about. This is about young people who have cancer, and the treatment can change the rest of their lives. This presentation shows that we can make a change. Survivorship of cancer patients is of major importance for the cancer community.”
For the study, Lambertini and colleagues reviewed PubMed, Embase, the Cochrane Library, and the proceedings of major conferences through 2015 to identify relevant studies. The search brought up 676 articles, of which 12 were identified that contained enough information to help answer the question of whether LHRHa treatment was helpful.
‘Sizable Population of Women’
The question addressed is important to a sizable population of women, Lambertini noted: “Approximately 11 percent of breast cancer occurs in women younger than age 45--about 25,500 in the United States every year—six percent of women with breast cancer are younger than 40.
“As many as 97 percent of these women will receive chemotherapy and be at risk for premature ovarian failure and infertility. We know that about 50 percent of young breast cancer patients are interested in having a pregnancy after the end of treatment. We know that chemotherapy has many side effects and one of the side effects in these women is premature ovarian failure--that is, the women become postmenopausal due to their treatment.”
Multiple Options for Fertility Preservation
There are multiple options for fertility preservation, Lambertini said, including cryopreservation of embryos or oocytes; cryopreservation of ovarian tissue; and temporary ovarian suppression with LHRHa during chemotherapy.
Cryopreservation of embryos or oocytes are standard strategies but require a two-week delay in starting anti-cancer therapies, as well as a surgical procedure and do not include preservation of ovarian function. “On the other hand, temporary ovarian suppression with LHRHa during chemotherapy requires no delay in starting anti-cancer therapy; is a widely available option consisting of a single intramuscular injection given once a month during the duration of chemotherapy, which can last five to six months in these patients; and can preserve both ovarian function and fertility.”
Chemotherapy-induced menopause has major impacts on a woman's health, Lambertini said: “Chemotherapy can damage the ovaries and push young women into menopause. The women may experience infertility, sleep disturbance, sexual dysfunction, and osteoporosis. It is psychologically distressing, harmful to health, and affects the treatment decisions of many young women.”
Use of LHRHa has been curtailed because both the 2013 American Society of Clinical Oncology and the European Society of Medical Oncology still list LHRHa as an experimental strategy due to conflicting results in randomized studies and a paucity of reports on outcomes—which is why the team undertook the meta-analysis, Lambertini said.
“Our findings indicate that the use of LHRHa during chemotherapy might be considered as an option for women interested in preserving their ovarian function, and might play a role in increasing the likelihood of becoming pregnant after cessation of chemotherapy.
“Current guidelines on fertility preservation should consider the use of LHRHa during chemotherapy as an option to increase the likelihood of resuming menses and eventually become pregnant after chemotherapy.”
Thursday, October 01, 2015
BY ED SUSMAN
VIENNA, Austria--In the space of 30 minutes, an empty landscape for treating progressive neuroendocrine tumors of the lung and mid-gut remarkably now has two candidate therapies that exhibit potent efficacy, according to research presented here at the European Cancer Conference.
At a news conference, James Yao, MD, Professor of Gastrointestinal Medical Oncology at the University of Texas MD Anderson Cancer Center, demonstrated that treatment with everolimus in patients whose neuroendocrine tumors in the lungs and/or gut markedly improved progression-free survival when compared with placebo (Abstract 5LBA).
“Treatment for patients diagnosed with non-functional, progressing neuroendocrine tumors of the lung and gut remain limited,” he explained in his presentation. “In fact, there are no agents that are approved or have demonstrated any activity in patients with lung neuroendocrine tumors.”
But his study, which he described as the first Phase III study to test the use of everolimus in this population, showed a remarkable improvement in progression-free survival, the primary endpoint of the RADIANT-4 trial, which was supported by Novartis. Patients treated with everolimus achieved a median 11.0 months of progression-free survival compared with 3.9 months among patients assigned to placebo.
That translates to a 52 percent reduction in the risk of progression or death, a highly statistically significant difference (p<0.00001), he said.
In the trial 205 patients were treated with everolimus and 97 were assigned to the placebo arm of the trial. About 25 percent of the patients were diagnosed with gastrointestinal tumors, and the other 75 percent, with lung and other neuroendocrine tumors.
Isotope Added to Octreotide
But the good news for patients with these relatively rare tumors was not finished:
In another study, Philippe Ruszniewski, MD, Professor of Gastroenterology at Hospital Beaujon in France reported an improvement in progression-free survival achieved using the isotope 177Lu-Dotatate in addition to octreotide in patients with advanced, progressing mid-gut neuroendocrine tumors instead of just octreotide alone (Abstract 6LBA).
177Lu-Dotatate is a lutetium radionuclide chelated to a peptide, and the peptide targets somatostatin receptors, known to be overexpressed in about 80% of neuroendocrine tumors, he explained.
In the NETTER-1 study, the median progression-free survival of 8.4 months was achieved by patients who were treated with octreotide at 60 mg, but the median progression-free survival of the patients receiving the radionuclide had not been reached after a median of more than 40 months.
He calculated that the use of 177Lu-Dotatate reduced the risk of progression by 79.1 percent, also a highly statistically significant level (p<0.0001).
In addition, Ruszniewski said that of the 101 people assigned to 177Lu-Dotatate, one patient achieved a complete response; 13 had partial responses, and 77 maintained stable disease--a net clinical benefit of 95 percent. That result compared with three partial responses and 70 instances of stable disease among the 100 patients with octreotide--a 76 percent net clinical benefit. The difference in objective responses was significant (p=0.0004), he said.
“This shows that we were able to see tumor shrinkage in these patients.” A total of 90 percent of patients had tumor shrinkage, although in the majority of the cases the shrinkage did not meet RECIST criteria for a partial response designation, he said.
“I think we now have reasonable evidence that this represents a major advance in treatment of patients with progressing mid-gut endocrine tumors.”
‘At Verge of Practice-Changing Trials’
Exactly how the new therapies will be used and in what sequence are details that will undoubtedly require more clinical trials, said Christoph Zielinski, MD, Professor of Medicine at the University of Vienna, the moderator of the news briefing.
However, he did tell OT: “We are really at the verge of practice-changing trials. The question that always comes up is what would you rather use. The answer is: I don't know. This is something that would have to tested in a head-to-head comparison. The question again, though, is how would we ever perform this type of study.”
Zielinski said that he found the RADIANT-4 results compelling enough to change his practice. “I will be using everolimus with my neuroendocrine patients who are progressing,” he said.
He suggested that the United States, through the National Cancer Institute, would be better positioned to do such a trial rather that in Europe, where researchers are more dependent on pharmaceutical support for these studies.
Incidence on Rise
The researchers noted that while neuroendocrine tumors are relative rare, their incidence is on the rise. The incidence was 1.09 per 100,000 people in 1973 and by 2004 had risen to 5.25 per 100,000 people. Ruszniewski said that in the United States and Europe there are about 47,500 cases.
In both trials, the researchers performed interim analyses of overall survival, and in both cases the outcome favored treatment with the new drugs. The risk of death was reduced 36 percent among patients on everolimus in the RADIANT-4 trial (p=0.037), but did not achieve the pre-specified criteria for significance (p=0.0002), Yao said. His study has been ongoing for more than 27 months, and the next interim analysis for overall survival is expected in 2016.
Similarly, the number of deaths with 177Lu-Dotatate was 13 compared with 22 deaths of patients on octreotide alone (P<0.0186) but that was also an interim analysis and missed the criteria for significance (P<0.0001), Ruszniewski said. He noted that median overall survival had not been reached for either arm of the study. The study has been ongoing for more than 25 months. Both researchers said that they would have to wait for the results of the trial to mature to see if the treatments produce a significant survival advantage.
Yao said that the safety profile for patients in the study reflected the known safety profile for everolimus in other studies; and Ruszniewski also reported a favorable safety profile with 177Lu-Dotatate. He said seven patients were observed with serious blood and lymphatic system disorders, including three cases of lymphocytopenia; three patients were diagnosed with serious kidney disorders, and one patient had portal hypertension.
“We have conducted a sub-study in other patients to study the fate of the radionuclide,” Ruszniewski said in response to reporters' questions. “It does disappear from the blood. It is not entirely impossible that it could cause damage in the long run--this is radiation. From our Phase I and II studies we think that damage is possible but rare.
“The two organs that should be carefully watched are the bone marrow and the kidneys. To limit damage to the kidneys, amino acids are infused along with the radionuclide to compete with the radioactive agent and limit damage to those organs.” He said that in the long run there might be a risk of myelodysplastic syndromes in approximately three to four percent of patients.
Ruszniewski noted that in his study patients were eligible if they were progressing on octreotide, which meant that they were likely sensitive to somatostatin-targeted drugs at the onset of the trial. He said that patients with neuroendocrine tumors have, generally, better prognoses than patients diagnosed with other cancers: “This is not a case where patients will have to choose one treatment or another. Most of our patients receive all that we have. It is just a question of order.”
He said that patients who are diagnosed with progressing neuroendocrine tumors of the mid-gut should undergo tests to make sure they have overexpressed somatostatin receptors. In 15 to 20 percent of the patients there is no overexpression, and, he said, success with the radionuclide would be limited in these patients.
“In this particular disease,” Yao told OT, “I think we will need both of these treatments. It may not be that important to know which one is better. I think a head-to-head study would be very unlikely even with support from the National Institutes of Health.”
The European Cancer Congress, which had about 15,000 attendees, includes the meetings of the European CanCer Organization, European Society for Medical Oncology, European Society for Radiotherapy & Oncology, European Society for Surgical Oncology, European Association for Cancer Research, the European Oncology Nursing Society, and the European Society for Pediatric Oncology.
All the abstracts from the meeting are searchable here.
Sunday, September 27, 2015
BY SARAH DIGIULIO
SAN FRANCISCO—Matthew Ellis, MD, BChir, PhD, Director of the Lester and Sue Smith Breast Center and Professor of Medicine and Cellular and Molecular Biology at Baylor College of Medicine, was awarded the 2015 Gianni Bonadonna Breast Cancer Award and Lecture here at the 2015 Breast Cancer Symposium. The award recognizes Ellis' research on the clinical relevance of activating mutations in HER2 and the deployment of patient-derived xenografts for the pharmacological annotation of breast cancer genomes.
Ellis played a key role in developing a Genome Atlas and Therapeutic Road Map for estrogen receptor-positive breast cancer. He is also co-leader for The Cancer Genome Atlas Breast Project and co-principal investigator for the Clinical Proteomic Tumor Analysis Consortium, which has the aim of translating TCGA genomic discoveries into protein-based biomarkers with clinical utility.
Ellis’ lecture walked through some of the seminal findings by him and his colleagues that have guided his work and led him to investigate the new theory that maybe genomic testing to guide therapy in breast cancer is of more limited value than has been thought.
“With genomics, it’s just not measuring enough of what you need to know in most cases,” he said in an interview after the session. “We’re good at identifying poor-prognosis patients using genomic profiling or grade—we have lots of surrogates for poor prognosis. But we still don’t know exactly how to rescue those patients’ poor prognosis with a very targeted approach. We haven’t made enough progress, and we need to develop new approaches to actually measure the biochemistry that we need to drug.”
Those new approaches may come in the form of proteomics, he explained. “The role of the mutations are to disrupt the biochemistry either via an accelerating mutation, like a HER2 mutation, or by stopping the negative receptors, like tumor suppressors.
“The idea of the proteomic profile is where we can measure all the biochemistry, so we get the integrated effect of these mutations and get to see exactly how which biochemistry has become active—and in particular, which kinase has become active so we can drug that kinase. So, you’re drugging to kinase activity, not to the mutation.”
And that’s what the Clinical Proteomic Tumor Analysis Consortium (funded by the National Cancer Institute) is all about, Ellis explained. “There are some new technologies on the horizon—mainly focusing on the proteomic approaches where we can better understand what are the biochemical events that are unleashed by the mutations. And you’re trying to drug that biochemistry.
“So this next approach is going to integrate proteomics, where you’re measuring not just the genes, but also proteins to build a better map of the treatment approach.”
The Bonadonna Legacy
The award, which has been given annually since 2007, was named in honor of cancer research pioneer Gianni Bonadonna and recognizes an active clinical and/or translational researcher with a distinguished record of accomplishments in advancing the field of breast cancer and who has exceptional mentoring abilities. The presentation of this year’s award included an extra tribute to Bonadonna, who died earlier this month at age 81. In a video shown here at the meeting, several of the awards past recipients praised Bonadonna’s contributions as scientist, clinician, mentor, and humanitarian.
Ellis gave his own tribute to the award’s namesake by sharing a thought Bonadonna had passed down to the award’s 2011 recipient, Luca Gianni, MD, of San Raffaele Cancer Center in Milan (which L. Gianni had shared with Ellis via email): “Gianni expressed to me in a book his regret of having realized too late and too little the key aspect of empathy and human attention to the patient.”
Ellis added: “In our drive to achieve scientific advances and put patients on trial, we still have to remember that each patient is struggling and each patient requires our empathy and our attention. Sometimes I say to the patients, ‘if at the end you feel better as a result of my consultation today, I’ll have partially achieved my job.’”
Sunday, September 27, 2015
BY ROBERT H. CARLSON
SAN FRANCISCO – A study of four major breast cancer clinical trials shows that after accounting for tumor characteristics, there were no observed differences in pathologic complete response (pCR) rates according to race, age, or body mass index following neoadjuvant chemotherapy.
The study, presented here at the Breast Cancer Symposium (Abstract 33), combined data sets from four trials by the Alliance for Clinical Trials in Oncology.
Erica T. Warner, ScD, Research Associate in the Harvard T.H. Chan School of Public Health, explained that pathologic complete response is more common in the more aggressive phenotypes of breast cancer. The pCR rates for triple-negative, ER-/PR-, and HER2+ breast cancers are much higher than for ER+ tumors. But few studies have examined whether pCR differs according to young age, black race, and obesity.
This study assessed the associations of age at diagnosis, BMI, and race with pCR in women enrolled in the CALGB 40601, CALGB 40603, ACOSOG Z1031, and ACOSOG Z1041 trials.
“The overall pathologic complete response rates we found were high--44.2 percent--likely because of the definition for pathologic complete response, the tumor subtypes included, and the use of combination therapy,” she said.
Pathologic complete response is an important prognostic indicator and surrogate endpoint, particularly for patients with hormone receptor-negative breast cancer. “Previous studies have suggested differential response to preoperative therapy by age and body mass index, though no association has been seen by race.”
She noted that the null association of race with pCR found in this study is consistent with the literature. But previous studies found higher pCR rates among young women and lower rates among overweight and obese women.
In the study reported at the symposium, age, race, and body mass index were abstracted from patient records at baseline. Tumor subtype was assessed using immunohistochemical staining and/or fluorescence in situ hybridization. Logistic regression models were used to determine the association of race/ethnicity and age at diagnosis with pathologic complete response.
A total of 1,146 women with a mean age of 51.5 were included: 13.6 percent were black; 51.5 percent of the tumors were HER2-positive; 14.7 percent were ER+/HER2-; and 33.8 percent were triple negative.
Praise from Charles Geyer
The Discussant for this study, Charles E. Geyer Jr, MD, Associate Director for Clinical Research and Professor of the Division of Hematology, Oncology and Palliative Care at Virginia Commonwealth University Massey Cancer Center, applauded the work: “It is encouraging that pathologic complete response in HER2-positive and triple- negative cancer is not altered by race, age, or BMI,” he said. “That is counterintuitive to what a lot of us think might be going on.
“There is a lot to the disparity question, particularly in breast cancer with the heterogeneity that we need to continue to look at,” Geyer said.
He did say, though, that he would not have included ACOSOG Z1031in this study.
“This study was trying to correlate pathologic complete response with other endpoints, and the rate in Z1031 in the published paper was only 0.6 percent. We know that with neoadjuvant endocrine therapy you just don’t see that endpoint.”
Geyer agreed with Warner’s plan that the next step for the research will be to study whether pathologic complete response has the same overall survival benefits for all the groups.
Warner’s coauthors for the study were Karla V. Ballman, Aman Buzdar, Lisa A. Carey, William M. Sikov, Carrie Strand, and Ann H. Partridge.