Article

Key clinical point: Patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) advanced breast cancer (BC) reported greater clinical benefits with oral vinorelbine + cyclophosphamide + capecitabine (VEX) regimen vs intravenous paclitaxel without experiencing unmanageable adverse events (AE).

Major finding: Oral metronomic VEX vs intravenous paclitaxel significantly improved the median time to treatment failure (8.3 vs 5.7 months; hazard ratio [HR] 0.61; P = .008) and median progression-free survival (11.1 vs 6.9 months; HR 0.67; P = .03). Although the frequency of targeted grade 3 or 4 AE was higher in the VEX vs paclitaxel group (42.9% vs 28.6%), they were mostly manageable.

Study details: Findings are from the phase 2 METEORA-II study including 140 patients with ER+/ERBB2− metastatic BC who were treated with ≥ 1 line of chemotherapy and were randomly assigned to receive oral VEX or weekly intravenous paclitaxel in 4-week cycles.

Disclosures: This study was funded by Pierre-Fabre Pharma Srl and other sources. Some authors declared receiving grants, personal fees, consulting fees, funding, speaker honoraria, and having other ties with various sources, including the funding agencies.

Source: Munzone E et al for the International Breast Cancer Study Group (IBCSG). Efficacy of metronomic oral vinorelbine, cyclophosphamide, and capecitabine vs weekly intravenous paclitaxel in patients with estrogen receptor-positive, ERBB2-negative metastatic breast cancer: Final results from the phase 2 METEORA-II randomized clinical trial. JAMA Oncol. 2023 (Jul 13). doi: 10.1001/jamaoncol.2023.2150

Key clinical point: Patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) advanced breast cancer (BC) reported greater clinical benefits with oral vinorelbine + cyclophosphamide + capecitabine (VEX) regimen vs intravenous paclitaxel without experiencing unmanageable adverse events (AE).

Major finding: Oral metronomic VEX vs intravenous paclitaxel significantly improved the median time to treatment failure (8.3 vs 5.7 months; hazard ratio [HR] 0.61; P = .008) and median progression-free survival (11.1 vs 6.9 months; HR 0.67; P = .03). Although the frequency of targeted grade 3 or 4 AE was higher in the VEX vs paclitaxel group (42.9% vs 28.6%), they were mostly manageable.

Study details: Findings are from the phase 2 METEORA-II study including 140 patients with ER+/ERBB2− metastatic BC who were treated with ≥ 1 line of chemotherapy and were randomly assigned to receive oral VEX or weekly intravenous paclitaxel in 4-week cycles.

Disclosures: This study was funded by Pierre-Fabre Pharma Srl and other sources. Some authors declared receiving grants, personal fees, consulting fees, funding, speaker honoraria, and having other ties with various sources, including the funding agencies.

Source: Munzone E et al for the International Breast Cancer Study Group (IBCSG). Efficacy of metronomic oral vinorelbine, cyclophosphamide, and capecitabine vs weekly intravenous paclitaxel in patients with estrogen receptor-positive, ERBB2-negative metastatic breast cancer: Final results from the phase 2 METEORA-II randomized clinical trial. JAMA Oncol. 2023 (Jul 13). doi: 10.1001/jamaoncol.2023.2150

Key clinical point: Patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) advanced breast cancer (BC) reported greater clinical benefits with oral vinorelbine + cyclophosphamide + capecitabine (VEX) regimen vs intravenous paclitaxel without experiencing unmanageable adverse events (AE).

Major finding: Oral metronomic VEX vs intravenous paclitaxel significantly improved the median time to treatment failure (8.3 vs 5.7 months; hazard ratio [HR] 0.61; P = .008) and median progression-free survival (11.1 vs 6.9 months; HR 0.67; P = .03). Although the frequency of targeted grade 3 or 4 AE was higher in the VEX vs paclitaxel group (42.9% vs 28.6%), they were mostly manageable.

Study details: Findings are from the phase 2 METEORA-II study including 140 patients with ER+/ERBB2− metastatic BC who were treated with ≥ 1 line of chemotherapy and were randomly assigned to receive oral VEX or weekly intravenous paclitaxel in 4-week cycles.

Disclosures: This study was funded by Pierre-Fabre Pharma Srl and other sources. Some authors declared receiving grants, personal fees, consulting fees, funding, speaker honoraria, and having other ties with various sources, including the funding agencies.

Source: Munzone E et al for the International Breast Cancer Study Group (IBCSG). Efficacy of metronomic oral vinorelbine, cyclophosphamide, and capecitabine vs weekly intravenous paclitaxel in patients with estrogen receptor-positive, ERBB2-negative metastatic breast cancer: Final results from the phase 2 METEORA-II randomized clinical trial. JAMA Oncol. 2023 (Jul 13). doi: 10.1001/jamaoncol.2023.2150

Key clinical point: Biological aging was faster in women who were diagnosed and treated for breast cancer (BC) vs women who remained free of BC.

Major finding: Women who were diagnosed and treated for BC had higher epigenetic age acceleration metrics (PhenoAge epigenetic clock: standardized mean difference [β] 0.13; P = .04; GrimAge epigenetic clock: β 0.14; P = .01) and aging rates (Dunedin Pace of Aging: β 0.37; P < .001) than those who remained free of BC.

Study details: Findings are from a case-control analysis of the Sister Study cohort including paired blood samples from 417 women collected on an average of 7.7 years apart, of whom 190 women were diagnosed and treated for BC and 227 women remained free of BC.

Disclosures: This study was supported by the Intramural Research Program of the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Kresovich JK et al. Changes in methylation-based aging in women who do and do not develop breast cancer. J Natl Cancer Inst. 2023 (Jul 19). doi: 10.1093/jnci/djad117

Key clinical point: Biological aging was faster in women who were diagnosed and treated for breast cancer (BC) vs women who remained free of BC.

Major finding: Women who were diagnosed and treated for BC had higher epigenetic age acceleration metrics (PhenoAge epigenetic clock: standardized mean difference [β] 0.13; P = .04; GrimAge epigenetic clock: β 0.14; P = .01) and aging rates (Dunedin Pace of Aging: β 0.37; P < .001) than those who remained free of BC.

Study details: Findings are from a case-control analysis of the Sister Study cohort including paired blood samples from 417 women collected on an average of 7.7 years apart, of whom 190 women were diagnosed and treated for BC and 227 women remained free of BC.

Disclosures: This study was supported by the Intramural Research Program of the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Kresovich JK et al. Changes in methylation-based aging in women who do and do not develop breast cancer. J Natl Cancer Inst. 2023 (Jul 19). doi: 10.1093/jnci/djad117

Key clinical point: Biological aging was faster in women who were diagnosed and treated for breast cancer (BC) vs women who remained free of BC.

Major finding: Women who were diagnosed and treated for BC had higher epigenetic age acceleration metrics (PhenoAge epigenetic clock: standardized mean difference [β] 0.13; P = .04; GrimAge epigenetic clock: β 0.14; P = .01) and aging rates (Dunedin Pace of Aging: β 0.37; P < .001) than those who remained free of BC.

Study details: Findings are from a case-control analysis of the Sister Study cohort including paired blood samples from 417 women collected on an average of 7.7 years apart, of whom 190 women were diagnosed and treated for BC and 227 women remained free of BC.

Disclosures: This study was supported by the Intramural Research Program of the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Kresovich JK et al. Changes in methylation-based aging in women who do and do not develop breast cancer. J Natl Cancer Inst. 2023 (Jul 19). doi: 10.1093/jnci/djad117

Key clinical point: Continued breast cancer (BC) screening leads to the detection of a higher number of BC cases which may increase the risk of BC overdiagnosis in women age ≥ 70 years.

Major finding: The cumulative incidence of BC was 6.1 vs 4.2 cases per 100 screened vs unscreened women age 70-74 years, and the rate of BC overdiagnosis was estimated to be 31%. The estimated rates of BC overdiagnosis increased to 47% and 54% in women age 75-84 years and ≥85 years, respectively, and screening did not improve BC-specific mortality in any of these age groups.

Study details: This retrospective cohort study evaluated 54,635 women from the Surveillance, Epidemiology, and End Results-Medicare (SEER) registry who were age ≥ 70 years and underwent screening.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, salary support, or research funding from various sources, including the National Cancer Institute.

Source: Richman IB et al. Estimating breast cancer overdiagnosis after screening mammography among older women in the United States. Ann Intern Med. 2023 (Aug 8). doi: 10.7326/M23-0133

Key clinical point: Continued breast cancer (BC) screening leads to the detection of a higher number of BC cases which may increase the risk of BC overdiagnosis in women age ≥ 70 years.

Major finding: The cumulative incidence of BC was 6.1 vs 4.2 cases per 100 screened vs unscreened women age 70-74 years, and the rate of BC overdiagnosis was estimated to be 31%. The estimated rates of BC overdiagnosis increased to 47% and 54% in women age 75-84 years and ≥85 years, respectively, and screening did not improve BC-specific mortality in any of these age groups.

Study details: This retrospective cohort study evaluated 54,635 women from the Surveillance, Epidemiology, and End Results-Medicare (SEER) registry who were age ≥ 70 years and underwent screening.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, salary support, or research funding from various sources, including the National Cancer Institute.

Source: Richman IB et al. Estimating breast cancer overdiagnosis after screening mammography among older women in the United States. Ann Intern Med. 2023 (Aug 8). doi: 10.7326/M23-0133

Key clinical point: Continued breast cancer (BC) screening leads to the detection of a higher number of BC cases which may increase the risk of BC overdiagnosis in women age ≥ 70 years.

Major finding: The cumulative incidence of BC was 6.1 vs 4.2 cases per 100 screened vs unscreened women age 70-74 years, and the rate of BC overdiagnosis was estimated to be 31%. The estimated rates of BC overdiagnosis increased to 47% and 54% in women age 75-84 years and ≥85 years, respectively, and screening did not improve BC-specific mortality in any of these age groups.

Study details: This retrospective cohort study evaluated 54,635 women from the Surveillance, Epidemiology, and End Results-Medicare (SEER) registry who were age ≥ 70 years and underwent screening.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, salary support, or research funding from various sources, including the National Cancer Institute.

Source: Richman IB et al. Estimating breast cancer overdiagnosis after screening mammography among older women in the United States. Ann Intern Med. 2023 (Aug 8). doi: 10.7326/M23-0133

Key clinical point: A higher body mass index (BMI) was associated with a lower frequency of hematologic toxicities and, consequently, with a lower rate of treatment discontinuation in women with early-stage hormone receptor-positive (HR+) breast cancer (BC) who received palbociclib + endocrine therapy (ET).

Major finding: In women who received palbociclib, higher BMI was associated with a significantly lower rate of neutropenia (odds ratio for a 1-unit change in BMI 0.93; 95% CI 0.92-0.95) and hence, with a lower rate of treatment discontinuation (adjusted hazard ratio for a 10-unit change in BMI 0.75; 95% CI 0.67-0.83).

Study details: Findings are from an analysis of the PALLAS trial including 5698 patients with early-stage II-III, HR+/human epidermal growth factor receptor 2-negative BC who were randomly assigned to receive adjuvant ET for ≥ 5 years with or without palbociclib for 2 years.

Disclosures: This study was supported by Pfizer and other sources. Two authors declared being employees and stockholders of Pfizer. The other authors reported ties with several sources, including Pfizer.

Source: Pfeiler G et al on behalf of the PALLAS Groups and Investigators. Impact of BMI in patients with early hormone receptor-positive breast cancer receiving endocrine therapy with or without palbociclib in the PALLAS trial. J Clin Oncol. 2023 (Aug 9). doi: 10.1200/JCO.23.00126

Key clinical point: A higher body mass index (BMI) was associated with a lower frequency of hematologic toxicities and, consequently, with a lower rate of treatment discontinuation in women with early-stage hormone receptor-positive (HR+) breast cancer (BC) who received palbociclib + endocrine therapy (ET).

Major finding: In women who received palbociclib, higher BMI was associated with a significantly lower rate of neutropenia (odds ratio for a 1-unit change in BMI 0.93; 95% CI 0.92-0.95) and hence, with a lower rate of treatment discontinuation (adjusted hazard ratio for a 10-unit change in BMI 0.75; 95% CI 0.67-0.83).

Study details: Findings are from an analysis of the PALLAS trial including 5698 patients with early-stage II-III, HR+/human epidermal growth factor receptor 2-negative BC who were randomly assigned to receive adjuvant ET for ≥ 5 years with or without palbociclib for 2 years.

Disclosures: This study was supported by Pfizer and other sources. Two authors declared being employees and stockholders of Pfizer. The other authors reported ties with several sources, including Pfizer.

Source: Pfeiler G et al on behalf of the PALLAS Groups and Investigators. Impact of BMI in patients with early hormone receptor-positive breast cancer receiving endocrine therapy with or without palbociclib in the PALLAS trial. J Clin Oncol. 2023 (Aug 9). doi: 10.1200/JCO.23.00126

Key clinical point: A higher body mass index (BMI) was associated with a lower frequency of hematologic toxicities and, consequently, with a lower rate of treatment discontinuation in women with early-stage hormone receptor-positive (HR+) breast cancer (BC) who received palbociclib + endocrine therapy (ET).

Major finding: In women who received palbociclib, higher BMI was associated with a significantly lower rate of neutropenia (odds ratio for a 1-unit change in BMI 0.93; 95% CI 0.92-0.95) and hence, with a lower rate of treatment discontinuation (adjusted hazard ratio for a 10-unit change in BMI 0.75; 95% CI 0.67-0.83).

Study details: Findings are from an analysis of the PALLAS trial including 5698 patients with early-stage II-III, HR+/human epidermal growth factor receptor 2-negative BC who were randomly assigned to receive adjuvant ET for ≥ 5 years with or without palbociclib for 2 years.

Disclosures: This study was supported by Pfizer and other sources. Two authors declared being employees and stockholders of Pfizer. The other authors reported ties with several sources, including Pfizer.

Source: Pfeiler G et al on behalf of the PALLAS Groups and Investigators. Impact of BMI in patients with early hormone receptor-positive breast cancer receiving endocrine therapy with or without palbociclib in the PALLAS trial. J Clin Oncol. 2023 (Aug 9). doi: 10.1200/JCO.23.00126

Key clinical point: Trastuzumab deruxtecan can be considered a safe treatment option in patients with metastatic breast cancer (BC) given the low incidence of interstitial lung disease (ILD) and cardiotoxicity events and the fact that a 5.4 mg/kg dosing is significantly safer than a 6.4 mg/kg dosing.

Major finding: The incidence rate of ILD was 11.7%, with ILD being reported in a significantly higher proportion of patients receiving 6.4 mg/kg vs 5.4 mg/kg (22.7% vs 10.2%; P < .01) of trastuzumab deruxtecan. The majority (80.2%) of ILD cases were of grade 1 or 2 and mostly manageable. Cardiotoxicity measured by decreased left ventricular ejection fraction was reported in 1.95% patients.

Study details: Findings are from a meta-analysis of 15 studies including 1970 patients with metastatic BC who received ≥ 1 dose of trastuzumab deruxtecan.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Soares LR et al. Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: A systematic review and single-arm meta-analysis. ESMO Open. 2023;8(4):101613 (Jul 21). doi: 10.1016/j.esmoop.2023.101613

Key clinical point: Trastuzumab deruxtecan can be considered a safe treatment option in patients with metastatic breast cancer (BC) given the low incidence of interstitial lung disease (ILD) and cardiotoxicity events and the fact that a 5.4 mg/kg dosing is significantly safer than a 6.4 mg/kg dosing.

Major finding: The incidence rate of ILD was 11.7%, with ILD being reported in a significantly higher proportion of patients receiving 6.4 mg/kg vs 5.4 mg/kg (22.7% vs 10.2%; P < .01) of trastuzumab deruxtecan. The majority (80.2%) of ILD cases were of grade 1 or 2 and mostly manageable. Cardiotoxicity measured by decreased left ventricular ejection fraction was reported in 1.95% patients.

Study details: Findings are from a meta-analysis of 15 studies including 1970 patients with metastatic BC who received ≥ 1 dose of trastuzumab deruxtecan.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Soares LR et al. Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: A systematic review and single-arm meta-analysis. ESMO Open. 2023;8(4):101613 (Jul 21). doi: 10.1016/j.esmoop.2023.101613

Key clinical point: Trastuzumab deruxtecan can be considered a safe treatment option in patients with metastatic breast cancer (BC) given the low incidence of interstitial lung disease (ILD) and cardiotoxicity events and the fact that a 5.4 mg/kg dosing is significantly safer than a 6.4 mg/kg dosing.

Major finding: The incidence rate of ILD was 11.7%, with ILD being reported in a significantly higher proportion of patients receiving 6.4 mg/kg vs 5.4 mg/kg (22.7% vs 10.2%; P < .01) of trastuzumab deruxtecan. The majority (80.2%) of ILD cases were of grade 1 or 2 and mostly manageable. Cardiotoxicity measured by decreased left ventricular ejection fraction was reported in 1.95% patients.

Study details: Findings are from a meta-analysis of 15 studies including 1970 patients with metastatic BC who received ≥ 1 dose of trastuzumab deruxtecan.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Soares LR et al. Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: A systematic review and single-arm meta-analysis. ESMO Open. 2023;8(4):101613 (Jul 21). doi: 10.1016/j.esmoop.2023.101613

Key clinical point: Pyrotinib showed promising anti-tumor activity in first-, second-, and third- or later-line treatment settings along with a manageable safety profile in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: Median real-world progression-free survival (rwPFS) was 14.3 months (95% CI 13.3-15.2) for the total population. Median rwPFS was 17.8 months (95% CI 15.2-24.9) in the first-line treatment setting, 14.4 months (95% CI 12.9-15.3) in the second-line setting, and 9.3 months (95% CI 8.4-11.8) in the third- or later-line settings. Diarrhea (any grade) was the most common adverse event (73.4%).

Study details: This prospective observational study included 1129 patients with HER2+ advanced BC who received pyrotinib-based therapy in first- (n = 437), second- (n = 476), and third- or later-line (n = 216) settings.

Disclosures: This study was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences and Jiangsu Hengrui Pharmaceuticals Co., Ltd. The authors declared no conflicts of interest.

Source: Li Y et al. Real-world treatment patterns and outcomes of pyrotinib-based therapy in patients with HER2-positive advanced breast cancer (PRETTY): A nationwide, prospective, observational study. Int J Cancer. 2023 (Aug 6). doi: 10.1002/ijc.34676

Key clinical point: Pyrotinib showed promising anti-tumor activity in first-, second-, and third- or later-line treatment settings along with a manageable safety profile in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: Median real-world progression-free survival (rwPFS) was 14.3 months (95% CI 13.3-15.2) for the total population. Median rwPFS was 17.8 months (95% CI 15.2-24.9) in the first-line treatment setting, 14.4 months (95% CI 12.9-15.3) in the second-line setting, and 9.3 months (95% CI 8.4-11.8) in the third- or later-line settings. Diarrhea (any grade) was the most common adverse event (73.4%).

Study details: This prospective observational study included 1129 patients with HER2+ advanced BC who received pyrotinib-based therapy in first- (n = 437), second- (n = 476), and third- or later-line (n = 216) settings.

Disclosures: This study was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences and Jiangsu Hengrui Pharmaceuticals Co., Ltd. The authors declared no conflicts of interest.

Source: Li Y et al. Real-world treatment patterns and outcomes of pyrotinib-based therapy in patients with HER2-positive advanced breast cancer (PRETTY): A nationwide, prospective, observational study. Int J Cancer. 2023 (Aug 6). doi: 10.1002/ijc.34676

Key clinical point: Pyrotinib showed promising anti-tumor activity in first-, second-, and third- or later-line treatment settings along with a manageable safety profile in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: Median real-world progression-free survival (rwPFS) was 14.3 months (95% CI 13.3-15.2) for the total population. Median rwPFS was 17.8 months (95% CI 15.2-24.9) in the first-line treatment setting, 14.4 months (95% CI 12.9-15.3) in the second-line setting, and 9.3 months (95% CI 8.4-11.8) in the third- or later-line settings. Diarrhea (any grade) was the most common adverse event (73.4%).

Study details: This prospective observational study included 1129 patients with HER2+ advanced BC who received pyrotinib-based therapy in first- (n = 437), second- (n = 476), and third- or later-line (n = 216) settings.

Disclosures: This study was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences and Jiangsu Hengrui Pharmaceuticals Co., Ltd. The authors declared no conflicts of interest.

Source: Li Y et al. Real-world treatment patterns and outcomes of pyrotinib-based therapy in patients with HER2-positive advanced breast cancer (PRETTY): A nationwide, prospective, observational study. Int J Cancer. 2023 (Aug 6). doi: 10.1002/ijc.34676

Key clinical point: Surgery followed by adjuvant chemotherapy (ACT) did not demonstrate inferior survival outcomes compared with neoadjuvant chemotherapy (NACT) followed by surgery in patients with clinical stage T1 node-negative (T1N0) triple negative breast cancer (TNBC), whereas NACT was more effective than ACT in clinical stage T1c BC.

Major finding: Patients with T1N0 TNBC who received NACT vs ACT had worse overall survival (OS) outcomes (hazard ratio 1.42; P < .001); however, OS was better in patients with clinical stage T1c TNBC who achieved pathological complete response with NACT vs those with unchanged stages who underwent surgery and received ACT (94.4% vs 91.9%; P = .025).

Study details: This retrospective analysis included 35,521 patients with T1N0 TNBC from the US National Cancer Database who received either adjuvant chemotherapy after upfront surgery (n = 32,066) or neoadjuvant chemotherapy before surgery (n = 3455).

Disclosures: This study did not declare any funding source or conflicts of interest.

Source: Huang K et al. Overall survival following neoadjuvant chemotherapy versus adjuvant chemotherapy in clinically node negative T1 triple negative breast cancer. Ann Surg Oncol. 2023 (Jul 25). doi: 10.1245/s10434-023-13977-4

Key clinical point: Surgery followed by adjuvant chemotherapy (ACT) did not demonstrate inferior survival outcomes compared with neoadjuvant chemotherapy (NACT) followed by surgery in patients with clinical stage T1 node-negative (T1N0) triple negative breast cancer (TNBC), whereas NACT was more effective than ACT in clinical stage T1c BC.

Major finding: Patients with T1N0 TNBC who received NACT vs ACT had worse overall survival (OS) outcomes (hazard ratio 1.42; P < .001); however, OS was better in patients with clinical stage T1c TNBC who achieved pathological complete response with NACT vs those with unchanged stages who underwent surgery and received ACT (94.4% vs 91.9%; P = .025).

Study details: This retrospective analysis included 35,521 patients with T1N0 TNBC from the US National Cancer Database who received either adjuvant chemotherapy after upfront surgery (n = 32,066) or neoadjuvant chemotherapy before surgery (n = 3455).

Disclosures: This study did not declare any funding source or conflicts of interest.

Source: Huang K et al. Overall survival following neoadjuvant chemotherapy versus adjuvant chemotherapy in clinically node negative T1 triple negative breast cancer. Ann Surg Oncol. 2023 (Jul 25). doi: 10.1245/s10434-023-13977-4

Key clinical point: Surgery followed by adjuvant chemotherapy (ACT) did not demonstrate inferior survival outcomes compared with neoadjuvant chemotherapy (NACT) followed by surgery in patients with clinical stage T1 node-negative (T1N0) triple negative breast cancer (TNBC), whereas NACT was more effective than ACT in clinical stage T1c BC.

Major finding: Patients with T1N0 TNBC who received NACT vs ACT had worse overall survival (OS) outcomes (hazard ratio 1.42; P < .001); however, OS was better in patients with clinical stage T1c TNBC who achieved pathological complete response with NACT vs those with unchanged stages who underwent surgery and received ACT (94.4% vs 91.9%; P = .025).

Study details: This retrospective analysis included 35,521 patients with T1N0 TNBC from the US National Cancer Database who received either adjuvant chemotherapy after upfront surgery (n = 32,066) or neoadjuvant chemotherapy before surgery (n = 3455).

Disclosures: This study did not declare any funding source or conflicts of interest.

Source: Huang K et al. Overall survival following neoadjuvant chemotherapy versus adjuvant chemotherapy in clinically node negative T1 triple negative breast cancer. Ann Surg Oncol. 2023 (Jul 25). doi: 10.1245/s10434-023-13977-4

Key clinical point: In patients with cT1-2 N0 breast cancer (BC) who underwent mastectomy and had 1-2 positive nodes on sentinel lymph node biopsy (SLNB), the rate of local-regional recurrence (LRR) was extremely low regardless of completion axillary node dissection (CLND) or radiation therapy.

Major finding: The 5-year cumulative incidence rate of overall LRR was comparable between patients who underwent vs did not undergo CLND (1.8% vs 1.3%; P = .93), with the receipt of post-mastectomy radiation therapy not affecting the LRR rate in both categories of patients who underwent SLNB alone and SLNB with CLND (P = .1638 for both).

Study details: Findings are from the analysis of a prospective institutional database including 548 patients with cT1-2 N0 BC who underwent mastectomy and had 1-2 positive lymph nodes on SLNB, and 77% of these patients underwent CLND.

Disclosures: This study was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research and other sources. The authors declared no conflicts of interest.

Source: Zaveri S et al. Extremely low incidence of local-regional recurrences observed among T1-2 N1 (1 or 2 positive SLNs) breast cancer patients receiving upfront mastectomy without completion axillary node dissection. Ann Surg Oncol. 2023 (Jul 17). doi: 10.1245/s10434-023-13942-1

Key clinical point: In patients with cT1-2 N0 breast cancer (BC) who underwent mastectomy and had 1-2 positive nodes on sentinel lymph node biopsy (SLNB), the rate of local-regional recurrence (LRR) was extremely low regardless of completion axillary node dissection (CLND) or radiation therapy.

Major finding: The 5-year cumulative incidence rate of overall LRR was comparable between patients who underwent vs did not undergo CLND (1.8% vs 1.3%; P = .93), with the receipt of post-mastectomy radiation therapy not affecting the LRR rate in both categories of patients who underwent SLNB alone and SLNB with CLND (P = .1638 for both).

Study details: Findings are from the analysis of a prospective institutional database including 548 patients with cT1-2 N0 BC who underwent mastectomy and had 1-2 positive lymph nodes on SLNB, and 77% of these patients underwent CLND.

Disclosures: This study was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research and other sources. The authors declared no conflicts of interest.

Source: Zaveri S et al. Extremely low incidence of local-regional recurrences observed among T1-2 N1 (1 or 2 positive SLNs) breast cancer patients receiving upfront mastectomy without completion axillary node dissection. Ann Surg Oncol. 2023 (Jul 17). doi: 10.1245/s10434-023-13942-1

Key clinical point: In patients with cT1-2 N0 breast cancer (BC) who underwent mastectomy and had 1-2 positive nodes on sentinel lymph node biopsy (SLNB), the rate of local-regional recurrence (LRR) was extremely low regardless of completion axillary node dissection (CLND) or radiation therapy.

Major finding: The 5-year cumulative incidence rate of overall LRR was comparable between patients who underwent vs did not undergo CLND (1.8% vs 1.3%; P = .93), with the receipt of post-mastectomy radiation therapy not affecting the LRR rate in both categories of patients who underwent SLNB alone and SLNB with CLND (P = .1638 for both).

Study details: Findings are from the analysis of a prospective institutional database including 548 patients with cT1-2 N0 BC who underwent mastectomy and had 1-2 positive lymph nodes on SLNB, and 77% of these patients underwent CLND.

Disclosures: This study was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research and other sources. The authors declared no conflicts of interest.

Source: Zaveri S et al. Extremely low incidence of local-regional recurrences observed among T1-2 N1 (1 or 2 positive SLNs) breast cancer patients receiving upfront mastectomy without completion axillary node dissection. Ann Surg Oncol. 2023 (Jul 17). doi: 10.1245/s10434-023-13942-1

Key clinical point: Patients with advanced or metastatic breast cancer (BC) who received concomitant proton pump inhibitors (PPI) plus palbociclib experienced less favorable survival outcomes compared with those who received palbociclib only.

Major finding: Patients who received concomitant PPI + palbociclib vs only palbociclib had significantly shorter progression-free survival (hazard ratio [HR] 1.76; 95% CI 1.46-2.13) and overall survival (HR 2.72; 95% CI 2.07-3.53) rates.

Study details: This retrospective cohort study included 1310 patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced or metastatic BC, of which 344 and 966 patients received concomitant PPI + palbociclib and palbociclib only, respectively.

Disclosures: This study was funded by Sungkyunkwan University (South Korea), the Korean Ministry of Education, and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Lee J-E et al. Concomitant use of proton pump inhibitors and palbociclib among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2324852 (Jul 21). doi: 10.1001/jamanetworkopen.2023.24852

Key clinical point: Patients with advanced or metastatic breast cancer (BC) who received concomitant proton pump inhibitors (PPI) plus palbociclib experienced less favorable survival outcomes compared with those who received palbociclib only.

Major finding: Patients who received concomitant PPI + palbociclib vs only palbociclib had significantly shorter progression-free survival (hazard ratio [HR] 1.76; 95% CI 1.46-2.13) and overall survival (HR 2.72; 95% CI 2.07-3.53) rates.

Study details: This retrospective cohort study included 1310 patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced or metastatic BC, of which 344 and 966 patients received concomitant PPI + palbociclib and palbociclib only, respectively.

Disclosures: This study was funded by Sungkyunkwan University (South Korea), the Korean Ministry of Education, and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Lee J-E et al. Concomitant use of proton pump inhibitors and palbociclib among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2324852 (Jul 21). doi: 10.1001/jamanetworkopen.2023.24852

Key clinical point: Patients with advanced or metastatic breast cancer (BC) who received concomitant proton pump inhibitors (PPI) plus palbociclib experienced less favorable survival outcomes compared with those who received palbociclib only.

Major finding: Patients who received concomitant PPI + palbociclib vs only palbociclib had significantly shorter progression-free survival (hazard ratio [HR] 1.76; 95% CI 1.46-2.13) and overall survival (HR 2.72; 95% CI 2.07-3.53) rates.

Study details: This retrospective cohort study included 1310 patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced or metastatic BC, of which 344 and 966 patients received concomitant PPI + palbociclib and palbociclib only, respectively.

Disclosures: This study was funded by Sungkyunkwan University (South Korea), the Korean Ministry of Education, and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Lee J-E et al. Concomitant use of proton pump inhibitors and palbociclib among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2324852 (Jul 21). doi: 10.1001/jamanetworkopen.2023.24852

Key clinical point: Discontinuing adjuvant hormone therapy (HT) was associated with a higher likelihood of discontinuing cardiovascular therapy and an increased risk for mortality due to cardiovascular diseases in patients with estrogen receptor-positive breast cancer (ER+ BC).

Major finding: Compared with patients who continued adjuvant HT, the rate of discontinuing cardiovascular therapy was higher among patients who discontinued HT within a period of 3 months before (incidence rate ratio [IRR] 1.83; 95% CI 1.41-2.37) and after (IRR 2.31; 95% CI 1.74-3.05) adjuvant HT discontinuation. Discontinuation of adjuvant HT was also associated with a higher risk for death due to cardiovascular diseases (hazard ratio 1.79; 95% CI 1.15-2.81).

Study details: Findings are from a population-based cohort study including 5493 patients with nonmetastatic ER+ BC who initiated adjuvant HT and concomitantly used cardiovascular therapy.

Disclosures: This study was supported by grants from the Swedish Research Council and other sources. The authors declared no conflicts of interest.

Source: He W et al. Concomitant discontinuation of cardiovascular therapy and adjuvant hormone therapy among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2323752 (Jul 17). doi: 10.1001/jamanetworkopen.2023.23752

Key clinical point: Discontinuing adjuvant hormone therapy (HT) was associated with a higher likelihood of discontinuing cardiovascular therapy and an increased risk for mortality due to cardiovascular diseases in patients with estrogen receptor-positive breast cancer (ER+ BC).

Major finding: Compared with patients who continued adjuvant HT, the rate of discontinuing cardiovascular therapy was higher among patients who discontinued HT within a period of 3 months before (incidence rate ratio [IRR] 1.83; 95% CI 1.41-2.37) and after (IRR 2.31; 95% CI 1.74-3.05) adjuvant HT discontinuation. Discontinuation of adjuvant HT was also associated with a higher risk for death due to cardiovascular diseases (hazard ratio 1.79; 95% CI 1.15-2.81).

Study details: Findings are from a population-based cohort study including 5493 patients with nonmetastatic ER+ BC who initiated adjuvant HT and concomitantly used cardiovascular therapy.

Disclosures: This study was supported by grants from the Swedish Research Council and other sources. The authors declared no conflicts of interest.

Source: He W et al. Concomitant discontinuation of cardiovascular therapy and adjuvant hormone therapy among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2323752 (Jul 17). doi: 10.1001/jamanetworkopen.2023.23752

Key clinical point: Discontinuing adjuvant hormone therapy (HT) was associated with a higher likelihood of discontinuing cardiovascular therapy and an increased risk for mortality due to cardiovascular diseases in patients with estrogen receptor-positive breast cancer (ER+ BC).

Major finding: Compared with patients who continued adjuvant HT, the rate of discontinuing cardiovascular therapy was higher among patients who discontinued HT within a period of 3 months before (incidence rate ratio [IRR] 1.83; 95% CI 1.41-2.37) and after (IRR 2.31; 95% CI 1.74-3.05) adjuvant HT discontinuation. Discontinuation of adjuvant HT was also associated with a higher risk for death due to cardiovascular diseases (hazard ratio 1.79; 95% CI 1.15-2.81).

Study details: Findings are from a population-based cohort study including 5493 patients with nonmetastatic ER+ BC who initiated adjuvant HT and concomitantly used cardiovascular therapy.

Disclosures: This study was supported by grants from the Swedish Research Council and other sources. The authors declared no conflicts of interest.

Source: He W et al. Concomitant discontinuation of cardiovascular therapy and adjuvant hormone therapy among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2323752 (Jul 17). doi: 10.1001/jamanetworkopen.2023.23752