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HOPA Annual Conference 2019

Advances in Breast Cancer: Are We Moving the Needle to Better Survival?

Recent advancements in research continue to improve breast cancer outcomes across all subsets of the disease, according to a review presented by Sandra Cuellar, PharmD, BCOP, Clinical Assistant Professor, Pharmacy Practice at the University of Illinois at Chicago College of Pharmacy, and a Clinical Oncology Pharmacist at the University of Illinois Hospital & Health Sciences System.

In assessing the efficacy of adjuvant chemotherapy in early-stage breast cancer, results show that adding chemotherapy decreases recurrences by 25% in ER positive, HER2 negative, and node negative breast cancer patients. However, while clinical guidelines recommend chemotherapy, most patients are adequately treated with a combination of surgery and/or radiation and hormonal therapy. To evaluate which breast cancer patients would benefit from adjuvant chemotherapy, physicians often employ Oncotype DX®, a tumor profile test that determines the benefit of using chemotherapy in tandem with hormone therapy. This multigene assay classifies patients into three risk categories by age:

  • People under 18 – this patient population would see minimal, if any benefit from adjuvant chemotherapy.
  • People aged 18-30 – adjuvant chemotherapy has an intermediate effect on this population.
  • People aged 31 and above – this population can greatly benefit from adjuvant chemotherapy.

For patients with HER2 positive breast cancer, this presentation examined the role of extended adjuvant chemotherapy when used with neratinib, as well as the effect of trastuzumab emtansine on patients with residual HER2 positive breast cancer. Based on the takeaways of a clinical trial, and according to American Society of Clinical Oncology (ASCO) guidelines, neratinib may be used over an extended period after trastuzumab in patients with early-stage, HER2 positive breast cancer, with preferential use for patients who are HR, and node-positive.

Despite the emergence of new therapies, the presentation notes that “breast cancer remains a significant health burden even after improvements in adjuvant therapy.” However, the treatment landscape continues to evolve. In her conclusion, the presenter wrote in response to the question “are we moving the needle to better survival? that “(breast cancer) research continues to improve survival across all subsets,” and that “trends continue to tailoring treatment based on tumor biology and characteristics.”

Cuellar S. Advances in Breast Cancer: Are We Moving the Needle to Better Survival? Presented at the Hematology/Oncology Pharmacy Association Annual Conference; April 3-6, 2019; Fort Worth, TX.

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