Extracts From Euro Conference

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Here are a few extracts of the report on the 17TH INTERNATIONAL CONGRESS ON ANTI-CANCER TREATMENT (jan-feb2006) related to breast cancer. Many other extracts on various cancer types are listed in this long report. In particular a few on the new DOXIL (pegylated liposomal adryamicin) combined with other drugs drugs which complement the recently released report on the US/Canada phase 2 trial on DOXIL+Herceptin.
http://www.icact.com/Abstract_Book_ICACT_2006.pdf

POSTER SESSION page 168
Efficay of anti-HER2 monoclonal antibodyin old women with HER2
overexpressing metastatic breast cancer progressing after chemotherapy: case reports
Borgonovo Karen, G. Farina, N. La Verde,S. Cobelli, M. Dimaiuta, A. Scanni Fatebenefratelli Hospital, Oncology Dep. - Milan - Italy

We know Trastuzumab obtains good responses in HER2 overexpressing advanced breast cancer, in association with chemotherapy. Few informations are available about efficacy of Trastuzumab alone in chemoresistant
advanced breast cancer.In this abstract we want to report our experience in two old patients affected by advanced breast cancer HER2 iperexpressing, resistant to standard therapeutic regimens.In our hospital in the last two years we treated with weekly Trastuzumab alone, two patients affected by chemoresistant, HER2 iperexpressed advanced breast cancer; in these patients we obtained a very good response with this regimen. The first patient is a 76 years old woman with bone, liver and lung metastases; she was treated with vinorelbine in first line therapy but after 3 cycles she had progression disease (liver, skin and axillar limphonodes; CEA 2885). Because of age we decided to treat her with Trastuzumabalone (weekly schedule); after 4 months of therapy she obtained CR at a liver ultrasound, SD of bone metastases, PR in the other side of disease, CEA 53,7.The second patient is a 78 years old woman; from 04/2002 to 03/2003 she was treated for liver metastases with locoregional treatment (radiofrequency), 3 cycles of FEC schedule, and 3 cycle of vinorelbine, but she progressed (CEA 480). In 04/2003 she started chemotherapy with taxolo and trastuzumab; because of good response obtained after 6 cycles (PR 50%, CEA 9,8), in 09/2003 she started manteinance therapy with weekly Trastuzumabalone; at intermediate evaluations she obtained liver PR; at the evaluation after 24 months of treatment a liver ultrasound documented PR >50%/CR of liver metastases;no other site of disease; CEA 2; she had a tumor growth control of 24 months +.The treatment is very well tolerated in both patients and it is going on. They have ECOGPS = 0.
In 19991 Cobleigh M.A. reported his experience in 213 patients affected by HER2-overexpressing metastatic breast cancer that had progressed after one or two chemotherapy regimens: he obtained 8 complete response (4%) and 26 partial response (11%), for an objective response rate of 15%; 22% of patients were free of disease progression at 6 months. In the responders group the median duration of responses was 9,1 months. These results - and our experience too - would support the use of Trastuzumab in patients who have tumors that overexpress HER2; because of good toxicity profile thiscould be a good choice expecially in old patient.
RÉFÉRENCE
1. M.A. Cobleigh, C.L. Vogel, D. Tripathy et al. Multinational study of the efficacy and safety of humanized anti-HER2 monoclonal antibody in women who have HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease. JCO, Vol 17, Sep, 1999: pp 2639-2648.

POSTER SESSION page.169

Gemcitabine plus Docetaxel seem to be an exquisite first line treatment option for lung-metastasized breast cancer patients

Draganescu Madalina, Nicolae Gutulescu, Daniela Zob Bucharest - Romania

82 patients with metastatic breast cancer were treated in first line with Gemcitabine 1/m2 day 1,8 plus Docetaxel 75 mg/m2 day 1 every 21 days. None of the patients had been tested for Her2neu and they either had received the maximum allowed anthracycline dose in adjuvant (65) orhad cardiac contraindication for anthracyclines (17). The distribution of metastatic sites was as follows:

M1 PUL only- 10 patients
M1 PUL, M1 LYM- 12 patients
M1 PUL, M1 HEP, M1 OSS- 16 patients
M1 PUL, M1 PLE- 20 patients
M1 PUL, M1SKY- 24 patients.
We evaluated 80 patients after 6 cycles of treatment (2 patients in the group with liver metastases had disease progression after the first cycle of chemotherapy).We had an ORR of 36%, but we had no lack of response as far as lung metastases were concerned (14 patients- stable disease in the lung, 40 patients- partial response of lung metastases, 36 patients- complete response of lung metastases).
Toxicities were manageable, with 200 grade 2 neutropenia,10 grade 3 neutropenia and 315 grade 1 mucositis out of the total of 480 treatment administrations. Progresion free survival ranged between 7.5 and 26 months, with the longest PFS for the patients with only M1 PUL or M1 PUL, PLE.
CONCLUSION
Gemcitabine plus Docetaxel is probably the first lineoption for patients with lung metastasized breast cancer who cannot be treated with anthracyclines containing regimens.
■POSTER SESSION p175.176

Effects of exercise on fatigue during breast cancer treatment

Lakdizajee Sima, Kobra Parvan & Alireza Mohajel Agdam Tabriz Nursing & Midwifery School - Tabriz - Iran

BACKGROUND
Fatigue is frequent problem during & after cancer treatment.However, little is known about this symptom in our people who have cancer. In a pilot study, authors evaluated the effects of a home based moderate walking exercise intervention on fatigue during breast cancer treatment.
METHOD
A consecutive series of thirty women were recruited from Imam hospital for this pilot study with an experimental design. Subjects were randomly assigned to the walking program or usual care during adjuvant chemotherapy or radiation therapy for breast cancer. Fatigue was measured at base line and
fourth week when the subjects were required to have home
base walking for 20 minutes each day by Brief Fatigue Inventory during cancer treatment.
CONCLUSION
A home- based walking exercise program can reduce fatigue. It is potentially effective, low cost and feasible which is suggested for women under breast cancer treatment, but it needs further testing in large randomized clinical trials.
KEYWORDS
Exercise, Fatigue, Breast cancer
RESEARCH ARTICLE
The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes
Kerry S. Courneya1*, Christine M. Friedenreich2,Rami A. Sela1, H. Arthur Quinney1, Ryan. E. Rhodes3, Michael Handman1 1Faculty of Physical Education, University of Alberta,Alberta, Canada T6G 2H9 2Alberta Cancer Board, Alberta, Canada 3University of Victoria, Canada

Physical exercise has been shown to enhance quality of life (QOL) in cancer survivors using pretest-posttest designs and compared to usual care (i.e. no intervention). In the present study, we conducted a randomized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy (GP).We matched 22 GP classes (N=108) on content and then randomly assigned 11 (n=48) to GP alone and 11 (n=60) to GP plus home-based, moderate-intensity exercise (GP+EX). Participants completed a physical fitness test and QOL measures (e.g. Functional Assessment of Cancer Therapy scales) at the beginning and end of GP classes (about 10 weeks). We had excellent recruitment (81%), retention (89%), and adherence (84%) rates and a modest contamination (22%) rate.Using intention-to-treat repeated measures analyses of variance, we found significant Time by Condition interactions for functional well-being,fatigue, and sum of skinfolds.We also found borderline significant interactions for physical well-being, satisfaction with life, and flexibility. All interactions favored the GP+EX condition. We conclude that a home-based, moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP, particularly in relation to physical and functional well-being. Copyright© 2003John Wiley & Sons, Ltd.

■ POSTER SESSION p181

Effect of Local Hyperthermia combined with External Radiation Therapy as Anti Cancer-treatment in Recurrent Breast Cancer
Rigler Marcus Yves, Spenger M, Lenhart U. med-uni-graz - Graz - Austria

Hyperthermia combined with radiation therapy has been confirmed in several randomised studies to be more effectivethan radiation therapy alone in various cancers. We evaluated the potential synergistic effect of local hyperthermia and conventional external beam radiation. We used a wave-guide applicator with a typical emitting diameter of 15 cm and a frequency of 150-430 MHz with a therapeutic depth of 3 cm. Hyperthermia was performed for 60 minutes for at total of six sessions, twice weekly, the temperature was exactly calibrated between 40 and 43 degrees C. Immediately after hyperthermia external radiation with 60 Gy was applied in a daily fraction of 1.5 Gy. No major side effects were observed during hyperthermia. Twelve patients were treated and followed for during 2-12 months. Ten of the tumours responded to the treatment(3 CR, 7PR), two patients died of distant metastases withinone year.
Local hyperthermia combined with conventional radiation therapy may be useful tool to promote tumor regression and the local recurrence-free survival in cases of recurrance breast cancer.We conclude that hyperthermia and radiation therapy is effective in treatment breast cancer treatment and should be used in selected cancer patients