10 Years On Tamoxifen Halves Breast Cancer Recurrence Risk

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Main Category: Breast Cancer
Also Included In: Cancer / Oncology
Article Date: 03 Jun 2013 - 4:00 PDT
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10 Years On Tamoxifen Halves Breast Cancer Recurrence Risk

Survivors who take tamoxifen for ten years have half the risk of dying from estrogen receptor positive breast cancer, researchers from Cancer Research UK reported at the ASCO Annual Meeting in Chicago, Illinois, USA.

Lead researcher, Dr Daniel Rea reported that the "aTTom" study demonstrated that estrogen receptor positive breast cancer patients who took tamoxifen for longer than five years were much less likely to suffer cancer recurrence or die from the disease. Currently, the recommended period for tamoxifen therapy is five years.

The study involved 6,953 adult females with breast cancer. 580 patients from 3,468 women took tamoxifen for ten years, while 672 of 3,485 patients stopped tamoxifen after five years.

Dr Rea reported that: 25% of the 10-year tamoxifen patients had fewer recurrences of breast cancer than those on just five years of therapyThere were 23% fewer deaths in the 10-year tamoxifen groupDr Daniel Rea, who is based at the University of Birmingham, England, said:

"These results are important as they establish that giving tamoxifen for longer than the current standard of five years significantly cuts the risk of breast cancer returning.

Doctors are now likely to recommend continuing tamoxifen for an extra five years and this will result in many fewer breast cancer recurrences and breast cancer deaths worldwide. Tamoxifen is cheap and widely available so this could have an immediate impact."

Approximately three-quarters of all breast cancers are of the estrogen receptor positive kind. This type of breast cancer benefits from hormone therapy. Estrogen, a female hormone, encourages breast cancers to grow by activating estrogen receptors. Tamoxifen works by blocking these receptors, thus making it much harder for the cancer to recur after surgery or invade the other breast.

Tamoxifen side effects - patients on tamoxifen may experience menopausal-type symptoms, including hot flashes (UK: hot flushes) and night sweats. A Norwegian study found that acupuncture reduces menopausal symptoms in tamoxifen patients by 50%. More rarely, tamoxifen has also been linked to an increased risk of developing blood clots, endometrial cancer and stroke.

Stroke risk did not rise with 10 years of tamoxifen therapy compared to five years, the researchers found. However, the risk of endometrial cancer did increase. Fortunately, endometrial cancer is usually diagnosed in the early stages of the disease, when it can be treated successfully.

According to the researchers, thirty breast cancer deaths would be prevented for every endometrial cancer death due to long-term tamoxifen therapy.

Professor Richard Gray, who is based at the University of Oxford and was also presenting the aTTom trial results at ASCO, said:

"Five years of tamoxifen is already an excellent treatment but there have been concerns that giving it for longer might not produce extra benefits and could even be harmful. The aTTom study establishes that the benefits of taking tamoxifen for longer greatly outweigh the risks.

Kate Law, director of clinical research at Cancer Research UK, said: "Large clinical trials like aTTom are vitally important to understand how drugs such as tamoxifen work and how best to use them. We need these sorts of studies so we can be sure the benefits from cancer drugs outweigh the side-effects that they may have."

The aTTom trial was funded by the Medical Research Council, UK.

A trial led by Oxford University's Clinical Trial Service Unit reported in The Lancet (December 2012 issue) that taking tamoxifen for ten years after breast cancer surgery is more effective than five years. The study was called ATLAS.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Study Finds Bladder Cancer Recurrence And Mortality Could Improve With Better Treatment Compliance

Main Category: Cancer / Oncology
Also Included In: Urology / Nephrology;??Compliance
Article Date: 05 Jun 2013 - 0:00 PDT Current ratings for:
Study Finds Bladder Cancer Recurrence And Mortality Could Improve With Better Treatment Compliance

Researchers at UCLA's Jonsson Comprehensive Cancer Center led by Dr. Karim Chamie, assistant professor-in-residence in the department of urology, have found that the burden of bladder cancer on the population is very high, and that more intense surveillance and treatment in the first two years after diagnosis could reduce the number of patients whose cancer returns after treatment and lower the death rate from this disease. The study was published online ahead of press today in the journal Cancer.

Based on their previous research showing underutilization of care for patients with bladder cancer, this is the first study to examine the natural history of the disease from a population standpoint. To date no one has examined the morbidity of recurrence of disease in the US. Chamie and colleagues found that nearly three quarters of patients with high-grade, non-muscle-invasive bladder cancer will suffer return of the disease (recurrence) within 10 years. Thirty-three percent of patients will have their cancers progress to a more advanced form requiring removal of their bladder, radiation therapy, or systemic chemotherapy. An additional 41% will recur without further spread of the disease (progression).

"Even though 80% of bladder cancer patients don't die of their disease within 5 years, most patients will either die of other causes or bladder cancer, require aggressive treatment (removal of the bladder, radiation, and/or chemotherapy), or have recurrence of their disease. What this study hopes to do is highlight the need to comply with treatment guidelines--prevent recurrences by instilling anticancer agents inside the bladder (intravesical) and follow patients more closely within the first two years of diagnosis," said Chamie.

The study was based on a nationwide sample of Medicare Beneficiaries who had high-grade, non-muscle-invasive bladder cancer. "We have level-one evidence that demonstrates that a single instillation of chemotherapy into the bladder can minimize recurrences, and that six instillations can minimize recurrence and progression," Chamie stated further, "Efforts should be increased to offer patients intravesical therapy with the goal of minimizing the burden of this disease."

The researchers also found that the elderly, women, and African-American patients had higher likelihood of dying of bladder cancer than younger patients, men, and whites, respectively.

This study was supported by the American Cancer Society, Ruth L. Kirschstein National Research Service Award Extramural, Jonsson Comprehensive Cancer Center, National Institutes of Health, and National Institute of Diabetes and Digestive and Kidney Diseases.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Delay in Radiation Therapy Increases Risk of Breast Cancer Recurrence

Among older women who undergo breast-conserving surgery (lumpectomy) for early breast cancer, a longer interval between surgery and the start of radiation therapy increases the risk of local cancer recurrence. These results were published in the British Medical Journal.

Surgery for early-stage breast cancer involves either a mastectomy or a lumpectomy. A mastectomy involves removal of the entire breast, whereas a lumpectomy involves removal of the cancer and some surrounding tissue.? Because a lumpectomy alone is associated with a higher rate of cancer recurrence than mastectomy, patients who elect to have a lumpectomy are also treated with radiation therapy. The combination of lumpectomy and radiation is referred to as breast-conserving therapy. Breast-conserving therapy and mastectomy produce similar rates of long-term survival.

Among women who undergo breast-conserving therapy, prompt treatment with radiation therapy after surgery may result in better outcomes than delayed radiation therapy. To explore this issue, researchers evaluated information from a large U.S. database that links cancer registry data with Medicare claims data. Information was available for more than 18,000 women over the age of 65 who had undergone breast-conserving therapy for Stage 0-II breast cancer. The study was restricted to women who did not receive chemotherapy.

The primary outcome of interest was the rate of local cancer recurrence (cancer recurrence within the breast).

The median time from surgery to start of radiation therapy was 34 days. Thirty percent of women started radiation therapy more than six weeks after surgery.

Longer intervals between surgery and the start of radiation therapy were linked with an increased risk of local cancer recurrence. For example, women who started radiation therapy more than six weeks after surgery were 19% more likely to experience local cancer recurrence than women who had a shorter interval between surgery and radiation.Women were more likely to have a longer interval between surgery and the start of radiation therapy if they had positive lymph nodes, other health conditions, a history of low income, or were of Hispanic ethnicity or non-White race. Longer intervals were also more common in regions of the United States that had higher rates of breast-conserving therapy, suggesting that busy treatment facilities may have longer wait times.

These results suggest that starting radiation therapy as soon as possible after lumpectomy may reduce the risk of local cancer recurrence.

Reference: Punglia RS, Saito AM, Neville BA, Earle CC, Weeks JC. Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis. British Medical Journal [early online publication]. March 2, 2010.

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Aspirin May Reduce Risk of Breast Cancer Recurrence and Death

Among women who are at least one year beyond a diagnosis of early-stage breast cancer, regular aspirin use may reduce the risk of breast cancer recurrence and death. These results were published in the Journal of Clinical Oncology.

Nonsteroidal anti-inflammatory drugs (NSAIDS) include drugs such as aspirin and ibuprofen. These drugs are commonly used to reduce inflammation and relieve pain. Studies conducted in the lab suggest that these drugs may have the ability to reduce breast cancer growth.

To explore the relationship between aspirin use and breast cancer outcomes, researchers conducted a study among more than 4,000 participants in the Nurses’ Health Study. The women included in the analysis had been diagnosed with Stage I-Stage III breast cancer between 1976 and 2002, and were observed until 2006.

Because women undergoing cancer treatment may need to avoid aspirin, information about aspirin use was not collected until at least one year after breast cancer diagnosis.

Compared with women who reported no aspirin use, risk of breast cancer death was reduced by 71% among women who used aspirin 2-5 times per week and by 64% among women who used aspirin 6-7 days per week.? Risk of distant recurrence was also reduced among aspirin users.The effect of aspirin on risk of distant recurrence and death did not appear to vary by cancer stage, menopausal status, body mass index, or estrogen receptor status.

These results suggest that among women living at least one year after a breast cancer diagnosis, regular aspirin use may reduce the risk of cancer recurrence and death. However, there are significant limitations of the study and aspirin should not be considered a standard treatment to prevent breast cancer recurrence.? In addition, there are risks associated with regular aspirin use.? Women with a history of breast cancer should talk to their doctors if they have further questions.

Reference: Holmes MD, Chen WY, Li L et al. Aspirin intake and survival after breast cancer. Journal of Clinical Oncology [early online publication]. February 16, 2010.

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Oncotype DX® Predicts Recurrence Risk in Node-negative and Node-positive Breast Cancer Treated with Tamoxifen or Arimidex

Oncotype DXR Predicts Recurrence Risk in Node-negative and Node-positive Breast Cancer Treated with Tamoxifen or Arimidex
Among postmenopausal women with early, hormone receptor-positive breast cancer treated with either tamoxifen (NolvadexR) or ArimidexR (anastrozole), the Oncotype DX test predicts the risk of distant cancer recurrence in both node-negative and node-positive patients. These results were published in the Journal of Clinical Oncology.

Oncotype DX is a genomic test that has been shown to predict the likelihood of distant cancer recurrence and the likelihood of chemotherapy benefit in women with early-stage, estrogen receptor-positive breast cancer that is treated with tamoxifen. The test evaluates the activity of 21 genes from a sample of the patient’s cancer to determine the patient’s Recurrence Score. The higher the Recurrence Score, the higher the risk of cancer recurrence. Oncotype DX has been added to U.S. medical guidelines for early-stage breast cancer.

The current analysis assessed how the Recurrence Score performed among women treated with the aromatase inhibitor drug Arimidex and among those with node-positive breast cancer.

The researchers collected information from 1,231 women who participated in the ATAC (Arimidex, Tamoxifen, Alone or in Combination) study. The study enrolled postmenopausal women with early, hormone receptor-positive breast cancer. Study participants received hormonal therapy with either tamoxifen or Arimidex.

The Recurrence Score (RS) predicted the risk of distant cancer recurrence among women with node-negative and node-positive breast cancer:

Among women with node-negative breast cancer, nine-year risk of distant cancer recurrence was 4% among women with a low Recurrence Score, 12% among women with an intermediate Recurrence Score, and 25% among women with a high Recurrence Score.Among women with node-positive breast cancer, nine-year risk of distant cancer recurrence was 17% among women with a low Recurrence Score, 28% among women with an intermediate Recurrence Score, and 49% among women with a high Recurrence Score.

The relationship between Recurrence Score and risk of distant cancer recurrence was similar regardless of the type of hormonal therapy that the women received.

This study suggests that the Oncotype DX test provides information about risk of distant cancer recurrence in both node-negative and node-positive, hormone-receptor positive breast cancer. Furthermore, Oncotype DX was predictive of distant recurrence risk among women treated with tamoxifen as well as women treated with Arimidex.

Reference: Dowsett M, Cuzick J, Wales C et al. Prediction of risk of distant recurrence using the 21-gene recurrence score in node-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study. Journal of Clinical Oncology [early online publication]. March 8, 2010.

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Oncotype DX DCIS Score Predicts Recurrence Risk for Women with DCIS

A DCIS Score generated by the Oncotype DX breast cancer test provides information about how likely it is that breast ductal carcinoma in situ (DCIS) will recur. This may help guide decisions about whether women with DCIS need radiation therapy after breast-conserving surgery. These results were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.????

Ductal carcinoma in situ refers to a condition in which abnormal cells are found within a breast duct but have not spread outside of the duct to other tissues in the breast. It is most commonly detected by screening mammography. If not treated, some cases of DCIS may progress to invasive breast cancer.?

Treatment for DCIS may involve breast-conserving surgery (lumpectomy) or mastectomy. For DCIS patients who choose breast-conserving surgery, additional treatment with radiation therapy has been shown to reduce the risk of recurrence, but may not be necessary for all women. If the characteristics of the DCIS suggest that it is unlikely to recur, surgery alone (without radiation therapy) may be an option.??

The Oncotype DX breast cancer test was originally developed to provide information about recurrence risk and need for chemotherapy to certain groups of women with early-stage, invasive breast cancer. The test has been added to US medical guidelines for this purpose.????

To determine whether the test can also predict recurrence risk in women with DCIS, researchers developed a DCIS Score that can be generated by the test. The ability of the DCIS Score to predict recurrence risk was evaluated among 327 women with DCIS who had participated in an earlier clinical trial of DCIS treatment. The women had been treated with breast-conserving surgery but had not received radiation therapy.????

Three-quarters of the patients had a low risk of recurrence based on the DCIS Score. These patients may not need radiation therapy after breast-conserving surgery.?Among women with a low risk of recurrence based on the DCIS Score, the likelihood of any kind of local recurrence (a recurrence that was either DCIS or invasive breast cancer) was 12 percent. The likelihood of a recurrence that involved invasive breast cancer 5 percent.?Among women with a high risk of recurrence based on the DCIS Score, the likelihood of any kind of local recurrence was 27 percent. The likelihood of a recurrence that involved invasive breast cancer was 19 percent.?

These results suggest that the Oncotype DX DCIS Score provides information about the risk of recurrence among women with DCIS. This information may help guide decisions about whether radiation therapy is necessary.?

Reference: Solin LJ, Gray R, Baehner FL. A Quantitative Multigene RT-PCR Assay for Predicting Recurrence Risk after Surgical Excision Alone without Irradiation for Ductal Carcinoma In Situ (DCIS): A Prospective Validation Study of the DCIS Score from ECOG E5194. Presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium. December 6-10, 2011. Abstract S4-6.?

Posted December 13, 2011?

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Femara Results in Lower Risk of Breast Cancer Recurrence Than Tamoxifen

Among postmenopausal women with early-stage, hormone receptor-positive breast cancer, five years of hormonal therapy with FemaraR (letrozole) results in a lower risk of cancer recurrence than five years of tamoxifen. These results were published in Lancet Oncology.?

The majority of breast cancers are hormone receptor-positive. These cancers are stimulated to grow by the circulating female hormones estrogen and/or progesterone. Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen as well as drugs known as aromatase inhibitors, such as Femara. Tamoxifen acts by blocking estrogen receptors, whereas aromatase inhibitors suppress the production of estrogen in postmenopausal women.?

The Breast International Group (BIG) 1-98 Trial is a Phase III clinical trial involving over 8,000 postmenopausal women with hormone receptor-positive early breast cancer. The women were assigned one of four different approaches to hormonal therapy:??

Five years of tamoxifen?Five years of Femara?Two years of Femara followed by three years of tamoxifen?Two years of tamoxifen followed by three years of Femara?

Previous results from this study showed that five years of Femara resulted in a lower risk of breast cancer recurrence than five years of tamoxifen, and that sequential treatment with the two drugs (Femara followed by tamoxifen or tamoxifen followed by Femara) did not appear to be superior to Femara alone.??

Study participants continue to be followed in order to assess longer-term outcomes. The women have now been followed for a median of just over eight years.?

At eight years, the percentage of women alive and free of cancer was 73.8% among women assigned to five years of Femara and 70.4% among women assigned to five years of tamoxifen.?Overall survival was 83.4% among women assigned to five years of Femara and 81.2% among women assigned to five years of tamoxifen.?Sequential treatment with Femara and tamoxifen did not appear to be more effective than Femara alone.?

For postmenopausal women with hormone receptor-positive breast cancer, these results continue to suggest that five years of Femara is more effective against breast cancer recurrence than five years of tamoxifen. Sequential treatment with the two drugs may be a useful strategy for some women.?

Reference: Regan MM, Neven P, Giobbie-Hurder A et al. Assessment of letrozole and tamoxifen alone and in sequence for postmenopausal women with steroid hormone receptor-positive breast cancer: the BIG 1-98 randomised clinical trial at 8.1 years median follow-up. Lancet Oncology. 2011;12:1101-1108.?

Posted November 9, 2011

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