HER2 Support Group Forums - View Single Post

OzzieSue · 10-06-2008, 03:06 PM

Just came across this on OncologyStat. I'm sure I've seen threats asking about this option. Thought there might be some interested members.

A New Approach to Adjuvant Therapy for Breast Cancer

Dr. Clifford Hudis is Chief, Breast Cancer Medicine Service, Memorial-Sloan Kettering Cancer Center.

1. In your view, which development that has occurred since September 2007 could have the most significant impact on oncology in the area of breast cancer?
The development from this year that could have the biggest long-term impact on breast cancer is the observation that the bisphosphonates, widely used for treating and preventing osteoporosis, may have a role in adjuvant therapy for breast cancer.
2. What specific changes in oncology, specifically in the treatment of breast cancer, have you observed or do you foresee as a result of this development?
If the results of the Austrian Breast and Colorectal Cancer Study Group-12 trial, initially presented at the 2008 annual meeting of the American Society of Clinical Oncology (ASCO) by Dr. Michael Gnant, are confirmed by additional ongoing studies, the impact on breast cancer treatment could be profound. As was widely reported during the ASCO meeting, this randomized trial of approximately 1800 premenopausal women with stage I or II endocrine-responsive breast cancer found that the addition of zoledronic acid (Zometa) to endocrine therapy (tamoxifen or anastrozole) lowered the risk of relapse by 36% compared with endocrine therapy alone. This could mean that a large number of women who until now have been treated with direct anticancer drugs that prevent recurrence of early-stage breast cancer could, in addition, be treated with the bisphosphonates.
The reason this is so important is that the bisphosphonate drugs are relatively safe, comparatively speaking, and they have known health benefits related to osteoporosis. Now, they appear to have a direct anti−breast cancer effect. They may have anticancer effects against other tumors as well. The use of bisphosphonates as adjuvant therapy would represent a new frontier in preventing recurrence of early-stage breast cancer. Considering that breast cancer is such a common disease and is reasonably well treated in many parts of the world, the addition of bisphosphonate therapy would be an important incremental step toward improving overall outcomes.
3. Could you put this development into historical perspective for the practicing oncologist?
The treatment of breast cancer in its early stages is essentially directed at eradicating the primary tumor and any microscopic metastatic disease. These are 2 different objectives. For the first, we treat the breast with surgery and possibly radiation therapy; for the second, we treat the rest of the body with systemic therapy, which has conventionally involved chemotherapy or hormone manipulations. Recently, we have added trastuzumab for patients who are HER2 positive.
The reason that the bisphosphonate story is so interesting and potentially revolutionary is that it represents yet another separate treatment dimension. The bisphosphonates are a different class of drugs with a different purpose. After trastuzumab, this would be the next big step in breast cancer therapy, and one that is more broadly applicable than the narrowly targeted anti−HER2 approaches, which, of course, are also very important.
4. Would you sum up, in a few sentences, why you chose this development as the top story of the past year?
I chose the bisphosphonate story as a top story of the past year because it was somewhat unexpected, as we had not seen consistent prior evidence in this direction. So this really does represent a new approach to the adjuvant treatment of breast cancer. Also, bisphosphonate therapy is probably safer than many of the widely accepted, standard options already in use, and it may add another layer of protection for patients with a very common illness. For that reason, it could have a significant public health impact, and this is why I picked this development because of its potential for having a long-range impact on a common disease.
One caution, however, is that, to date, we only have the results from a single large study. Several other large trials of bisphosphonate therapy in breast cancer are nearing completion, and the results will be available soon. One of these is the phase III AZURE trial, which is assessing the addition of zoledronic acid to neoadjuvant or adjuvant chemotherapy and/or hormonal therapy in women with stage II or III breast cancer. Until the results of all of these large trials are in, it may be premature to implement adjuvant bisphosphonate therapy in regular clinical practice. As oncologists, we will be watching these developments closely.

10-06-2008, 03:06 PM	#1
OzzieSue Member Join Date: Jan 2007 Location: Queensland, Australia Posts: 18	Bisphosphonates as preventative Just came across this on OncologyStat. I'm sure I've seen threats asking about this option. Thought there might be some interested members. A New Approach to Adjuvant Therapy for Breast Cancer Dr. Clifford Hudis is Chief, Breast Cancer Medicine Service, Memorial-Sloan Kettering Cancer Center. 1. In your view, which development that has occurred since September 2007 could have the most significant impact on oncology in the area of breast cancer? The development from this year that could have the biggest long-term impact on breast cancer is the observation that the bisphosphonates, widely used for treating and preventing osteoporosis, may have a role in adjuvant therapy for breast cancer. 2. What specific changes in oncology, specifically in the treatment of breast cancer, have you observed or do you foresee as a result of this development? If the results of the Austrian Breast and Colorectal Cancer Study Group-12 trial, initially presented at the 2008 annual meeting of the American Society of Clinical Oncology (ASCO) by Dr. Michael Gnant, are confirmed by additional ongoing studies, the impact on breast cancer treatment could be profound. As was widely reported during the ASCO meeting, this randomized trial of approximately 1800 premenopausal women with stage I or II endocrine-responsive breast cancer found that the addition of zoledronic acid (Zometa) to endocrine therapy (tamoxifen or anastrozole) lowered the risk of relapse by 36% compared with endocrine therapy alone. This could mean that a large number of women who until now have been treated with direct anticancer drugs that prevent recurrence of early-stage breast cancer could, in addition, be treated with the bisphosphonates. The reason this is so important is that the bisphosphonate drugs are relatively safe, comparatively speaking, and they have known health benefits related to osteoporosis. Now, they appear to have a direct anti−breast cancer effect. They may have anticancer effects against other tumors as well. The use of bisphosphonates as adjuvant therapy would represent a new frontier in preventing recurrence of early-stage breast cancer. Considering that breast cancer is such a common disease and is reasonably well treated in many parts of the world, the addition of bisphosphonate therapy would be an important incremental step toward improving overall outcomes. 3. Could you put this development into historical perspective for the practicing oncologist? The treatment of breast cancer in its early stages is essentially directed at eradicating the primary tumor and any microscopic metastatic disease. These are 2 different objectives. For the first, we treat the breast with surgery and possibly radiation therapy; for the second, we treat the rest of the body with systemic therapy, which has conventionally involved chemotherapy or hormone manipulations. Recently, we have added trastuzumab for patients who are HER2 positive. The reason that the bisphosphonate story is so interesting and potentially revolutionary is that it represents yet another separate treatment dimension. The bisphosphonates are a different class of drugs with a different purpose. After trastuzumab, this would be the next big step in breast cancer therapy, and one that is more broadly applicable than the narrowly targeted anti−HER2 approaches, which, of course, are also very important. 4. Would you sum up, in a few sentences, why you chose this development as the top story of the past year? I chose the bisphosphonate story as a top story of the past year because it was somewhat unexpected, as we had not seen consistent prior evidence in this direction. So this really does represent a new approach to the adjuvant treatment of breast cancer. Also, bisphosphonate therapy is probably safer than many of the widely accepted, standard options already in use, and it may add another layer of protection for patients with a very common illness. For that reason, it could have a significant public health impact, and this is why I picked this development because of its potential for having a long-range impact on a common disease. One caution, however, is that, to date, we only have the results from a single large study. Several other large trials of bisphosphonate therapy in breast cancer are nearing completion, and the results will be available soon. One of these is the phase III AZURE trial, which is assessing the addition of zoledronic acid to neoadjuvant or adjuvant chemotherapy and/or hormonal therapy in women with stage II or III breast cancer. Until the results of all of these large trials are in, it may be premature to implement adjuvant bisphosphonate therapy in regular clinical practice. As oncologists, we will be watching these developments closely.