AVAHO

I’m speaking today about the ever-rising prominence of neoadjuvant therapy for patients with locally advanced lung cancers. There are more and more data emerging suggesting that the neoadjuvant strategy is a better one.

Many of you saw the press release from Merck announcing that their randomized trial comparing chemo with chemo plus pembrolizumab in the neoadjuvant setting led to improved event-free survival and also improved pathologic complete response rate.

This comes in addition to the data from the AstraZeneca trial with durvalumab saying they’ve already achieved their endpoint of higher pathologic complete response rate vs. chemotherapy alone and also the data with nivolumab from Bristol-Myers Squibb saying that nivolumab plus chemotherapy leads to a better event-free survival and a better pathologic complete response rate. That information has led to Food and Drug Administration approval for their regimen.

We’re running the table with these very positive data, and I think it’s just a sign that the approach is safe and effective.

A huge question has come up. I just came from a meeting of lung cancer experts asking what to do if you have a patient with a small tumor, for example, a 3-cm tumor. Do you recommend immediate surgery followed by adjuvant therapy, chemotherapy, and then a checkpoint inhibitor if appropriate? Or do you proceed with neoadjuvant therapy if appropriate? The truth is that it’s a very difficult decision.

We have overwhelming data that the neoadjuvant approach works for that patient. Please remember that this is a clinically staged patient. This is not the patient after their surgery, where I think we have a very clear path. We have adjuvant data and adjuvant trials for those patients.

For the patient who’s in your office with a small tumor or a small tumor and only hilar lymphadenopathy, the decision there isn’t data driven, but rather it is experience driven. The data that are out there right now suggest that neoadjuvant therapy is a better way to go. Why is that?

Well, I think that the first reason is that it is probably a better regimen. I think many of you saw the recent clinical trial by Patel and colleagues in the New England Journal of Medicine with melanoma. It was an interesting trial. They gave a checkpoint inhibitor for 18 doses after surgery for melanoma versus three doses of checkpoint inhibitor, surgery, and then 15 doses of the checkpoint inhibitor.

It was 18 doses versus 18 doses, with the only difference being the three doses before surgery. Lo and behold, the three doses before surgery led to a better event-free survival.

There are preclinical data in lung cancer demonstrating that the same thing is true. Tina Cascone published on that years ago. We could talk about why, but it appears that neoadjuvant is just better.

There are other advantages to it as well. I think a big one is that all the information shows that it’s better tolerated, so you’re more likely to give all the drug. You can see if the drug isn’t working, and you can stop the drug. Also, if the drug is causing a side effect, you can see whether it’s working or not and use that decision to stop. It’s different than when you’re giving a drug in the adjuvant setting where you don’t really know whether it is working or not.

I think that it’s time to change some of our standards. When patients appear with lung cancers other than tiny ones that might be detected through screening, you need to convene your multidisciplinary group. You need to weigh the pros and cons I think that it’s time to change some of our standards. When patients appear with lung cancers other than tiny ones that might be detected through screening, you need to convene your multidisciplinary group coming in. It’s already an FDA-approved regimen with nivolumab and chemotherapy, and I think we’re moving to making that our standard of care now.

The way to handle it today, though, is to convene your multidisciplinary panel about every patient other than those with the tiniest of lung cancers and put your heads together to see what the best treatment is for that patient.

Dr. Kris is professor of medicine, Weill Cornell Medicine, and the William and Joy Ruane Chair in Thoracic Oncology, Memorial Sloan Kettering Cancer Center, both in New York. He disclosed ties with Ariad Pharmaceuticals, AstraZeneca, Pfizer, PUMA, and Roche/Genentech.

A version of this article appeared on Medscape.com.

I’m speaking today about the ever-rising prominence of neoadjuvant therapy for patients with locally advanced lung cancers. There are more and more data emerging suggesting that the neoadjuvant strategy is a better one.

Many of you saw the press release from Merck announcing that their randomized trial comparing chemo with chemo plus pembrolizumab in the neoadjuvant setting led to improved event-free survival and also improved pathologic complete response rate.

This comes in addition to the data from the AstraZeneca trial with durvalumab saying they’ve already achieved their endpoint of higher pathologic complete response rate vs. chemotherapy alone and also the data with nivolumab from Bristol-Myers Squibb saying that nivolumab plus chemotherapy leads to a better event-free survival and a better pathologic complete response rate. That information has led to Food and Drug Administration approval for their regimen.

We’re running the table with these very positive data, and I think it’s just a sign that the approach is safe and effective.

A huge question has come up. I just came from a meeting of lung cancer experts asking what to do if you have a patient with a small tumor, for example, a 3-cm tumor. Do you recommend immediate surgery followed by adjuvant therapy, chemotherapy, and then a checkpoint inhibitor if appropriate? Or do you proceed with neoadjuvant therapy if appropriate? The truth is that it’s a very difficult decision.

We have overwhelming data that the neoadjuvant approach works for that patient. Please remember that this is a clinically staged patient. This is not the patient after their surgery, where I think we have a very clear path. We have adjuvant data and adjuvant trials for those patients.

For the patient who’s in your office with a small tumor or a small tumor and only hilar lymphadenopathy, the decision there isn’t data driven, but rather it is experience driven. The data that are out there right now suggest that neoadjuvant therapy is a better way to go. Why is that?

Well, I think that the first reason is that it is probably a better regimen. I think many of you saw the recent clinical trial by Patel and colleagues in the New England Journal of Medicine with melanoma. It was an interesting trial. They gave a checkpoint inhibitor for 18 doses after surgery for melanoma versus three doses of checkpoint inhibitor, surgery, and then 15 doses of the checkpoint inhibitor.

It was 18 doses versus 18 doses, with the only difference being the three doses before surgery. Lo and behold, the three doses before surgery led to a better event-free survival.

There are preclinical data in lung cancer demonstrating that the same thing is true. Tina Cascone published on that years ago. We could talk about why, but it appears that neoadjuvant is just better.

There are other advantages to it as well. I think a big one is that all the information shows that it’s better tolerated, so you’re more likely to give all the drug. You can see if the drug isn’t working, and you can stop the drug. Also, if the drug is causing a side effect, you can see whether it’s working or not and use that decision to stop. It’s different than when you’re giving a drug in the adjuvant setting where you don’t really know whether it is working or not.

I think that it’s time to change some of our standards. When patients appear with lung cancers other than tiny ones that might be detected through screening, you need to convene your multidisciplinary group. You need to weigh the pros and cons I think that it’s time to change some of our standards. When patients appear with lung cancers other than tiny ones that might be detected through screening, you need to convene your multidisciplinary group coming in. It’s already an FDA-approved regimen with nivolumab and chemotherapy, and I think we’re moving to making that our standard of care now.

The way to handle it today, though, is to convene your multidisciplinary panel about every patient other than those with the tiniest of lung cancers and put your heads together to see what the best treatment is for that patient.

Dr. Kris is professor of medicine, Weill Cornell Medicine, and the William and Joy Ruane Chair in Thoracic Oncology, Memorial Sloan Kettering Cancer Center, both in New York. He disclosed ties with Ariad Pharmaceuticals, AstraZeneca, Pfizer, PUMA, and Roche/Genentech.

A version of this article appeared on Medscape.com.

I’m speaking today about the ever-rising prominence of neoadjuvant therapy for patients with locally advanced lung cancers. There are more and more data emerging suggesting that the neoadjuvant strategy is a better one.

Many of you saw the press release from Merck announcing that their randomized trial comparing chemo with chemo plus pembrolizumab in the neoadjuvant setting led to improved event-free survival and also improved pathologic complete response rate.

This comes in addition to the data from the AstraZeneca trial with durvalumab saying they’ve already achieved their endpoint of higher pathologic complete response rate vs. chemotherapy alone and also the data with nivolumab from Bristol-Myers Squibb saying that nivolumab plus chemotherapy leads to a better event-free survival and a better pathologic complete response rate. That information has led to Food and Drug Administration approval for their regimen.

We’re running the table with these very positive data, and I think it’s just a sign that the approach is safe and effective.

A huge question has come up. I just came from a meeting of lung cancer experts asking what to do if you have a patient with a small tumor, for example, a 3-cm tumor. Do you recommend immediate surgery followed by adjuvant therapy, chemotherapy, and then a checkpoint inhibitor if appropriate? Or do you proceed with neoadjuvant therapy if appropriate? The truth is that it’s a very difficult decision.

We have overwhelming data that the neoadjuvant approach works for that patient. Please remember that this is a clinically staged patient. This is not the patient after their surgery, where I think we have a very clear path. We have adjuvant data and adjuvant trials for those patients.

For the patient who’s in your office with a small tumor or a small tumor and only hilar lymphadenopathy, the decision there isn’t data driven, but rather it is experience driven. The data that are out there right now suggest that neoadjuvant therapy is a better way to go. Why is that?

Well, I think that the first reason is that it is probably a better regimen. I think many of you saw the recent clinical trial by Patel and colleagues in the New England Journal of Medicine with melanoma. It was an interesting trial. They gave a checkpoint inhibitor for 18 doses after surgery for melanoma versus three doses of checkpoint inhibitor, surgery, and then 15 doses of the checkpoint inhibitor.

It was 18 doses versus 18 doses, with the only difference being the three doses before surgery. Lo and behold, the three doses before surgery led to a better event-free survival.

There are preclinical data in lung cancer demonstrating that the same thing is true. Tina Cascone published on that years ago. We could talk about why, but it appears that neoadjuvant is just better.

There are other advantages to it as well. I think a big one is that all the information shows that it’s better tolerated, so you’re more likely to give all the drug. You can see if the drug isn’t working, and you can stop the drug. Also, if the drug is causing a side effect, you can see whether it’s working or not and use that decision to stop. It’s different than when you’re giving a drug in the adjuvant setting where you don’t really know whether it is working or not.

I think that it’s time to change some of our standards. When patients appear with lung cancers other than tiny ones that might be detected through screening, you need to convene your multidisciplinary group. You need to weigh the pros and cons I think that it’s time to change some of our standards. When patients appear with lung cancers other than tiny ones that might be detected through screening, you need to convene your multidisciplinary group coming in. It’s already an FDA-approved regimen with nivolumab and chemotherapy, and I think we’re moving to making that our standard of care now.

The way to handle it today, though, is to convene your multidisciplinary panel about every patient other than those with the tiniest of lung cancers and put your heads together to see what the best treatment is for that patient.

Dr. Kris is professor of medicine, Weill Cornell Medicine, and the William and Joy Ruane Chair in Thoracic Oncology, Memorial Sloan Kettering Cancer Center, both in New York. He disclosed ties with Ariad Pharmaceuticals, AstraZeneca, Pfizer, PUMA, and Roche/Genentech.

A version of this article appeared on Medscape.com.

Key clinical point: Postmastectomy breast reconstruction (PMbR) showed breast cancer-specific survival (BCSS) outcomes comparable with those of conventional mastectomy and may be recommended in patients with stage T0-3N2-3M0 non-triple-negative breast cancer (BC).

Major finding: Compared with conventional mastectomy, PMbR did not have any significant detrimental effect on BCSS outcomes (hazard ratio [HR] 0.85; P = .197); however, histopathological grade levels III-IV (HR 3.28; P = .010), T4 stage (HR 3.08; P = .013), and triple-negative BC (HR 4.84; P < .001) were associated with worsened BCSS outcomes in the PMbR group.

Study details: This retrospective study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database and included 2545 women with N2-3M0 stage BC who underwent either PMbR (n = 761) or conventional mastectomy (n = 1784).

Disclosures: This study was supported by the Clinical Research Program of the first affiliated Hospital of Xi'an Jiaotong University, China, and other sources. The authors declared no conflicts of interest.

Source: Zhao Y, Yan L, et al. Efficacy of breast reconstruction for N2-3M0 stage female breast cancer on breast cancer-specific survival: A population-based propensity score analysis. Cancer Med. 2023 (Oct 5). doi: 10.1002/cam4.6579

Key clinical point: Postmastectomy breast reconstruction (PMbR) showed breast cancer-specific survival (BCSS) outcomes comparable with those of conventional mastectomy and may be recommended in patients with stage T0-3N2-3M0 non-triple-negative breast cancer (BC).

Major finding: Compared with conventional mastectomy, PMbR did not have any significant detrimental effect on BCSS outcomes (hazard ratio [HR] 0.85; P = .197); however, histopathological grade levels III-IV (HR 3.28; P = .010), T4 stage (HR 3.08; P = .013), and triple-negative BC (HR 4.84; P < .001) were associated with worsened BCSS outcomes in the PMbR group.

Study details: This retrospective study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database and included 2545 women with N2-3M0 stage BC who underwent either PMbR (n = 761) or conventional mastectomy (n = 1784).

Disclosures: This study was supported by the Clinical Research Program of the first affiliated Hospital of Xi'an Jiaotong University, China, and other sources. The authors declared no conflicts of interest.

Source: Zhao Y, Yan L, et al. Efficacy of breast reconstruction for N2-3M0 stage female breast cancer on breast cancer-specific survival: A population-based propensity score analysis. Cancer Med. 2023 (Oct 5). doi: 10.1002/cam4.6579

Key clinical point: Postmastectomy breast reconstruction (PMbR) showed breast cancer-specific survival (BCSS) outcomes comparable with those of conventional mastectomy and may be recommended in patients with stage T0-3N2-3M0 non-triple-negative breast cancer (BC).

Major finding: Compared with conventional mastectomy, PMbR did not have any significant detrimental effect on BCSS outcomes (hazard ratio [HR] 0.85; P = .197); however, histopathological grade levels III-IV (HR 3.28; P = .010), T4 stage (HR 3.08; P = .013), and triple-negative BC (HR 4.84; P < .001) were associated with worsened BCSS outcomes in the PMbR group.

Study details: This retrospective study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database and included 2545 women with N2-3M0 stage BC who underwent either PMbR (n = 761) or conventional mastectomy (n = 1784).

Disclosures: This study was supported by the Clinical Research Program of the first affiliated Hospital of Xi'an Jiaotong University, China, and other sources. The authors declared no conflicts of interest.

Source: Zhao Y, Yan L, et al. Efficacy of breast reconstruction for N2-3M0 stage female breast cancer on breast cancer-specific survival: A population-based propensity score analysis. Cancer Med. 2023 (Oct 5). doi: 10.1002/cam4.6579

Key clinical point: Human epidermal growth factor receptor 2 (HER2)-low vs HER2-0 expression was associated with improved breast cancer-specific survival (BCSS) outcomes in patients with early-stage triple-negative breast cancer (TNBC), particularly in the high-risk subgroups.

Major finding: Patients with HER2-low vs HER2-0 BC had significantly better BCSS rates in the overall population (96.6% vs 93.7%; log-rank P = .027) and in high-risk subpopulations comprising patients without a pathological complete response despite neoadjuvant chemotherapy (log-rank P = .047) or those with stage-III BC (log-rank P = .010).

Study details: Findings are from a study including 1445 female patients with early-stage TNBC, of whom 51.7% and 48.3% showed HER2-0 and HER2-low status, respectively.

Disclosures: This study was sponsored by the Health Commission of Henan Province, China. The authors declared no conflicts of interest.

Source: Ma Y et al. HER2-low status was associated with better breast cancer-specific survival in early-stage triple-negative breast cancer. Oncologist. 2023 (Sep 28). doi: 10.1093/oncolo/oyad275

Key clinical point: Human epidermal growth factor receptor 2 (HER2)-low vs HER2-0 expression was associated with improved breast cancer-specific survival (BCSS) outcomes in patients with early-stage triple-negative breast cancer (TNBC), particularly in the high-risk subgroups.

Major finding: Patients with HER2-low vs HER2-0 BC had significantly better BCSS rates in the overall population (96.6% vs 93.7%; log-rank P = .027) and in high-risk subpopulations comprising patients without a pathological complete response despite neoadjuvant chemotherapy (log-rank P = .047) or those with stage-III BC (log-rank P = .010).

Study details: Findings are from a study including 1445 female patients with early-stage TNBC, of whom 51.7% and 48.3% showed HER2-0 and HER2-low status, respectively.

Disclosures: This study was sponsored by the Health Commission of Henan Province, China. The authors declared no conflicts of interest.

Source: Ma Y et al. HER2-low status was associated with better breast cancer-specific survival in early-stage triple-negative breast cancer. Oncologist. 2023 (Sep 28). doi: 10.1093/oncolo/oyad275

Key clinical point: Human epidermal growth factor receptor 2 (HER2)-low vs HER2-0 expression was associated with improved breast cancer-specific survival (BCSS) outcomes in patients with early-stage triple-negative breast cancer (TNBC), particularly in the high-risk subgroups.

Major finding: Patients with HER2-low vs HER2-0 BC had significantly better BCSS rates in the overall population (96.6% vs 93.7%; log-rank P = .027) and in high-risk subpopulations comprising patients without a pathological complete response despite neoadjuvant chemotherapy (log-rank P = .047) or those with stage-III BC (log-rank P = .010).

Study details: Findings are from a study including 1445 female patients with early-stage TNBC, of whom 51.7% and 48.3% showed HER2-0 and HER2-low status, respectively.

Disclosures: This study was sponsored by the Health Commission of Henan Province, China. The authors declared no conflicts of interest.

Source: Ma Y et al. HER2-low status was associated with better breast cancer-specific survival in early-stage triple-negative breast cancer. Oncologist. 2023 (Sep 28). doi: 10.1093/oncolo/oyad275

Key clinical point: This real-world study confirmed the effectiveness of tucatinib across all treatment lines in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC).

Major finding: Median real-world time-to-treatment discontinuation was 6.5 months (95% CI 5.4-8.8 months) for the overall population but was longer in patients who received tucatinib in combination with trastuzumab and capecitabine in a metastatic setting (8.1 months; 95% CI 5.7-9.5 months) or as second-line or third-line therapy (9.4 months; 95% CI 6.3-14.1 months). Median real-world overall survival was 26.6 months (95% CI 20.2-not reached).

Study details: Findings are from a retrospective cohort study including 216 patients with HER2+ metastatic BC who received tucatinib in any line of therapy.

Disclosures: This study was sponsored by Seagen Inc. and Merck Sharp & Dohme LLC. Seven authors declared being employees of and holding stock or stock options in Seagen Inc., and the other authors declared ties with various sources, including Seagen and Merck Sharp & Dohme.

Source: Kaufman PA et al. Real-world patient characteristics, treatment patterns, and clinical outcomes associated with tucatinib therapy in HER2-positive metastatic breast cancer. Front Oncol. 2023;13:1264861 (Oct 2). doi: 10.3389/fonc.2023.1264861

Key clinical point: This real-world study confirmed the effectiveness of tucatinib across all treatment lines in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC).

Major finding: Median real-world time-to-treatment discontinuation was 6.5 months (95% CI 5.4-8.8 months) for the overall population but was longer in patients who received tucatinib in combination with trastuzumab and capecitabine in a metastatic setting (8.1 months; 95% CI 5.7-9.5 months) or as second-line or third-line therapy (9.4 months; 95% CI 6.3-14.1 months). Median real-world overall survival was 26.6 months (95% CI 20.2-not reached).

Study details: Findings are from a retrospective cohort study including 216 patients with HER2+ metastatic BC who received tucatinib in any line of therapy.

Disclosures: This study was sponsored by Seagen Inc. and Merck Sharp & Dohme LLC. Seven authors declared being employees of and holding stock or stock options in Seagen Inc., and the other authors declared ties with various sources, including Seagen and Merck Sharp & Dohme.

Source: Kaufman PA et al. Real-world patient characteristics, treatment patterns, and clinical outcomes associated with tucatinib therapy in HER2-positive metastatic breast cancer. Front Oncol. 2023;13:1264861 (Oct 2). doi: 10.3389/fonc.2023.1264861

Key clinical point: This real-world study confirmed the effectiveness of tucatinib across all treatment lines in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC).

Major finding: Median real-world time-to-treatment discontinuation was 6.5 months (95% CI 5.4-8.8 months) for the overall population but was longer in patients who received tucatinib in combination with trastuzumab and capecitabine in a metastatic setting (8.1 months; 95% CI 5.7-9.5 months) or as second-line or third-line therapy (9.4 months; 95% CI 6.3-14.1 months). Median real-world overall survival was 26.6 months (95% CI 20.2-not reached).

Study details: Findings are from a retrospective cohort study including 216 patients with HER2+ metastatic BC who received tucatinib in any line of therapy.

Disclosures: This study was sponsored by Seagen Inc. and Merck Sharp & Dohme LLC. Seven authors declared being employees of and holding stock or stock options in Seagen Inc., and the other authors declared ties with various sources, including Seagen and Merck Sharp & Dohme.

Source: Kaufman PA et al. Real-world patient characteristics, treatment patterns, and clinical outcomes associated with tucatinib therapy in HER2-positive metastatic breast cancer. Front Oncol. 2023;13:1264861 (Oct 2). doi: 10.3389/fonc.2023.1264861

Key clinical point: Unlike partial breast irradiation (PBI), intraoperative radiation therapy (IORT) was associated with higher ipsilateral breast tumor recurrence (IBTR) rates than whole breast irradiation (WBI) in patients with early-stage breast cancer (BC) who underwent breast-conserving surgery (BCS).

Major finding: The risk for IBTR was comparable in patients treated with PBI and WBI (hazard ratio [HR] 1.20; P = .12) but was significantly higher in patients treated with IORT vs WBI (HR 1.46; P < .01).

Study details: Findings are from a meta-analysis of 11 randomized controlled trials including 15,460 patients with early-stage BC who underwent BCS, of whom 7190 patients, 4931 patients, and 2372 patients received WBI, PBI, and IORT, respectively.

Disclosures: This study did not receive any specific funding. Some authors declared serving as consultants for or receiving grants from various sources.

Source: Ravani LV et al. Comparison of partial-breast irradiation and intraoperative radiation to whole-breast irradiation in early-stage breast cancer patients: A Kaplan-Meier-derived patient data meta-analysis. Breast Cancer Res Treat. 2023 (Sep 22). doi: 10.1007/s10549-023-07112-w

Key clinical point: Unlike partial breast irradiation (PBI), intraoperative radiation therapy (IORT) was associated with higher ipsilateral breast tumor recurrence (IBTR) rates than whole breast irradiation (WBI) in patients with early-stage breast cancer (BC) who underwent breast-conserving surgery (BCS).

Major finding: The risk for IBTR was comparable in patients treated with PBI and WBI (hazard ratio [HR] 1.20; P = .12) but was significantly higher in patients treated with IORT vs WBI (HR 1.46; P < .01).

Study details: Findings are from a meta-analysis of 11 randomized controlled trials including 15,460 patients with early-stage BC who underwent BCS, of whom 7190 patients, 4931 patients, and 2372 patients received WBI, PBI, and IORT, respectively.

Disclosures: This study did not receive any specific funding. Some authors declared serving as consultants for or receiving grants from various sources.

Source: Ravani LV et al. Comparison of partial-breast irradiation and intraoperative radiation to whole-breast irradiation in early-stage breast cancer patients: A Kaplan-Meier-derived patient data meta-analysis. Breast Cancer Res Treat. 2023 (Sep 22). doi: 10.1007/s10549-023-07112-w

Key clinical point: Unlike partial breast irradiation (PBI), intraoperative radiation therapy (IORT) was associated with higher ipsilateral breast tumor recurrence (IBTR) rates than whole breast irradiation (WBI) in patients with early-stage breast cancer (BC) who underwent breast-conserving surgery (BCS).

Major finding: The risk for IBTR was comparable in patients treated with PBI and WBI (hazard ratio [HR] 1.20; P = .12) but was significantly higher in patients treated with IORT vs WBI (HR 1.46; P < .01).

Study details: Findings are from a meta-analysis of 11 randomized controlled trials including 15,460 patients with early-stage BC who underwent BCS, of whom 7190 patients, 4931 patients, and 2372 patients received WBI, PBI, and IORT, respectively.

Disclosures: This study did not receive any specific funding. Some authors declared serving as consultants for or receiving grants from various sources.

Source: Ravani LV et al. Comparison of partial-breast irradiation and intraoperative radiation to whole-breast irradiation in early-stage breast cancer patients: A Kaplan-Meier-derived patient data meta-analysis. Breast Cancer Res Treat. 2023 (Sep 22). doi: 10.1007/s10549-023-07112-w

Key clinical point: Compared with good or low adherence to adjuvant hormone therapy (HT), excellent adherence was associated with a significantly reduced risk for subsequent breast tumors (SBT) in older women with ductal carcinoma in situ (DCIS) of the breast.

Major finding: In patients with excellent vs low adherence to adjuvant HT, both breast-conserving surgery (BCS) and BCS + radiation therapy (RT) significantly reduced the risks for SBT (−10.54 and −6.24 percentage points, respectively; both P < .00001) or subsequent invasive breast cancer (−8.85 and −4.28 percentage points, respectively; both P < .00001). Similar results were obtained in patients with excellent vs good adherence to adjuvant HT.

Study details: Findings are from an analysis of a population-based study including 3075 women with DCIS who were age ≥ 65 years and underwent BCS either with (75%) or without RT (25%).

Disclosures: This study was supported by the US National Cancer Institute. Two authors declared serving as consultants for various sources.

Source: Mitchell JM et al. Adherence to hormonal therapy after surgery among older women with ductal carcinoma in situ: Implications for breast cancer-related adverse health events. Cancer. 2023 (Sep 26). Doi: 10.1002/cncr.35009

Key clinical point: Compared with good or low adherence to adjuvant hormone therapy (HT), excellent adherence was associated with a significantly reduced risk for subsequent breast tumors (SBT) in older women with ductal carcinoma in situ (DCIS) of the breast.

Major finding: In patients with excellent vs low adherence to adjuvant HT, both breast-conserving surgery (BCS) and BCS + radiation therapy (RT) significantly reduced the risks for SBT (−10.54 and −6.24 percentage points, respectively; both P < .00001) or subsequent invasive breast cancer (−8.85 and −4.28 percentage points, respectively; both P < .00001). Similar results were obtained in patients with excellent vs good adherence to adjuvant HT.

Study details: Findings are from an analysis of a population-based study including 3075 women with DCIS who were age ≥ 65 years and underwent BCS either with (75%) or without RT (25%).

Disclosures: This study was supported by the US National Cancer Institute. Two authors declared serving as consultants for various sources.

Source: Mitchell JM et al. Adherence to hormonal therapy after surgery among older women with ductal carcinoma in situ: Implications for breast cancer-related adverse health events. Cancer. 2023 (Sep 26). Doi: 10.1002/cncr.35009

Key clinical point: Compared with good or low adherence to adjuvant hormone therapy (HT), excellent adherence was associated with a significantly reduced risk for subsequent breast tumors (SBT) in older women with ductal carcinoma in situ (DCIS) of the breast.

Major finding: In patients with excellent vs low adherence to adjuvant HT, both breast-conserving surgery (BCS) and BCS + radiation therapy (RT) significantly reduced the risks for SBT (−10.54 and −6.24 percentage points, respectively; both P < .00001) or subsequent invasive breast cancer (−8.85 and −4.28 percentage points, respectively; both P < .00001). Similar results were obtained in patients with excellent vs good adherence to adjuvant HT.

Study details: Findings are from an analysis of a population-based study including 3075 women with DCIS who were age ≥ 65 years and underwent BCS either with (75%) or without RT (25%).

Disclosures: This study was supported by the US National Cancer Institute. Two authors declared serving as consultants for various sources.

Source: Mitchell JM et al. Adherence to hormonal therapy after surgery among older women with ductal carcinoma in situ: Implications for breast cancer-related adverse health events. Cancer. 2023 (Sep 26). Doi: 10.1002/cncr.35009

Key clinical point: Prophylactic salpingo-oophorectomy (PSO) after breast surgery leads to significantly improved overall survival (OS) outcomes and can be considered in patients with BRCA1/2 breast cancer (BC), particularly in those with the BRCA1 variant.

Major finding: Patients who did vs did not undergo PSO had significantly improved OS outcomes in the overall population (hazard ratio [HR] 0.40; P < .001) and in subgroups of patients with BRCA1 BC (HR 0.35;  95% CI 0.20-0.63), triple-negative BC (HR 0.21;  95% CI 0.09-0.46), and invasive ductal carcinoma (HR 0.51;  95% CI 0.31-0.84).

Study details: Findings are from a retrospective cohort study including 480 patients with BRCA1 (n = 290) or BRCA2 (n = 190) BC who underwent surgical resection, of whom 300 and 163 patients underwent PSO and prophylactic mastectomy, respectively.

Disclosures: This study did not disclose any funding source. Two authors declared being advisory board members of or receiving grants or personal fees from various sources unrelated to this study.

Source: Martelli G et al. Prophylactic salpingo-oophorectomy and survival after BRCA1/2 breast cancer resection. JAMA Surg. 2023 (Oct 4). doi: 10.1001/jamasurg.2023.4770

Key clinical point: Prophylactic salpingo-oophorectomy (PSO) after breast surgery leads to significantly improved overall survival (OS) outcomes and can be considered in patients with BRCA1/2 breast cancer (BC), particularly in those with the BRCA1 variant.

Major finding: Patients who did vs did not undergo PSO had significantly improved OS outcomes in the overall population (hazard ratio [HR] 0.40; P < .001) and in subgroups of patients with BRCA1 BC (HR 0.35;  95% CI 0.20-0.63), triple-negative BC (HR 0.21;  95% CI 0.09-0.46), and invasive ductal carcinoma (HR 0.51;  95% CI 0.31-0.84).

Study details: Findings are from a retrospective cohort study including 480 patients with BRCA1 (n = 290) or BRCA2 (n = 190) BC who underwent surgical resection, of whom 300 and 163 patients underwent PSO and prophylactic mastectomy, respectively.

Disclosures: This study did not disclose any funding source. Two authors declared being advisory board members of or receiving grants or personal fees from various sources unrelated to this study.

Source: Martelli G et al. Prophylactic salpingo-oophorectomy and survival after BRCA1/2 breast cancer resection. JAMA Surg. 2023 (Oct 4). doi: 10.1001/jamasurg.2023.4770

Key clinical point: Prophylactic salpingo-oophorectomy (PSO) after breast surgery leads to significantly improved overall survival (OS) outcomes and can be considered in patients with BRCA1/2 breast cancer (BC), particularly in those with the BRCA1 variant.

Major finding: Patients who did vs did not undergo PSO had significantly improved OS outcomes in the overall population (hazard ratio [HR] 0.40; P < .001) and in subgroups of patients with BRCA1 BC (HR 0.35;  95% CI 0.20-0.63), triple-negative BC (HR 0.21;  95% CI 0.09-0.46), and invasive ductal carcinoma (HR 0.51;  95% CI 0.31-0.84).

Study details: Findings are from a retrospective cohort study including 480 patients with BRCA1 (n = 290) or BRCA2 (n = 190) BC who underwent surgical resection, of whom 300 and 163 patients underwent PSO and prophylactic mastectomy, respectively.

Disclosures: This study did not disclose any funding source. Two authors declared being advisory board members of or receiving grants or personal fees from various sources unrelated to this study.

Source: Martelli G et al. Prophylactic salpingo-oophorectomy and survival after BRCA1/2 breast cancer resection. JAMA Surg. 2023 (Oct 4). doi: 10.1001/jamasurg.2023.4770

Key clinical point: The development of contralateral breast cancer (CBC) was associated with worsened survival outcomes if the primary breast cancer (PBC) subtype was hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−) or if the patients had CBC onset within 1.5 years after PBC surgery.

Major finding: Compared with patients who did not develop CBC, the risk for death was higher in patients who developed CBC within 1.5 years after PBC surgery (hazard ratio 2.014; P = .04) and in those with HR+/ERBB2− PBC (hazard ratio 1.882; P = .01).

Study details: Findings are from a cohort study including 16,251 patients with stages 0-III PBC, of whom 418 patients developed CBC.

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

Source: Kim H et al. Survival after development of contralateral breast cancer in Korean patients with breast cancer. JAMA Netw Open. 2023;6(9):e2333557 (Sep 14). doi: 10.1001/jamanetworkopen.2023.33557

Key clinical point: The development of contralateral breast cancer (CBC) was associated with worsened survival outcomes if the primary breast cancer (PBC) subtype was hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−) or if the patients had CBC onset within 1.5 years after PBC surgery.

Major finding: Compared with patients who did not develop CBC, the risk for death was higher in patients who developed CBC within 1.5 years after PBC surgery (hazard ratio 2.014; P = .04) and in those with HR+/ERBB2− PBC (hazard ratio 1.882; P = .01).

Study details: Findings are from a cohort study including 16,251 patients with stages 0-III PBC, of whom 418 patients developed CBC.

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

Source: Kim H et al. Survival after development of contralateral breast cancer in Korean patients with breast cancer. JAMA Netw Open. 2023;6(9):e2333557 (Sep 14). doi: 10.1001/jamanetworkopen.2023.33557

Key clinical point: The development of contralateral breast cancer (CBC) was associated with worsened survival outcomes if the primary breast cancer (PBC) subtype was hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−) or if the patients had CBC onset within 1.5 years after PBC surgery.

Major finding: Compared with patients who did not develop CBC, the risk for death was higher in patients who developed CBC within 1.5 years after PBC surgery (hazard ratio 2.014; P = .04) and in those with HR+/ERBB2− PBC (hazard ratio 1.882; P = .01).

Study details: Findings are from a cohort study including 16,251 patients with stages 0-III PBC, of whom 418 patients developed CBC.

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

Source: Kim H et al. Survival after development of contralateral breast cancer in Korean patients with breast cancer. JAMA Netw Open. 2023;6(9):e2333557 (Sep 14). doi: 10.1001/jamanetworkopen.2023.33557

Key clinical point: Women who were exposed to fine particulate matter, ie, airborne particles with an aerodynamic diameter ≤ 2.5 μm (PM_2.5), showed an increased risk of developing breast cancer (BC), particularly estrogen receptor-positive (ER+) BC.

Major finding: As little as a 10 µg/m³ increase in PM_2.5 concentration during 1980-1984 increased the incident risk for BC by 8% (hazard ratio [HR] 1.08;  95% CI 1.02-1.13), with the risk being even higher in case of ER+ BC (HR 1.10;  95% CI 1.04-1.17).

Study details: Findings are from an analysis of a prospective, US-based cohort including 196,905 women with no prior history of cancer, of whom 15,870 developed incident BC.

Disclosures: This study was funded by the US National Institutes of Environmental Health Sciences and the US National Cancer Institute Intramural Program. The authors declared no conflicts of interest.

Source: White AJ et al. Ambient fine particulate matter and breast cancer incidence in a large prospective US cohort. J Natl Cancer Inst. 2023 (Sep 11). doi: 10.1093/jnci/djad170

Key clinical point: Women who were exposed to fine particulate matter, ie, airborne particles with an aerodynamic diameter ≤ 2.5 μm (PM_2.5), showed an increased risk of developing breast cancer (BC), particularly estrogen receptor-positive (ER+) BC.

Major finding: As little as a 10 µg/m³ increase in PM_2.5 concentration during 1980-1984 increased the incident risk for BC by 8% (hazard ratio [HR] 1.08;  95% CI 1.02-1.13), with the risk being even higher in case of ER+ BC (HR 1.10;  95% CI 1.04-1.17).

Study details: Findings are from an analysis of a prospective, US-based cohort including 196,905 women with no prior history of cancer, of whom 15,870 developed incident BC.

Disclosures: This study was funded by the US National Institutes of Environmental Health Sciences and the US National Cancer Institute Intramural Program. The authors declared no conflicts of interest.

Source: White AJ et al. Ambient fine particulate matter and breast cancer incidence in a large prospective US cohort. J Natl Cancer Inst. 2023 (Sep 11). doi: 10.1093/jnci/djad170

Key clinical point: Women who were exposed to fine particulate matter, ie, airborne particles with an aerodynamic diameter ≤ 2.5 μm (PM_2.5), showed an increased risk of developing breast cancer (BC), particularly estrogen receptor-positive (ER+) BC.

Major finding: As little as a 10 µg/m³ increase in PM_2.5 concentration during 1980-1984 increased the incident risk for BC by 8% (hazard ratio [HR] 1.08;  95% CI 1.02-1.13), with the risk being even higher in case of ER+ BC (HR 1.10;  95% CI 1.04-1.17).

Study details: Findings are from an analysis of a prospective, US-based cohort including 196,905 women with no prior history of cancer, of whom 15,870 developed incident BC.

Disclosures: This study was funded by the US National Institutes of Environmental Health Sciences and the US National Cancer Institute Intramural Program. The authors declared no conflicts of interest.

Source: White AJ et al. Ambient fine particulate matter and breast cancer incidence in a large prospective US cohort. J Natl Cancer Inst. 2023 (Sep 11). doi: 10.1093/jnci/djad170

Key clinical point: Women who survived cancer during childhood and received ≥ 200 mg/m² cumulative doxorubicin dose as a part of the treatment may have an increased risk of developing subsequent breast cancer (SBC).

Major finding: A ≥200 mg/m² cumulative doxorubicin dose vs no doxorubicin treatment led to > 2-fold increase in the risk for SBC (hazard ratio [HR] for 200-299  mg/m²: 2.50, 95% CI 1.85-3.40; HR for 300-399  mg/m²: 2.33, 95% CI 1.68-3.23; and HR for ≥ 400  mg/m²: 2.78, 95% CI 1.99-3.88). Every 100 mg/m² increase in the cumulative doxorubicin dose increased SBC risk in patients who survived cancer and either received (HR 1.11;  95% CI 1.02-1.21) or did not receive chest radiotherapy (HR 1.26;  95% CI 1.17-1.36).

<Study details: Findings are from an analysis of a pooled cohort including 17,903 females who survived cancer for ≥ 5 years, of whom 782 survivors developed SBC.

Disclosures: This study was supported by the Children Cancer Free Foundation (aka Foundation KiKa, Stichting Kinderen Kankervrij), Amsterdam. The authors declared no conflicts of interest.

Source: Wang Y et al for The International Consortium for Pooled Studies on Subsequent Malignancies after Childhood and Adolescent Cancer. Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer. Nat Med. 2023;29(9):2268-2277 (Sep 11). doi: 10.1038/s41591-023-02514-1

Key clinical point: Women who survived cancer during childhood and received ≥ 200 mg/m² cumulative doxorubicin dose as a part of the treatment may have an increased risk of developing subsequent breast cancer (SBC).

Major finding: A ≥200 mg/m² cumulative doxorubicin dose vs no doxorubicin treatment led to > 2-fold increase in the risk for SBC (hazard ratio [HR] for 200-299  mg/m²: 2.50, 95% CI 1.85-3.40; HR for 300-399  mg/m²: 2.33, 95% CI 1.68-3.23; and HR for ≥ 400  mg/m²: 2.78, 95% CI 1.99-3.88). Every 100 mg/m² increase in the cumulative doxorubicin dose increased SBC risk in patients who survived cancer and either received (HR 1.11;  95% CI 1.02-1.21) or did not receive chest radiotherapy (HR 1.26;  95% CI 1.17-1.36).

<Study details: Findings are from an analysis of a pooled cohort including 17,903 females who survived cancer for ≥ 5 years, of whom 782 survivors developed SBC.

Disclosures: This study was supported by the Children Cancer Free Foundation (aka Foundation KiKa, Stichting Kinderen Kankervrij), Amsterdam. The authors declared no conflicts of interest.

Source: Wang Y et al for The International Consortium for Pooled Studies on Subsequent Malignancies after Childhood and Adolescent Cancer. Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer. Nat Med. 2023;29(9):2268-2277 (Sep 11). doi: 10.1038/s41591-023-02514-1

Key clinical point: Women who survived cancer during childhood and received ≥ 200 mg/m² cumulative doxorubicin dose as a part of the treatment may have an increased risk of developing subsequent breast cancer (SBC).

Major finding: A ≥200 mg/m² cumulative doxorubicin dose vs no doxorubicin treatment led to > 2-fold increase in the risk for SBC (hazard ratio [HR] for 200-299  mg/m²: 2.50, 95% CI 1.85-3.40; HR for 300-399  mg/m²: 2.33, 95% CI 1.68-3.23; and HR for ≥ 400  mg/m²: 2.78, 95% CI 1.99-3.88). Every 100 mg/m² increase in the cumulative doxorubicin dose increased SBC risk in patients who survived cancer and either received (HR 1.11;  95% CI 1.02-1.21) or did not receive chest radiotherapy (HR 1.26;  95% CI 1.17-1.36).

<Study details: Findings are from an analysis of a pooled cohort including 17,903 females who survived cancer for ≥ 5 years, of whom 782 survivors developed SBC.

Disclosures: This study was supported by the Children Cancer Free Foundation (aka Foundation KiKa, Stichting Kinderen Kankervrij), Amsterdam. The authors declared no conflicts of interest.

Source: Wang Y et al for The International Consortium for Pooled Studies on Subsequent Malignancies after Childhood and Adolescent Cancer. Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer. Nat Med. 2023;29(9):2268-2277 (Sep 11). doi: 10.1038/s41591-023-02514-1