Article

Key clinical point: The risk for non-breast second primary cancer (SPC) at many sites was significantly elevated in female breast cancer (BC) survivors, particularly those who were first diagnosed with BC before the age of 50 years.

Major finding: The summary standardized incidence ratio (SIR) for non-breast SPC was estimated to be 1.24 (95% CI 1.14-1.36), with the risk being significantly higher among patients diagnosed with BC before vs after the age of 50 years (SIR 1.59 vs 1.13; P < .001). The risk for non-breast SPC was the highest at the thyroid (SIR 1.89; 95% CI 1.49-2.38), followed by corpus uteri, ovary, kidney, esophagus, skin (melanoma), blood (leukemia), lung, stomach, and bladder.

Study details: Findings are from a meta-analysis of one prospective and 27 retrospective studies.

Disclosures: This study was funded by the CRUK Catalyst Award CanGene-CanVar, UK. The authors declared no conflicts of interest.

Source: Allen I et al. Risks of second non-breast primaries following breast cancer in women: A systematic review and meta-analysis. Breast Cancer Res. 2023;25(1):18 (Feb 10). Doi: 10.1186/s13058-023-01610-x

Key clinical point: The risk for non-breast second primary cancer (SPC) at many sites was significantly elevated in female breast cancer (BC) survivors, particularly those who were first diagnosed with BC before the age of 50 years.

Major finding: The summary standardized incidence ratio (SIR) for non-breast SPC was estimated to be 1.24 (95% CI 1.14-1.36), with the risk being significantly higher among patients diagnosed with BC before vs after the age of 50 years (SIR 1.59 vs 1.13; P < .001). The risk for non-breast SPC was the highest at the thyroid (SIR 1.89; 95% CI 1.49-2.38), followed by corpus uteri, ovary, kidney, esophagus, skin (melanoma), blood (leukemia), lung, stomach, and bladder.

Study details: Findings are from a meta-analysis of one prospective and 27 retrospective studies.

Disclosures: This study was funded by the CRUK Catalyst Award CanGene-CanVar, UK. The authors declared no conflicts of interest.

Source: Allen I et al. Risks of second non-breast primaries following breast cancer in women: A systematic review and meta-analysis. Breast Cancer Res. 2023;25(1):18 (Feb 10). Doi: 10.1186/s13058-023-01610-x

Key clinical point: The risk for non-breast second primary cancer (SPC) at many sites was significantly elevated in female breast cancer (BC) survivors, particularly those who were first diagnosed with BC before the age of 50 years.

Major finding: The summary standardized incidence ratio (SIR) for non-breast SPC was estimated to be 1.24 (95% CI 1.14-1.36), with the risk being significantly higher among patients diagnosed with BC before vs after the age of 50 years (SIR 1.59 vs 1.13; P < .001). The risk for non-breast SPC was the highest at the thyroid (SIR 1.89; 95% CI 1.49-2.38), followed by corpus uteri, ovary, kidney, esophagus, skin (melanoma), blood (leukemia), lung, stomach, and bladder.

Study details: Findings are from a meta-analysis of one prospective and 27 retrospective studies.

Disclosures: This study was funded by the CRUK Catalyst Award CanGene-CanVar, UK. The authors declared no conflicts of interest.

Source: Allen I et al. Risks of second non-breast primaries following breast cancer in women: A systematic review and meta-analysis. Breast Cancer Res. 2023;25(1):18 (Feb 10). Doi: 10.1186/s13058-023-01610-x

Endocrine therapy (ET) has long been the therapeutic backbone for the treatment of HR+/HER2- breast cancer. However, for patients who already have advanced HR+/HER2- disease at the time of diagnosis, studies have shown that addition of a CDK4/6 inhibitor significantly improves outcomes compared with ET alone.

In this ReCAP, Dr Kevin Kalinsky, director of the Glenn Family Breast Center at Winship Cancer Institute in Atlanta, Georgia, examines important considerations in the frontline treatment of HR+/HER2- advanced breast cancer.

First, he reviews the PALOMA-2 data, which looked at the overall survival of the CDK4/6 inhibitor palbociclib plus letrozole. He then compares that data with the overall survival data of other CDK4/5 inhibitors.

Dr Kalinsky then examines the findings of MONALEESA-7, which looked at premenopausal patients with HR+/HER2- advanced breast cancer treated with ET plus or minus ribociclib. In that study population, the combination of ET and ribociclib showed an overall survival advantage.

Finally, he discusses data from the Right Choice trial, which found that patients did better when given hormonal therapy plus a CDK4/6 inhibitor as opposed to doublet chemotherapy.

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Kevin Kalinsky, MD, Director, Glenn Family Breast Center, Winship Cancer Institute, Atlanta, Georgia

Kevin Kalinsky, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Pfizer; Eli Lilly; Novartis ; Eisai; AstraZeneca; Daiichi Sankyo; Puma; 4D Pharma; Oncosec; Immunomedics; Merck; Seattle Genetics

Spouse holds stock in: Grail; Array Biopharma; Pfizer (prior employee)

Endocrine therapy (ET) has long been the therapeutic backbone for the treatment of HR+/HER2- breast cancer. However, for patients who already have advanced HR+/HER2- disease at the time of diagnosis, studies have shown that addition of a CDK4/6 inhibitor significantly improves outcomes compared with ET alone.

In this ReCAP, Dr Kevin Kalinsky, director of the Glenn Family Breast Center at Winship Cancer Institute in Atlanta, Georgia, examines important considerations in the frontline treatment of HR+/HER2- advanced breast cancer.

First, he reviews the PALOMA-2 data, which looked at the overall survival of the CDK4/6 inhibitor palbociclib plus letrozole. He then compares that data with the overall survival data of other CDK4/5 inhibitors.

Dr Kalinsky then examines the findings of MONALEESA-7, which looked at premenopausal patients with HR+/HER2- advanced breast cancer treated with ET plus or minus ribociclib. In that study population, the combination of ET and ribociclib showed an overall survival advantage.

Finally, he discusses data from the Right Choice trial, which found that patients did better when given hormonal therapy plus a CDK4/6 inhibitor as opposed to doublet chemotherapy.

--

Kevin Kalinsky, MD, Director, Glenn Family Breast Center, Winship Cancer Institute, Atlanta, Georgia

Kevin Kalinsky, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Pfizer; Eli Lilly; Novartis ; Eisai; AstraZeneca; Daiichi Sankyo; Puma; 4D Pharma; Oncosec; Immunomedics; Merck; Seattle Genetics

Spouse holds stock in: Grail; Array Biopharma; Pfizer (prior employee)

Endocrine therapy (ET) has long been the therapeutic backbone for the treatment of HR+/HER2- breast cancer. However, for patients who already have advanced HR+/HER2- disease at the time of diagnosis, studies have shown that addition of a CDK4/6 inhibitor significantly improves outcomes compared with ET alone.

In this ReCAP, Dr Kevin Kalinsky, director of the Glenn Family Breast Center at Winship Cancer Institute in Atlanta, Georgia, examines important considerations in the frontline treatment of HR+/HER2- advanced breast cancer.

First, he reviews the PALOMA-2 data, which looked at the overall survival of the CDK4/6 inhibitor palbociclib plus letrozole. He then compares that data with the overall survival data of other CDK4/5 inhibitors.

Dr Kalinsky then examines the findings of MONALEESA-7, which looked at premenopausal patients with HR+/HER2- advanced breast cancer treated with ET plus or minus ribociclib. In that study population, the combination of ET and ribociclib showed an overall survival advantage.

Finally, he discusses data from the Right Choice trial, which found that patients did better when given hormonal therapy plus a CDK4/6 inhibitor as opposed to doublet chemotherapy.

--

Kevin Kalinsky, MD, Director, Glenn Family Breast Center, Winship Cancer Institute, Atlanta, Georgia

Kevin Kalinsky, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Pfizer; Eli Lilly; Novartis ; Eisai; AstraZeneca; Daiichi Sankyo; Puma; 4D Pharma; Oncosec; Immunomedics; Merck; Seattle Genetics

Spouse holds stock in: Grail; Array Biopharma; Pfizer (prior employee)

Key clinical point: Patients with estrogen receptor-negative (ER−) primary breast cancer (BC) have a higher risk of developing secondary BC during the first 5 years after treatment than patients with ER-positive (ER+) primary BC.

Major finding: In women with ER− vs ER+ primary BC, the rates of secondary BCs were higher during the first 5 years of follow-up (16.0/1000 person-years [PY]; 95% CI 14.2-17.9/1000 PY vs 7.8/1000 PY; 95% CI 7.3-8.4/1000 PY) but were similar after 5 years (12.1/1000 PY; 95% CI 9.9-14.7/1000 PY vs 9.3/1000 PY; 95% CI 8.4-10.3/1000 PY).

Study details: Findings are from a study including 36,165 women with stage I-III primary BC who underwent breast‐conserving surgery or mastectomy.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, personal fees, payments, or travel support from several sources.

Source: Lowry KP et al. Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer. 2023 (Feb 15). Doi: 10.1002/cncr.34679

Key clinical point: Patients with estrogen receptor-negative (ER−) primary breast cancer (BC) have a higher risk of developing secondary BC during the first 5 years after treatment than patients with ER-positive (ER+) primary BC.

Major finding: In women with ER− vs ER+ primary BC, the rates of secondary BCs were higher during the first 5 years of follow-up (16.0/1000 person-years [PY]; 95% CI 14.2-17.9/1000 PY vs 7.8/1000 PY; 95% CI 7.3-8.4/1000 PY) but were similar after 5 years (12.1/1000 PY; 95% CI 9.9-14.7/1000 PY vs 9.3/1000 PY; 95% CI 8.4-10.3/1000 PY).

Study details: Findings are from a study including 36,165 women with stage I-III primary BC who underwent breast‐conserving surgery or mastectomy.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, personal fees, payments, or travel support from several sources.

Source: Lowry KP et al. Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer. 2023 (Feb 15). Doi: 10.1002/cncr.34679

Key clinical point: Patients with estrogen receptor-negative (ER−) primary breast cancer (BC) have a higher risk of developing secondary BC during the first 5 years after treatment than patients with ER-positive (ER+) primary BC.

Major finding: In women with ER− vs ER+ primary BC, the rates of secondary BCs were higher during the first 5 years of follow-up (16.0/1000 person-years [PY]; 95% CI 14.2-17.9/1000 PY vs 7.8/1000 PY; 95% CI 7.3-8.4/1000 PY) but were similar after 5 years (12.1/1000 PY; 95% CI 9.9-14.7/1000 PY vs 9.3/1000 PY; 95% CI 8.4-10.3/1000 PY).

Study details: Findings are from a study including 36,165 women with stage I-III primary BC who underwent breast‐conserving surgery or mastectomy.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, personal fees, payments, or travel support from several sources.

Source: Lowry KP et al. Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer. 2023 (Feb 15). Doi: 10.1002/cncr.34679

Key clinical point: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors plus endocrine therapy (ET) led to a significantly higher improvement in overall survival than ET alone in older patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (BC).

Major finding: ET+CDK4/6 inhibitor vs ET alone reduced mortality rate by 41% in the first-line treatment setting (adjusted hazard ratio [aHR] 0.590; 95% CI 0.423-0.823) and by 58% in the second-line setting (aHR 0.422; 95% CI 0.238-0.746).

Study details: This retrospective cohort study included 630 female patients aged ≥65 years with HR+/HER2− metastatic BC from the Survey Epidemiology and End Results (SEER)‐Medicare database, of which 461 and 169 patients received first‐line treatment with ET alone and ET+CDK4/6 inhibitor, respectively.

Disclosures: The acquisition of SEER‐Medicare data was supported by the University of Houston,  Texas,College of Pharmacy. The authors declared no conflicts of interest.

Source: Goyal RK et al. Overall survival associated with CDK4/6 inhibitors in patients with HR+/HER2− metastatic breast cancer in the United States: A SEER-Medicare population-based study. Cancer. 2023;129(7):1051-1063 (Feb 9). Doi: 10.1002/cncr.34675

Key clinical point: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors plus endocrine therapy (ET) led to a significantly higher improvement in overall survival than ET alone in older patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (BC).

Major finding: ET+CDK4/6 inhibitor vs ET alone reduced mortality rate by 41% in the first-line treatment setting (adjusted hazard ratio [aHR] 0.590; 95% CI 0.423-0.823) and by 58% in the second-line setting (aHR 0.422; 95% CI 0.238-0.746).

Study details: This retrospective cohort study included 630 female patients aged ≥65 years with HR+/HER2− metastatic BC from the Survey Epidemiology and End Results (SEER)‐Medicare database, of which 461 and 169 patients received first‐line treatment with ET alone and ET+CDK4/6 inhibitor, respectively.

Disclosures: The acquisition of SEER‐Medicare data was supported by the University of Houston,  Texas,College of Pharmacy. The authors declared no conflicts of interest.

Source: Goyal RK et al. Overall survival associated with CDK4/6 inhibitors in patients with HR+/HER2− metastatic breast cancer in the United States: A SEER-Medicare population-based study. Cancer. 2023;129(7):1051-1063 (Feb 9). Doi: 10.1002/cncr.34675

Key clinical point: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors plus endocrine therapy (ET) led to a significantly higher improvement in overall survival than ET alone in older patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (BC).

Major finding: ET+CDK4/6 inhibitor vs ET alone reduced mortality rate by 41% in the first-line treatment setting (adjusted hazard ratio [aHR] 0.590; 95% CI 0.423-0.823) and by 58% in the second-line setting (aHR 0.422; 95% CI 0.238-0.746).

Study details: This retrospective cohort study included 630 female patients aged ≥65 years with HR+/HER2− metastatic BC from the Survey Epidemiology and End Results (SEER)‐Medicare database, of which 461 and 169 patients received first‐line treatment with ET alone and ET+CDK4/6 inhibitor, respectively.

Disclosures: The acquisition of SEER‐Medicare data was supported by the University of Houston,  Texas,College of Pharmacy. The authors declared no conflicts of interest.

Source: Goyal RK et al. Overall survival associated with CDK4/6 inhibitors in patients with HR+/HER2− metastatic breast cancer in the United States: A SEER-Medicare population-based study. Cancer. 2023;129(7):1051-1063 (Feb 9). Doi: 10.1002/cncr.34675

Key clinical point: The rate of pathological complete response (pCR) was significantly higher in patients with early-stage breast cancer (BC) who received neoadjuvant treatment with pegylated liposomal doxorubicin-cyclophosphamide followed by docetaxel (LC-T) vs epirubicin-cyclophosphamide followed by docetaxel (EC-T).

Major finding: The pCR rate was significantly higher with LC-T vs EC-T in the overall cohort (25.3% vs 15.5%; P = .026) and in the subgroup of patients with triple-negative BC (47.1% vs 15.4%; P = .013).

Study details: Findings are from a retrospective study including 359 patients with stage I-III BC who received neoadjuvant treatment with LC-T (n = 178) or EC-T (n = 181) followed by surgery.

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

Source: Tsai J-H et al. Neoadjuvant pegylated liposomal doxorubicin- and epirubicin-based combination therapy regimens for early breast cancer: A multicenter retrospective case-control study. Breast Cancer Res Treat. 2023 (Mar 4). Doi: 10.1007/s10549-023-06867-6

Key clinical point: The rate of pathological complete response (pCR) was significantly higher in patients with early-stage breast cancer (BC) who received neoadjuvant treatment with pegylated liposomal doxorubicin-cyclophosphamide followed by docetaxel (LC-T) vs epirubicin-cyclophosphamide followed by docetaxel (EC-T).

Major finding: The pCR rate was significantly higher with LC-T vs EC-T in the overall cohort (25.3% vs 15.5%; P = .026) and in the subgroup of patients with triple-negative BC (47.1% vs 15.4%; P = .013).

Study details: Findings are from a retrospective study including 359 patients with stage I-III BC who received neoadjuvant treatment with LC-T (n = 178) or EC-T (n = 181) followed by surgery.

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

Source: Tsai J-H et al. Neoadjuvant pegylated liposomal doxorubicin- and epirubicin-based combination therapy regimens for early breast cancer: A multicenter retrospective case-control study. Breast Cancer Res Treat. 2023 (Mar 4). Doi: 10.1007/s10549-023-06867-6

Key clinical point: The rate of pathological complete response (pCR) was significantly higher in patients with early-stage breast cancer (BC) who received neoadjuvant treatment with pegylated liposomal doxorubicin-cyclophosphamide followed by docetaxel (LC-T) vs epirubicin-cyclophosphamide followed by docetaxel (EC-T).

Major finding: The pCR rate was significantly higher with LC-T vs EC-T in the overall cohort (25.3% vs 15.5%; P = .026) and in the subgroup of patients with triple-negative BC (47.1% vs 15.4%; P = .013).

Study details: Findings are from a retrospective study including 359 patients with stage I-III BC who received neoadjuvant treatment with LC-T (n = 178) or EC-T (n = 181) followed by surgery.

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

Source: Tsai J-H et al. Neoadjuvant pegylated liposomal doxorubicin- and epirubicin-based combination therapy regimens for early breast cancer: A multicenter retrospective case-control study. Breast Cancer Res Treat. 2023 (Mar 4). Doi: 10.1007/s10549-023-06867-6

Key clinical point: Contrary to women who received bilateral oophorectomy, women who underwent hysterectomy and concurrent estrogen plus progestin therapy had a significantly higher risk of developing breast cancer (BC).

Major finding: Bilateral oophorectomy (hazard ratio [HR] 0.91; 95% CI 0.83-1.00) did not increase the risk for BC irrespective of the use of hormone therapy. However, hysterectomy alone was positively associated with an increased risk for BC (HR 1.12; 95% CI 1.02-1.23), especially among those receiving estrogen plus progestin therapy (HR 1.25; 95% CI 1.01-1.55).

Study details: Findings are from a prospective cohort study, The Sister Study, including 50,701 women without BC who had a biological sister with BC, of which 13.8% and 18.1% of participants underwent hysterectomy only and bilateral oophorectomy with or without hysterectomy, respectively.

Disclosures: This study was funded by the Intramural Research Program at the US National Institutes of Health and other sources. The authors declared no conflicts of interest.

Source: Lovett SM et al. Hysterectomy, bilateral oophorectomy, and breast cancer risk in a racially diverse prospective cohort study. J Natl Cancer Inst. 2023 (Feb 20). Doi: 10.1093/jnci/djad038

Key clinical point: Contrary to women who received bilateral oophorectomy, women who underwent hysterectomy and concurrent estrogen plus progestin therapy had a significantly higher risk of developing breast cancer (BC).

Major finding: Bilateral oophorectomy (hazard ratio [HR] 0.91; 95% CI 0.83-1.00) did not increase the risk for BC irrespective of the use of hormone therapy. However, hysterectomy alone was positively associated with an increased risk for BC (HR 1.12; 95% CI 1.02-1.23), especially among those receiving estrogen plus progestin therapy (HR 1.25; 95% CI 1.01-1.55).

Study details: Findings are from a prospective cohort study, The Sister Study, including 50,701 women without BC who had a biological sister with BC, of which 13.8% and 18.1% of participants underwent hysterectomy only and bilateral oophorectomy with or without hysterectomy, respectively.

Disclosures: This study was funded by the Intramural Research Program at the US National Institutes of Health and other sources. The authors declared no conflicts of interest.

Source: Lovett SM et al. Hysterectomy, bilateral oophorectomy, and breast cancer risk in a racially diverse prospective cohort study. J Natl Cancer Inst. 2023 (Feb 20). Doi: 10.1093/jnci/djad038

Key clinical point: Contrary to women who received bilateral oophorectomy, women who underwent hysterectomy and concurrent estrogen plus progestin therapy had a significantly higher risk of developing breast cancer (BC).

Major finding: Bilateral oophorectomy (hazard ratio [HR] 0.91; 95% CI 0.83-1.00) did not increase the risk for BC irrespective of the use of hormone therapy. However, hysterectomy alone was positively associated with an increased risk for BC (HR 1.12; 95% CI 1.02-1.23), especially among those receiving estrogen plus progestin therapy (HR 1.25; 95% CI 1.01-1.55).

Study details: Findings are from a prospective cohort study, The Sister Study, including 50,701 women without BC who had a biological sister with BC, of which 13.8% and 18.1% of participants underwent hysterectomy only and bilateral oophorectomy with or without hysterectomy, respectively.

Disclosures: This study was funded by the Intramural Research Program at the US National Institutes of Health and other sources. The authors declared no conflicts of interest.

Source: Lovett SM et al. Hysterectomy, bilateral oophorectomy, and breast cancer risk in a racially diverse prospective cohort study. J Natl Cancer Inst. 2023 (Feb 20). Doi: 10.1093/jnci/djad038

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC) who achieved pathological complete response (pCR) after 12 weeks of conventional chemotherapy-free, de-escalated, neoadjuvant anti-HER2 treatment can forgo adjuvant chemotherapy.

Major finding: Risk for invasive disease-free survival (iDFS) was significantly lower in patients who did vs did not achieve pCR (unadjusted hazard ratio [HR] 0.40; 95% CI 0.18-0.85). Among patients who achieved pCR, iDFS rates were similar in those who did vs did not receive adjuvant chemotherapy (unadjusted HR 1.15; 95% CI 0.27-4.81).

Study details: Findings are from the phase 2, WSG-ADAPT-TP trial including 375 patients with HR+/HER2+ early BC who were randomly assigned to receive 12 weeks of trastuzumab-emtansine with or without endocrine therapy (ET) or trastuzumab+ET in a neoadjuvant setting.

Disclosures: This study was supported by F. Hoffmann-La Roche Ltd. The authors declared serving in consulting or advisory roles, receiving research funding, travel and accommodation expenses, or honoraria, or having other ties with several sources, including Roche.

Source: Harbeck N et al on behalf of the WSG-ADAPT investigators. De-escalated neoadjuvant trastuzumab-emtansine with or without endocrine therapy versus trastuzumab with endocrine therapy in HR+/HER2+ early breast cancer: 5-year survival in the WSG-ADAPT-TP trial. J Clin Oncol. 2023 (Feb 21). Doi: 10.1200/JCO.22.01816

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC) who achieved pathological complete response (pCR) after 12 weeks of conventional chemotherapy-free, de-escalated, neoadjuvant anti-HER2 treatment can forgo adjuvant chemotherapy.

Major finding: Risk for invasive disease-free survival (iDFS) was significantly lower in patients who did vs did not achieve pCR (unadjusted hazard ratio [HR] 0.40; 95% CI 0.18-0.85). Among patients who achieved pCR, iDFS rates were similar in those who did vs did not receive adjuvant chemotherapy (unadjusted HR 1.15; 95% CI 0.27-4.81).

Study details: Findings are from the phase 2, WSG-ADAPT-TP trial including 375 patients with HR+/HER2+ early BC who were randomly assigned to receive 12 weeks of trastuzumab-emtansine with or without endocrine therapy (ET) or trastuzumab+ET in a neoadjuvant setting.

Disclosures: This study was supported by F. Hoffmann-La Roche Ltd. The authors declared serving in consulting or advisory roles, receiving research funding, travel and accommodation expenses, or honoraria, or having other ties with several sources, including Roche.

Source: Harbeck N et al on behalf of the WSG-ADAPT investigators. De-escalated neoadjuvant trastuzumab-emtansine with or without endocrine therapy versus trastuzumab with endocrine therapy in HR+/HER2+ early breast cancer: 5-year survival in the WSG-ADAPT-TP trial. J Clin Oncol. 2023 (Feb 21). Doi: 10.1200/JCO.22.01816

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC) who achieved pathological complete response (pCR) after 12 weeks of conventional chemotherapy-free, de-escalated, neoadjuvant anti-HER2 treatment can forgo adjuvant chemotherapy.

Major finding: Risk for invasive disease-free survival (iDFS) was significantly lower in patients who did vs did not achieve pCR (unadjusted hazard ratio [HR] 0.40; 95% CI 0.18-0.85). Among patients who achieved pCR, iDFS rates were similar in those who did vs did not receive adjuvant chemotherapy (unadjusted HR 1.15; 95% CI 0.27-4.81).

Study details: Findings are from the phase 2, WSG-ADAPT-TP trial including 375 patients with HR+/HER2+ early BC who were randomly assigned to receive 12 weeks of trastuzumab-emtansine with or without endocrine therapy (ET) or trastuzumab+ET in a neoadjuvant setting.

Disclosures: This study was supported by F. Hoffmann-La Roche Ltd. The authors declared serving in consulting or advisory roles, receiving research funding, travel and accommodation expenses, or honoraria, or having other ties with several sources, including Roche.

Source: Harbeck N et al on behalf of the WSG-ADAPT investigators. De-escalated neoadjuvant trastuzumab-emtansine with or without endocrine therapy versus trastuzumab with endocrine therapy in HR+/HER2+ early breast cancer: 5-year survival in the WSG-ADAPT-TP trial. J Clin Oncol. 2023 (Feb 21). Doi: 10.1200/JCO.22.01816

Key clinical point: Anthracycline+taxane-based regimens demonstrated significantly higher improvement in survival outcomes than non-anthracycline-containing taxane-based regimens in patients with triple-negative breast cancer (TNBC) who were ≥76 years old and had ≥4 positive lymph nodes.

Major finding: Although anthracycline+taxane-based vs taxane-based regimens failed to improve cancer-specific survival (CSS) in the overall cohort of older patients with TNBC (hazard ratio [HR] 0.94; P = .79); they improved CSS in patients aged ≥76 years with ≥4 positive lymph nodes (HR 0.09; P = .02).

Study details: Findings are from a retrospective analysis of 1106 women aged ≥66 years with node-positive TNBC from the Surveillance, Epidemiology, and End Results-Medicare database, of which 661 women received adjuvant chemotherapy with anthracycline+taxane-based regimens (n = 364) or taxane-based regimens (n = 297).

Disclosures: This study was funded by the Women’s Cancer Developmental Therapeutics Program, University of Colorado Cancer Center. The authors declared no conflicts of interest.

Source: Roy S et al. Clinical outcomes of adjuvant taxane + anthracycline versus taxane-based chemotherapy regimens in older adults with node-positive, triple-negative breast cancer: A SEER-Medicare study. Eur J Cancer. 2023 (Feb 27). Doi: 10.1016/j.ejca.2023.02.014

Key clinical point: Anthracycline+taxane-based regimens demonstrated significantly higher improvement in survival outcomes than non-anthracycline-containing taxane-based regimens in patients with triple-negative breast cancer (TNBC) who were ≥76 years old and had ≥4 positive lymph nodes.

Major finding: Although anthracycline+taxane-based vs taxane-based regimens failed to improve cancer-specific survival (CSS) in the overall cohort of older patients with TNBC (hazard ratio [HR] 0.94; P = .79); they improved CSS in patients aged ≥76 years with ≥4 positive lymph nodes (HR 0.09; P = .02).

Study details: Findings are from a retrospective analysis of 1106 women aged ≥66 years with node-positive TNBC from the Surveillance, Epidemiology, and End Results-Medicare database, of which 661 women received adjuvant chemotherapy with anthracycline+taxane-based regimens (n = 364) or taxane-based regimens (n = 297).

Disclosures: This study was funded by the Women’s Cancer Developmental Therapeutics Program, University of Colorado Cancer Center. The authors declared no conflicts of interest.

Source: Roy S et al. Clinical outcomes of adjuvant taxane + anthracycline versus taxane-based chemotherapy regimens in older adults with node-positive, triple-negative breast cancer: A SEER-Medicare study. Eur J Cancer. 2023 (Feb 27). Doi: 10.1016/j.ejca.2023.02.014

Key clinical point: Anthracycline+taxane-based regimens demonstrated significantly higher improvement in survival outcomes than non-anthracycline-containing taxane-based regimens in patients with triple-negative breast cancer (TNBC) who were ≥76 years old and had ≥4 positive lymph nodes.

Major finding: Although anthracycline+taxane-based vs taxane-based regimens failed to improve cancer-specific survival (CSS) in the overall cohort of older patients with TNBC (hazard ratio [HR] 0.94; P = .79); they improved CSS in patients aged ≥76 years with ≥4 positive lymph nodes (HR 0.09; P = .02).

Study details: Findings are from a retrospective analysis of 1106 women aged ≥66 years with node-positive TNBC from the Surveillance, Epidemiology, and End Results-Medicare database, of which 661 women received adjuvant chemotherapy with anthracycline+taxane-based regimens (n = 364) or taxane-based regimens (n = 297).

Disclosures: This study was funded by the Women’s Cancer Developmental Therapeutics Program, University of Colorado Cancer Center. The authors declared no conflicts of interest.

Source: Roy S et al. Clinical outcomes of adjuvant taxane + anthracycline versus taxane-based chemotherapy regimens in older adults with node-positive, triple-negative breast cancer: A SEER-Medicare study. Eur J Cancer. 2023 (Feb 27). Doi: 10.1016/j.ejca.2023.02.014

Key clinical point: Human epidermal growth factor receptor 2-low (ERBB2-low) breast cancer (BC) did not have a prognosis noticeably different from ERBB2-negative BC, thereby contradicting its classification as a unique disease entity.

Major finding: ERBB2-low vs ERBB2-negative BC was associated with slightly higher improvements in overall survival (adjusted hazard ratio [aHR] 0.98; 95% CI 0.97-0.99), especially for stage III (aHR 0.92; 95% CI 0.89-0.96) and stage IV (aHR 0.91; 95% CI 0.87-0.96) triple-negative BC, and a marginally lower likelihood of achieving pathological complete response (adjusted odds ratio 0.89; 95% CI 0.86-0.92).

Study details: Findings are from a retrospective cohort study including 1,136,016 patients with invasive BC that was not ERBB2 positive.

Disclosures: This study was supported by the Breast Cancer Research Foundation, New York, and other sources. Some authors declared receiving grants, personal fees, or research funding from several sources.

Source: Peiffer DS et al. Clinicopathologic characteristics and prognosis of ERBB2-low breast cancer among patients in the National Cancer Database. JAMA Oncol. 2023;e227476 (Feb 23). Doi: 10.1001/jamaoncol.2022.7476

Key clinical point: Human epidermal growth factor receptor 2-low (ERBB2-low) breast cancer (BC) did not have a prognosis noticeably different from ERBB2-negative BC, thereby contradicting its classification as a unique disease entity.

Major finding: ERBB2-low vs ERBB2-negative BC was associated with slightly higher improvements in overall survival (adjusted hazard ratio [aHR] 0.98; 95% CI 0.97-0.99), especially for stage III (aHR 0.92; 95% CI 0.89-0.96) and stage IV (aHR 0.91; 95% CI 0.87-0.96) triple-negative BC, and a marginally lower likelihood of achieving pathological complete response (adjusted odds ratio 0.89; 95% CI 0.86-0.92).

Study details: Findings are from a retrospective cohort study including 1,136,016 patients with invasive BC that was not ERBB2 positive.

Disclosures: This study was supported by the Breast Cancer Research Foundation, New York, and other sources. Some authors declared receiving grants, personal fees, or research funding from several sources.

Source: Peiffer DS et al. Clinicopathologic characteristics and prognosis of ERBB2-low breast cancer among patients in the National Cancer Database. JAMA Oncol. 2023;e227476 (Feb 23). Doi: 10.1001/jamaoncol.2022.7476

Key clinical point: Human epidermal growth factor receptor 2-low (ERBB2-low) breast cancer (BC) did not have a prognosis noticeably different from ERBB2-negative BC, thereby contradicting its classification as a unique disease entity.

Major finding: ERBB2-low vs ERBB2-negative BC was associated with slightly higher improvements in overall survival (adjusted hazard ratio [aHR] 0.98; 95% CI 0.97-0.99), especially for stage III (aHR 0.92; 95% CI 0.89-0.96) and stage IV (aHR 0.91; 95% CI 0.87-0.96) triple-negative BC, and a marginally lower likelihood of achieving pathological complete response (adjusted odds ratio 0.89; 95% CI 0.86-0.92).

Study details: Findings are from a retrospective cohort study including 1,136,016 patients with invasive BC that was not ERBB2 positive.

Disclosures: This study was supported by the Breast Cancer Research Foundation, New York, and other sources. Some authors declared receiving grants, personal fees, or research funding from several sources.

Source: Peiffer DS et al. Clinicopathologic characteristics and prognosis of ERBB2-low breast cancer among patients in the National Cancer Database. JAMA Oncol. 2023;e227476 (Feb 23). Doi: 10.1001/jamaoncol.2022.7476

Key clinical point: In women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−) breast cancer (BC), adjuvant epirubicin+paclitaxel (EP) therapy led to favorable survival outcomes, noninferior to those with epirubicin+cyclophosphamide followed by paclitaxel (EC-P) therapy, and a higher frequency of adverse events (AE).

Major finding: After a median follow-up of 93.6 months, the 5-year disease-free survival with EP was noninferior to that with EC-P in the entire cohort (hazard ratio [HR] 0.82; 95% CI 0.62-1.10; noninferior P  =  .001) and in patients with luminal A BC (HR 0.84; 95% CI 0.45-1.57) and luminal B BC (HR 0.70; 95% CI 0.49-1.00). The AE rate was higher in the EP group.

Study details: This phase 3 study included 813 patients with HR+/ERBB2−, lymph node-positive, operable BC who were randomly assigned to receive adjuvant EP or EC-P.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Yuan P et al. Effect of epirubicin plus paclitaxel vs epirubicin and cyclophosphamide followed by paclitaxel on disease-free survival among patients with operable ERBB2-negative and lymph node-positive breast cancer: A randomized clinical trial. JAMA Netw Open. 2023;6(2):e230122 (Feb 24). Doi: 10.1001/jamanetworkopen.2023.0122

Key clinical point: In women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−) breast cancer (BC), adjuvant epirubicin+paclitaxel (EP) therapy led to favorable survival outcomes, noninferior to those with epirubicin+cyclophosphamide followed by paclitaxel (EC-P) therapy, and a higher frequency of adverse events (AE).

Major finding: After a median follow-up of 93.6 months, the 5-year disease-free survival with EP was noninferior to that with EC-P in the entire cohort (hazard ratio [HR] 0.82; 95% CI 0.62-1.10; noninferior P  =  .001) and in patients with luminal A BC (HR 0.84; 95% CI 0.45-1.57) and luminal B BC (HR 0.70; 95% CI 0.49-1.00). The AE rate was higher in the EP group.

Study details: This phase 3 study included 813 patients with HR+/ERBB2−, lymph node-positive, operable BC who were randomly assigned to receive adjuvant EP or EC-P.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Yuan P et al. Effect of epirubicin plus paclitaxel vs epirubicin and cyclophosphamide followed by paclitaxel on disease-free survival among patients with operable ERBB2-negative and lymph node-positive breast cancer: A randomized clinical trial. JAMA Netw Open. 2023;6(2):e230122 (Feb 24). Doi: 10.1001/jamanetworkopen.2023.0122

Key clinical point: In women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−) breast cancer (BC), adjuvant epirubicin+paclitaxel (EP) therapy led to favorable survival outcomes, noninferior to those with epirubicin+cyclophosphamide followed by paclitaxel (EC-P) therapy, and a higher frequency of adverse events (AE).

Major finding: After a median follow-up of 93.6 months, the 5-year disease-free survival with EP was noninferior to that with EC-P in the entire cohort (hazard ratio [HR] 0.82; 95% CI 0.62-1.10; noninferior P  =  .001) and in patients with luminal A BC (HR 0.84; 95% CI 0.45-1.57) and luminal B BC (HR 0.70; 95% CI 0.49-1.00). The AE rate was higher in the EP group.

Study details: This phase 3 study included 813 patients with HR+/ERBB2−, lymph node-positive, operable BC who were randomly assigned to receive adjuvant EP or EC-P.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Yuan P et al. Effect of epirubicin plus paclitaxel vs epirubicin and cyclophosphamide followed by paclitaxel on disease-free survival among patients with operable ERBB2-negative and lymph node-positive breast cancer: A randomized clinical trial. JAMA Netw Open. 2023;6(2):e230122 (Feb 24). Doi: 10.1001/jamanetworkopen.2023.0122