Breast Cancer

It was 2 a.m. And Rebecca Shatsky, MD, could not sleep.

The breast oncologist was thinking about a patient of hers with metastatic cancer.

The patient’s disease had been asymptomatic for some time. Then without warning, her cancer suddenly exploded. Her bone marrow was failing, and her liver was not far behind.

Dr. Shatsky had a treatment plan ready to go but still, she felt uneasy.

“I had to be honest with her that I didn’t know if this plan would work,” says Dr. Shatsky, a medical oncologist at University of California, San Diego (UCSD).

That night, after visiting the patient in the hospital, Dr. Shatsky lay awake going over her next move, making sure it was the right one and hoping it would help keep the disease at bay.

“It’s so much pressure when someone is depending on you to make life or death decisions,” Dr. Shatsky said.

And in the quiet hours of night, these concerns grow louder.

Dr. Shatsky is not alone. Oncologists face difficult decisions every day, and many wrestle with these choices long after their day in the clinic is over.

“There’s no off button,” says Aaron Goodman, MD, a hematologist at UCSD Health who goes by “Papa Heme” on Twitter. “I’m always thinking about my patients. Constantly.”

The public rarely gets a glimpse of these private moments. On occasion, oncologists will share a personal story, but more often, insights come from broad research on the ethical, emotional, and psychological toll of practicing medicine.

Many oncologists carry this baggage home with them because they have no other option.

“There is simply no time to process the weight of the day when I’ve got seven more patients who need my full attention before lunch,” Mark Lewis, MD, director, department of gastrointestinal oncology, Intermountain Healthcare, Salt Lake City, Utah. “That is why my processing happens outside of the office, when my brain can be quiet.”
 

What am I missing?

Dr. Goodman recognizes the gravity of each decision he makes. He pores over every detail of a patient’s scans, lab results, history, and symptoms.

But no matter how many times he checks and rechecks, one question nags at him: What am I missing?

For Dr. Goodman, this exhaustive level of attention is worth it.

“When errors are made, it’s someone’s life,” Dr. Goodman said. “Nothing would have prepared me for this responsibility. Until it lies on you, it’s impossible to understand how much trust patients put into us.”

That trust becomes most apparent for Dr. Goodman when facing a decision about how to treat a patient with acute myeloid leukemia who’s in remission.

Give more chemotherapy to root out the leukemia cells still lurking in the body, and the patient faces a high risk of the cancer returning. Pick stem cell transplant, and the chance of being cured goes up significantly, but the patient could also die within 100 days of the transplant.

“All together, the data show I’m helping patients with a transplant, but for the individual, I could be causing harm. Someone could be living less because of a decision I made,” Dr. Goodman said.

For patients with advanced cancer, oncologists may need to think several moves ahead. Mapping out a patient’s treatment options can feel like a game of chess. Dr. Shatsky is always trying to anticipate how the tumor will behave, what is driving it, and how lifestyle factors may influence a patient’s response in the present and the future.

“It is a mind game,” she says. “Like in chess, I try to outsmart my opponent. But with advanced cancer, there are not necessarily clear-cut guidelines or one way to manage the disease, and I have to do the best I can with drugs I have.”

That’s the art of oncology: Balancing the many knowns and unknowns of a person’s cancer alongside the toxicities of treatment and a patient’s hopes and goals.

Throughout the year, Don Dizon, MD, will see a number of patients with advanced disease. In these instances, the question he often wrestles with is if the patient can’t be cured, whether more treatment will just cause greater harm.

Dr. Dizon recently faced this dilemma with an older patient with metastatic disease who had not done well with an initial treatment regimen. After outlining the risks for more chemotherapy, he explained one option would be to forgo it and simply treat her symptoms.

“It’s an impossible choice,” says Dr. Dizon, director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital, Providence.

Chemotherapy can provide symptom relief, but it can also be toxic – and patients may be so frail, they can die from more therapy.

“I told my patient, if in your heart, you want to try more therapy, that’s okay. But it’s also okay if you don’t,” Dr. Dizon recalled.

Her response: “You’re supposed to give me the answer.”

However, for patients approaching the end of life, there often is no right answer. 

“It’s part of the discomfort you live with as a patient and oncologist, and when I leave the clinic, that’s one thing that follows me home,” Dr. Dizon said. “At the end of the day, I need to look in the mirror and know I did the best I could.”
 

The difficult conversation

Every Sunday, Dr. Lewis feels the weight of the week ahead. He and his wife, a pediatrician, call it the “Sunday scaries.”

It’s when Dr. Lewis begins thinking about the delicate conversations to come, rehearsing how he’s going to share the news that a person has advanced cancer or that a cancer, once in remission, has returned.

“Before the pandemic, I had 36 people come to a visit where I delivered some very heavy news and it became a Greek chorus of sobbing,” he recalls.

For every oncologist, delivering bad news is an integral part of the job. But after spending months, sometimes years, with a patient and the family, Dr. Lewis knows how to take the temperature of the room – who will likely prefer a more blunt style and who might need a gentler touch.

“The longer you know a patient and family, the better you can gauge the best approach,” Dr. Lewis said. “And for some, you know it’ll be complete devastation no matter what.”

When Jennifer Lycette, MD, prepares for a difficult conversation, she’ll run down all the possible ways it could go. Sometimes her brain will get stuck in a loop, cycling through the different trajectories on repeat.

“For years, I didn’t know how to cope with that,” said Dr. Lycette, medical director at Providence Oncology and Hematology Care Clinic in Seaside, Ore. “I wasn’t taught the tools to cope with that in my medical training. It took midcareer professional coaching that I sought out on my own to learn to remind myself that no matter what the person says, I have the experience and skill set to handle what comes next and to simply be present in the moment with the patient.”

The question that now sits with Dr. Lycette hours after a visit is what she could have done better. She knows from experience how important it is to choose her words carefully.

Early in her career, Dr. Lycette had a patient with stage IV cancer who wanted to know more about the death process. Because most people ask about pain, she assured him that he likely wouldn’t experience too much pain with his type of cancer.

“It will probably be like falling asleep,” said Dr. Lycette, hoping she was offering comfort. “When I saw him next, he told me he hadn’t slept.”

He was afraid that if he did, he wouldn’t wake up.

In that moment, Dr. Lycette realized the power that her words carry and the importance of trying to understand the inner lives of her patients.
 

Life outside the clinic

Sometimes an oncologist’s late-night ruminations have little to do with cancer itself.

Manali Patel, MD, finds herself worrying if her patients will have enough to eat and whether she will be able to help.

“I was up at 3 a.m. one morning, thinking about how we’re going to fund a project for patients from low-income households who we discovered were experiencing severe food insecurity – what grants we need, what foundations we can work with,” said Dr. Patel, a medical oncologist at Stanford Hospital and Clinics and the VA Palo Alto Health Care System in California.

The past few years of the pandemic have added a new layer of worry for Dr. Patel.

“I don’t want my patients to die from a preventable virus when they’ve already been through so much suffering,” Dr. Patel said.

This thought feeds worries about how her actions outside the clinic could unintentionally harm her patients. Should she go to a big medical conference? A family gathering? The grocery store?

“There are some places you can’t avoid, but these decisions have caused a lot of strife for me,” she said. “The health and safety of our patients – that’s in our wheelhouse – but so many of the policies are outside of our control.”
 

The inevitable losses and the wins

For patients with metastatic disease, eventually the treatment options will run out.

Dr. Shatsky likes to be up front with patients about that reality: “There will come a day when I will tell you there’s nothing more I can do, and you need to trust that I’m being honest with you and that’s the truth.”

For Dr. Goodman, the devastation that bad news brings patients and families is glaring. He knows there will be no more normalcy in their lives.

“I see a lot of suffering, but I know the suffering happens regardless of whether I see it or not,” Dr. Goodman said.

That’s why holding on to the victories can be so important. Dr. Goodman recalled a young patient who came to him with a 20-cm tumor and is now cured. “Had I not met that individual and done what I had done, he’d be dead, but now he’s going to live his life,” Dr. Goodman said. “But I don’t wake up at 2 a.m. thinking about that.”

Dr. Shatsky gets a lot of joy from the wins – the patients who do really well, the times when she can help a friend or colleagues – and those moments go a long way to outweigh the hurt, worry, and workload.

When dealing with so much gray, “the wins are important, knowing you can make a difference is important,” Dr. Dizon said.

And there’s a delicate balance.

“I think patients want an oncologist who cares and is genuinely invested in their outcomes but not someone who is so sad all the time,” Dr. Lewis said. “When I lose a patient, I still grieve each loss, but I can’t mourn every patient’s death like it’s a family member. Otherwise, I’d break.”

What would you do if you had terminal cancer?

Dr. Dizon recalled how a friend handled the news. She went home and made dinner, he said.

Ultimately, she lived for many years. She saw her kids get married, met her first grandchild, and had time to prepare, something not everyone gets the chance to do.

That’s why it’s important to “do what you normally do as long as you can,” Dr. Dizon said. “Live your life.”

A version of this article first appeared on Medscape.com.

It was 2 a.m. And Rebecca Shatsky, MD, could not sleep.

The breast oncologist was thinking about a patient of hers with metastatic cancer.

The patient’s disease had been asymptomatic for some time. Then without warning, her cancer suddenly exploded. Her bone marrow was failing, and her liver was not far behind.

Dr. Shatsky had a treatment plan ready to go but still, she felt uneasy.

“I had to be honest with her that I didn’t know if this plan would work,” says Dr. Shatsky, a medical oncologist at University of California, San Diego (UCSD).

That night, after visiting the patient in the hospital, Dr. Shatsky lay awake going over her next move, making sure it was the right one and hoping it would help keep the disease at bay.

“It’s so much pressure when someone is depending on you to make life or death decisions,” Dr. Shatsky said.

And in the quiet hours of night, these concerns grow louder.

Dr. Shatsky is not alone. Oncologists face difficult decisions every day, and many wrestle with these choices long after their day in the clinic is over.

“There’s no off button,” says Aaron Goodman, MD, a hematologist at UCSD Health who goes by “Papa Heme” on Twitter. “I’m always thinking about my patients. Constantly.”

The public rarely gets a glimpse of these private moments. On occasion, oncologists will share a personal story, but more often, insights come from broad research on the ethical, emotional, and psychological toll of practicing medicine.

Many oncologists carry this baggage home with them because they have no other option.

“There is simply no time to process the weight of the day when I’ve got seven more patients who need my full attention before lunch,” Mark Lewis, MD, director, department of gastrointestinal oncology, Intermountain Healthcare, Salt Lake City, Utah. “That is why my processing happens outside of the office, when my brain can be quiet.”
 

What am I missing?

Dr. Goodman recognizes the gravity of each decision he makes. He pores over every detail of a patient’s scans, lab results, history, and symptoms.

But no matter how many times he checks and rechecks, one question nags at him: What am I missing?

For Dr. Goodman, this exhaustive level of attention is worth it.

“When errors are made, it’s someone’s life,” Dr. Goodman said. “Nothing would have prepared me for this responsibility. Until it lies on you, it’s impossible to understand how much trust patients put into us.”

That trust becomes most apparent for Dr. Goodman when facing a decision about how to treat a patient with acute myeloid leukemia who’s in remission.

Give more chemotherapy to root out the leukemia cells still lurking in the body, and the patient faces a high risk of the cancer returning. Pick stem cell transplant, and the chance of being cured goes up significantly, but the patient could also die within 100 days of the transplant.

“All together, the data show I’m helping patients with a transplant, but for the individual, I could be causing harm. Someone could be living less because of a decision I made,” Dr. Goodman said.

For patients with advanced cancer, oncologists may need to think several moves ahead. Mapping out a patient’s treatment options can feel like a game of chess. Dr. Shatsky is always trying to anticipate how the tumor will behave, what is driving it, and how lifestyle factors may influence a patient’s response in the present and the future.

“It is a mind game,” she says. “Like in chess, I try to outsmart my opponent. But with advanced cancer, there are not necessarily clear-cut guidelines or one way to manage the disease, and I have to do the best I can with drugs I have.”

That’s the art of oncology: Balancing the many knowns and unknowns of a person’s cancer alongside the toxicities of treatment and a patient’s hopes and goals.

Throughout the year, Don Dizon, MD, will see a number of patients with advanced disease. In these instances, the question he often wrestles with is if the patient can’t be cured, whether more treatment will just cause greater harm.

Dr. Dizon recently faced this dilemma with an older patient with metastatic disease who had not done well with an initial treatment regimen. After outlining the risks for more chemotherapy, he explained one option would be to forgo it and simply treat her symptoms.

“It’s an impossible choice,” says Dr. Dizon, director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital, Providence.

Chemotherapy can provide symptom relief, but it can also be toxic – and patients may be so frail, they can die from more therapy.

“I told my patient, if in your heart, you want to try more therapy, that’s okay. But it’s also okay if you don’t,” Dr. Dizon recalled.

Her response: “You’re supposed to give me the answer.”

However, for patients approaching the end of life, there often is no right answer. 

“It’s part of the discomfort you live with as a patient and oncologist, and when I leave the clinic, that’s one thing that follows me home,” Dr. Dizon said. “At the end of the day, I need to look in the mirror and know I did the best I could.”
 

The difficult conversation

Every Sunday, Dr. Lewis feels the weight of the week ahead. He and his wife, a pediatrician, call it the “Sunday scaries.”

It’s when Dr. Lewis begins thinking about the delicate conversations to come, rehearsing how he’s going to share the news that a person has advanced cancer or that a cancer, once in remission, has returned.

“Before the pandemic, I had 36 people come to a visit where I delivered some very heavy news and it became a Greek chorus of sobbing,” he recalls.

For every oncologist, delivering bad news is an integral part of the job. But after spending months, sometimes years, with a patient and the family, Dr. Lewis knows how to take the temperature of the room – who will likely prefer a more blunt style and who might need a gentler touch.

“The longer you know a patient and family, the better you can gauge the best approach,” Dr. Lewis said. “And for some, you know it’ll be complete devastation no matter what.”

When Jennifer Lycette, MD, prepares for a difficult conversation, she’ll run down all the possible ways it could go. Sometimes her brain will get stuck in a loop, cycling through the different trajectories on repeat.

“For years, I didn’t know how to cope with that,” said Dr. Lycette, medical director at Providence Oncology and Hematology Care Clinic in Seaside, Ore. “I wasn’t taught the tools to cope with that in my medical training. It took midcareer professional coaching that I sought out on my own to learn to remind myself that no matter what the person says, I have the experience and skill set to handle what comes next and to simply be present in the moment with the patient.”

The question that now sits with Dr. Lycette hours after a visit is what she could have done better. She knows from experience how important it is to choose her words carefully.

Early in her career, Dr. Lycette had a patient with stage IV cancer who wanted to know more about the death process. Because most people ask about pain, she assured him that he likely wouldn’t experience too much pain with his type of cancer.

“It will probably be like falling asleep,” said Dr. Lycette, hoping she was offering comfort. “When I saw him next, he told me he hadn’t slept.”

He was afraid that if he did, he wouldn’t wake up.

In that moment, Dr. Lycette realized the power that her words carry and the importance of trying to understand the inner lives of her patients.
 

Life outside the clinic

Sometimes an oncologist’s late-night ruminations have little to do with cancer itself.

Manali Patel, MD, finds herself worrying if her patients will have enough to eat and whether she will be able to help.

“I was up at 3 a.m. one morning, thinking about how we’re going to fund a project for patients from low-income households who we discovered were experiencing severe food insecurity – what grants we need, what foundations we can work with,” said Dr. Patel, a medical oncologist at Stanford Hospital and Clinics and the VA Palo Alto Health Care System in California.

The past few years of the pandemic have added a new layer of worry for Dr. Patel.

“I don’t want my patients to die from a preventable virus when they’ve already been through so much suffering,” Dr. Patel said.

This thought feeds worries about how her actions outside the clinic could unintentionally harm her patients. Should she go to a big medical conference? A family gathering? The grocery store?

“There are some places you can’t avoid, but these decisions have caused a lot of strife for me,” she said. “The health and safety of our patients – that’s in our wheelhouse – but so many of the policies are outside of our control.”
 

The inevitable losses and the wins

For patients with metastatic disease, eventually the treatment options will run out.

Dr. Shatsky likes to be up front with patients about that reality: “There will come a day when I will tell you there’s nothing more I can do, and you need to trust that I’m being honest with you and that’s the truth.”

For Dr. Goodman, the devastation that bad news brings patients and families is glaring. He knows there will be no more normalcy in their lives.

“I see a lot of suffering, but I know the suffering happens regardless of whether I see it or not,” Dr. Goodman said.

That’s why holding on to the victories can be so important. Dr. Goodman recalled a young patient who came to him with a 20-cm tumor and is now cured. “Had I not met that individual and done what I had done, he’d be dead, but now he’s going to live his life,” Dr. Goodman said. “But I don’t wake up at 2 a.m. thinking about that.”

Dr. Shatsky gets a lot of joy from the wins – the patients who do really well, the times when she can help a friend or colleagues – and those moments go a long way to outweigh the hurt, worry, and workload.

When dealing with so much gray, “the wins are important, knowing you can make a difference is important,” Dr. Dizon said.

And there’s a delicate balance.

“I think patients want an oncologist who cares and is genuinely invested in their outcomes but not someone who is so sad all the time,” Dr. Lewis said. “When I lose a patient, I still grieve each loss, but I can’t mourn every patient’s death like it’s a family member. Otherwise, I’d break.”

What would you do if you had terminal cancer?

Dr. Dizon recalled how a friend handled the news. She went home and made dinner, he said.

Ultimately, she lived for many years. She saw her kids get married, met her first grandchild, and had time to prepare, something not everyone gets the chance to do.

That’s why it’s important to “do what you normally do as long as you can,” Dr. Dizon said. “Live your life.”

A version of this article first appeared on Medscape.com.

It was 2 a.m. And Rebecca Shatsky, MD, could not sleep.

The breast oncologist was thinking about a patient of hers with metastatic cancer.

The patient’s disease had been asymptomatic for some time. Then without warning, her cancer suddenly exploded. Her bone marrow was failing, and her liver was not far behind.

Dr. Shatsky had a treatment plan ready to go but still, she felt uneasy.

“I had to be honest with her that I didn’t know if this plan would work,” says Dr. Shatsky, a medical oncologist at University of California, San Diego (UCSD).

That night, after visiting the patient in the hospital, Dr. Shatsky lay awake going over her next move, making sure it was the right one and hoping it would help keep the disease at bay.

“It’s so much pressure when someone is depending on you to make life or death decisions,” Dr. Shatsky said.

And in the quiet hours of night, these concerns grow louder.

Dr. Shatsky is not alone. Oncologists face difficult decisions every day, and many wrestle with these choices long after their day in the clinic is over.

“There’s no off button,” says Aaron Goodman, MD, a hematologist at UCSD Health who goes by “Papa Heme” on Twitter. “I’m always thinking about my patients. Constantly.”

The public rarely gets a glimpse of these private moments. On occasion, oncologists will share a personal story, but more often, insights come from broad research on the ethical, emotional, and psychological toll of practicing medicine.

Many oncologists carry this baggage home with them because they have no other option.

“There is simply no time to process the weight of the day when I’ve got seven more patients who need my full attention before lunch,” Mark Lewis, MD, director, department of gastrointestinal oncology, Intermountain Healthcare, Salt Lake City, Utah. “That is why my processing happens outside of the office, when my brain can be quiet.”
 

What am I missing?

Dr. Goodman recognizes the gravity of each decision he makes. He pores over every detail of a patient’s scans, lab results, history, and symptoms.

But no matter how many times he checks and rechecks, one question nags at him: What am I missing?

For Dr. Goodman, this exhaustive level of attention is worth it.

“When errors are made, it’s someone’s life,” Dr. Goodman said. “Nothing would have prepared me for this responsibility. Until it lies on you, it’s impossible to understand how much trust patients put into us.”

That trust becomes most apparent for Dr. Goodman when facing a decision about how to treat a patient with acute myeloid leukemia who’s in remission.

Give more chemotherapy to root out the leukemia cells still lurking in the body, and the patient faces a high risk of the cancer returning. Pick stem cell transplant, and the chance of being cured goes up significantly, but the patient could also die within 100 days of the transplant.

“All together, the data show I’m helping patients with a transplant, but for the individual, I could be causing harm. Someone could be living less because of a decision I made,” Dr. Goodman said.

For patients with advanced cancer, oncologists may need to think several moves ahead. Mapping out a patient’s treatment options can feel like a game of chess. Dr. Shatsky is always trying to anticipate how the tumor will behave, what is driving it, and how lifestyle factors may influence a patient’s response in the present and the future.

“It is a mind game,” she says. “Like in chess, I try to outsmart my opponent. But with advanced cancer, there are not necessarily clear-cut guidelines or one way to manage the disease, and I have to do the best I can with drugs I have.”

That’s the art of oncology: Balancing the many knowns and unknowns of a person’s cancer alongside the toxicities of treatment and a patient’s hopes and goals.

Throughout the year, Don Dizon, MD, will see a number of patients with advanced disease. In these instances, the question he often wrestles with is if the patient can’t be cured, whether more treatment will just cause greater harm.

Dr. Dizon recently faced this dilemma with an older patient with metastatic disease who had not done well with an initial treatment regimen. After outlining the risks for more chemotherapy, he explained one option would be to forgo it and simply treat her symptoms.

“It’s an impossible choice,” says Dr. Dizon, director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital, Providence.

Chemotherapy can provide symptom relief, but it can also be toxic – and patients may be so frail, they can die from more therapy.

“I told my patient, if in your heart, you want to try more therapy, that’s okay. But it’s also okay if you don’t,” Dr. Dizon recalled.

Her response: “You’re supposed to give me the answer.”

However, for patients approaching the end of life, there often is no right answer. 

“It’s part of the discomfort you live with as a patient and oncologist, and when I leave the clinic, that’s one thing that follows me home,” Dr. Dizon said. “At the end of the day, I need to look in the mirror and know I did the best I could.”
 

The difficult conversation

Every Sunday, Dr. Lewis feels the weight of the week ahead. He and his wife, a pediatrician, call it the “Sunday scaries.”

It’s when Dr. Lewis begins thinking about the delicate conversations to come, rehearsing how he’s going to share the news that a person has advanced cancer or that a cancer, once in remission, has returned.

“Before the pandemic, I had 36 people come to a visit where I delivered some very heavy news and it became a Greek chorus of sobbing,” he recalls.

For every oncologist, delivering bad news is an integral part of the job. But after spending months, sometimes years, with a patient and the family, Dr. Lewis knows how to take the temperature of the room – who will likely prefer a more blunt style and who might need a gentler touch.

“The longer you know a patient and family, the better you can gauge the best approach,” Dr. Lewis said. “And for some, you know it’ll be complete devastation no matter what.”

When Jennifer Lycette, MD, prepares for a difficult conversation, she’ll run down all the possible ways it could go. Sometimes her brain will get stuck in a loop, cycling through the different trajectories on repeat.

“For years, I didn’t know how to cope with that,” said Dr. Lycette, medical director at Providence Oncology and Hematology Care Clinic in Seaside, Ore. “I wasn’t taught the tools to cope with that in my medical training. It took midcareer professional coaching that I sought out on my own to learn to remind myself that no matter what the person says, I have the experience and skill set to handle what comes next and to simply be present in the moment with the patient.”

The question that now sits with Dr. Lycette hours after a visit is what she could have done better. She knows from experience how important it is to choose her words carefully.

Early in her career, Dr. Lycette had a patient with stage IV cancer who wanted to know more about the death process. Because most people ask about pain, she assured him that he likely wouldn’t experience too much pain with his type of cancer.

“It will probably be like falling asleep,” said Dr. Lycette, hoping she was offering comfort. “When I saw him next, he told me he hadn’t slept.”

He was afraid that if he did, he wouldn’t wake up.

In that moment, Dr. Lycette realized the power that her words carry and the importance of trying to understand the inner lives of her patients.
 

Life outside the clinic

Sometimes an oncologist’s late-night ruminations have little to do with cancer itself.

Manali Patel, MD, finds herself worrying if her patients will have enough to eat and whether she will be able to help.

“I was up at 3 a.m. one morning, thinking about how we’re going to fund a project for patients from low-income households who we discovered were experiencing severe food insecurity – what grants we need, what foundations we can work with,” said Dr. Patel, a medical oncologist at Stanford Hospital and Clinics and the VA Palo Alto Health Care System in California.

The past few years of the pandemic have added a new layer of worry for Dr. Patel.

“I don’t want my patients to die from a preventable virus when they’ve already been through so much suffering,” Dr. Patel said.

This thought feeds worries about how her actions outside the clinic could unintentionally harm her patients. Should she go to a big medical conference? A family gathering? The grocery store?

“There are some places you can’t avoid, but these decisions have caused a lot of strife for me,” she said. “The health and safety of our patients – that’s in our wheelhouse – but so many of the policies are outside of our control.”
 

The inevitable losses and the wins

For patients with metastatic disease, eventually the treatment options will run out.

Dr. Shatsky likes to be up front with patients about that reality: “There will come a day when I will tell you there’s nothing more I can do, and you need to trust that I’m being honest with you and that’s the truth.”

For Dr. Goodman, the devastation that bad news brings patients and families is glaring. He knows there will be no more normalcy in their lives.

“I see a lot of suffering, but I know the suffering happens regardless of whether I see it or not,” Dr. Goodman said.

That’s why holding on to the victories can be so important. Dr. Goodman recalled a young patient who came to him with a 20-cm tumor and is now cured. “Had I not met that individual and done what I had done, he’d be dead, but now he’s going to live his life,” Dr. Goodman said. “But I don’t wake up at 2 a.m. thinking about that.”

Dr. Shatsky gets a lot of joy from the wins – the patients who do really well, the times when she can help a friend or colleagues – and those moments go a long way to outweigh the hurt, worry, and workload.

When dealing with so much gray, “the wins are important, knowing you can make a difference is important,” Dr. Dizon said.

And there’s a delicate balance.

“I think patients want an oncologist who cares and is genuinely invested in their outcomes but not someone who is so sad all the time,” Dr. Lewis said. “When I lose a patient, I still grieve each loss, but I can’t mourn every patient’s death like it’s a family member. Otherwise, I’d break.”

What would you do if you had terminal cancer?

Dr. Dizon recalled how a friend handled the news. She went home and made dinner, he said.

Ultimately, she lived for many years. She saw her kids get married, met her first grandchild, and had time to prepare, something not everyone gets the chance to do.

That’s why it’s important to “do what you normally do as long as you can,” Dr. Dizon said. “Live your life.”

A version of this article first appeared on Medscape.com.

Key clinical point: Human epidermal growth factor receptor 2 (ERBB2)-low breast cancer (BC) cannot be considered a distinct biologic subtype of BC because most of its clinicopathologic and prognostic differences are associated with hormone receptor (HR) expression.

Major finding: HR expression was a significant factor associated with the ERBB2 status (adjusted odds ratio for HR-positive vs HR-negative tumors 2.1; P < .001). The pathologic complete response rate was similar in ERBB2-low and ERBB2-0 tumors among patients with HR-positive (P  =  .08) or triple-negative (P  =  .40) BC.

Study details: Findings are from a large cohort study including 5235 patients with ERBB2-negative invasive, stage I-III BC, of which 55.7% and 44.3% of patients had ERBB2-low and ERBB2-0 tumors, respectively.

Disclosures: Dr. Tarantino was supported by an American-Italian Cancer Foundation postdoctoral research fellowship. The authors declared serving on advisory boards of or receiving personal fees, research grants, consulting fees, or honoraria from several sources.

Source: Tarantino P et al. Prognostic and biologic significance of ERBB2-low expression in early-stage breast cancer. JAMA Oncol. 2022 (Jun 23). Doi: 10.1001/jamaoncol.2022.2286

Key clinical point: Human epidermal growth factor receptor 2 (ERBB2)-low breast cancer (BC) cannot be considered a distinct biologic subtype of BC because most of its clinicopathologic and prognostic differences are associated with hormone receptor (HR) expression.

Major finding: HR expression was a significant factor associated with the ERBB2 status (adjusted odds ratio for HR-positive vs HR-negative tumors 2.1; P < .001). The pathologic complete response rate was similar in ERBB2-low and ERBB2-0 tumors among patients with HR-positive (P  =  .08) or triple-negative (P  =  .40) BC.

Study details: Findings are from a large cohort study including 5235 patients with ERBB2-negative invasive, stage I-III BC, of which 55.7% and 44.3% of patients had ERBB2-low and ERBB2-0 tumors, respectively.

Disclosures: Dr. Tarantino was supported by an American-Italian Cancer Foundation postdoctoral research fellowship. The authors declared serving on advisory boards of or receiving personal fees, research grants, consulting fees, or honoraria from several sources.

Source: Tarantino P et al. Prognostic and biologic significance of ERBB2-low expression in early-stage breast cancer. JAMA Oncol. 2022 (Jun 23). Doi: 10.1001/jamaoncol.2022.2286

Key clinical point: Human epidermal growth factor receptor 2 (ERBB2)-low breast cancer (BC) cannot be considered a distinct biologic subtype of BC because most of its clinicopathologic and prognostic differences are associated with hormone receptor (HR) expression.

Major finding: HR expression was a significant factor associated with the ERBB2 status (adjusted odds ratio for HR-positive vs HR-negative tumors 2.1; P < .001). The pathologic complete response rate was similar in ERBB2-low and ERBB2-0 tumors among patients with HR-positive (P  =  .08) or triple-negative (P  =  .40) BC.

Study details: Findings are from a large cohort study including 5235 patients with ERBB2-negative invasive, stage I-III BC, of which 55.7% and 44.3% of patients had ERBB2-low and ERBB2-0 tumors, respectively.

Disclosures: Dr. Tarantino was supported by an American-Italian Cancer Foundation postdoctoral research fellowship. The authors declared serving on advisory boards of or receiving personal fees, research grants, consulting fees, or honoraria from several sources.

Source: Tarantino P et al. Prognostic and biologic significance of ERBB2-low expression in early-stage breast cancer. JAMA Oncol. 2022 (Jun 23). Doi: 10.1001/jamaoncol.2022.2286

Key clinical point: The use of β-blocker at the time of breast cancer (BC) diagnosis reduced mortality in patients with triple-negative BC (TNBC).

Major finding: Although β-blocker use vs no use was not associated with BC-specific survival in the overall population, β-blockers reduced BC mortality by 34% in patients with TNBC (hazard ratio [HR] 0.66; 95% CI 0.47-0.91). The meta-analysis further confirmed that β-blocker use was associated with progression/recurrence-free survival (HR 0.58; 95% CI 0.38-0.89) in the TNBC population.

Study details: Findings are from a large population-based cohort study including 30,060 women aged ≥ 50 years with primary invasive BC, of which 15% used β-blockers at the time of BC diagnosis, and from a meta-analysis of 8 observational studies.

Disclosures: This study was funded by the Norwegian Research Council and other sources. EK Sloan declared serving as a scientific advisory board member for Cygnal Therapeutics.

Source: Løfling LL et al. β-blockers and breast cancer survival by molecular subtypes: A population-based cohort study and meta-analysis. Br J Cancer. 2022 (Jun 20). Doi: 10.1038/s41416-022-01891-7

Key clinical point: The use of β-blocker at the time of breast cancer (BC) diagnosis reduced mortality in patients with triple-negative BC (TNBC).

Major finding: Although β-blocker use vs no use was not associated with BC-specific survival in the overall population, β-blockers reduced BC mortality by 34% in patients with TNBC (hazard ratio [HR] 0.66; 95% CI 0.47-0.91). The meta-analysis further confirmed that β-blocker use was associated with progression/recurrence-free survival (HR 0.58; 95% CI 0.38-0.89) in the TNBC population.

Study details: Findings are from a large population-based cohort study including 30,060 women aged ≥ 50 years with primary invasive BC, of which 15% used β-blockers at the time of BC diagnosis, and from a meta-analysis of 8 observational studies.

Disclosures: This study was funded by the Norwegian Research Council and other sources. EK Sloan declared serving as a scientific advisory board member for Cygnal Therapeutics.

Source: Løfling LL et al. β-blockers and breast cancer survival by molecular subtypes: A population-based cohort study and meta-analysis. Br J Cancer. 2022 (Jun 20). Doi: 10.1038/s41416-022-01891-7

Key clinical point: The use of β-blocker at the time of breast cancer (BC) diagnosis reduced mortality in patients with triple-negative BC (TNBC).

Major finding: Although β-blocker use vs no use was not associated with BC-specific survival in the overall population, β-blockers reduced BC mortality by 34% in patients with TNBC (hazard ratio [HR] 0.66; 95% CI 0.47-0.91). The meta-analysis further confirmed that β-blocker use was associated with progression/recurrence-free survival (HR 0.58; 95% CI 0.38-0.89) in the TNBC population.

Study details: Findings are from a large population-based cohort study including 30,060 women aged ≥ 50 years with primary invasive BC, of which 15% used β-blockers at the time of BC diagnosis, and from a meta-analysis of 8 observational studies.

Disclosures: This study was funded by the Norwegian Research Council and other sources. EK Sloan declared serving as a scientific advisory board member for Cygnal Therapeutics.

Source: Løfling LL et al. β-blockers and breast cancer survival by molecular subtypes: A population-based cohort study and meta-analysis. Br J Cancer. 2022 (Jun 20). Doi: 10.1038/s41416-022-01891-7

Key clinical point: In patients with early-stage triple-negative breast cancer (TNBC), capecitabine improved survival and demonstrated a tolerable safety profile, with lower dosage, higher frequency, and adjuvant setting being related with better survival outcomes.

Major finding: Capecitabine vs chemotherapy without capecitabine improved disease-free survival (DFS; hazard ratio [HR] 0.77; P < .001) and overall survival (HR 0.73; P < .0001). A lower dose (<1000 mg; HR 0.69; P  =  .002), a higher dosage frequency (≥6 cycles; HR 0.72; P < .0001) and an adjuvant setting (HR 0.74; P < .0001) were associated with a higher DFS. Capecitabine was associated with higher risk for diarrhea (P < .0001), hand-foot syndrome (P < .0001), and leukopenia (P < .01).

Study details: Findings are from a meta-analysis of 11 phase 3 randomized controlled trials including 5175 female patients with early-stage TNBC who received neoadjuvant or adjuvant chemotherapy with or without capecitabine.

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

Source: Xun X et al. Efficacy and safety of capecitabine for triple-negative breast cancer: A meta-analysis. Front Oncol. 2022;12:899423 (Jul 7). Doi: 10.3389/fonc.2022.899423

Key clinical point: In patients with early-stage triple-negative breast cancer (TNBC), capecitabine improved survival and demonstrated a tolerable safety profile, with lower dosage, higher frequency, and adjuvant setting being related with better survival outcomes.

Major finding: Capecitabine vs chemotherapy without capecitabine improved disease-free survival (DFS; hazard ratio [HR] 0.77; P < .001) and overall survival (HR 0.73; P < .0001). A lower dose (<1000 mg; HR 0.69; P  =  .002), a higher dosage frequency (≥6 cycles; HR 0.72; P < .0001) and an adjuvant setting (HR 0.74; P < .0001) were associated with a higher DFS. Capecitabine was associated with higher risk for diarrhea (P < .0001), hand-foot syndrome (P < .0001), and leukopenia (P < .01).

Study details: Findings are from a meta-analysis of 11 phase 3 randomized controlled trials including 5175 female patients with early-stage TNBC who received neoadjuvant or adjuvant chemotherapy with or without capecitabine.

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

Source: Xun X et al. Efficacy and safety of capecitabine for triple-negative breast cancer: A meta-analysis. Front Oncol. 2022;12:899423 (Jul 7). Doi: 10.3389/fonc.2022.899423

Key clinical point: In patients with early-stage triple-negative breast cancer (TNBC), capecitabine improved survival and demonstrated a tolerable safety profile, with lower dosage, higher frequency, and adjuvant setting being related with better survival outcomes.

Major finding: Capecitabine vs chemotherapy without capecitabine improved disease-free survival (DFS; hazard ratio [HR] 0.77; P < .001) and overall survival (HR 0.73; P < .0001). A lower dose (<1000 mg; HR 0.69; P  =  .002), a higher dosage frequency (≥6 cycles; HR 0.72; P < .0001) and an adjuvant setting (HR 0.74; P < .0001) were associated with a higher DFS. Capecitabine was associated with higher risk for diarrhea (P < .0001), hand-foot syndrome (P < .0001), and leukopenia (P < .01).

Study details: Findings are from a meta-analysis of 11 phase 3 randomized controlled trials including 5175 female patients with early-stage TNBC who received neoadjuvant or adjuvant chemotherapy with or without capecitabine.

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

Source: Xun X et al. Efficacy and safety of capecitabine for triple-negative breast cancer: A meta-analysis. Front Oncol. 2022;12:899423 (Jul 7). Doi: 10.3389/fonc.2022.899423

Key clinical point: Postmastectomy radiotherapy (PMRT) did not influence locoregional recurrence (LRR) in patients with pT1-2 and 1-3 node-positive breast cancer (BC).

Major finding: Rate of LRR at 5 years was similar in patients receiving PMRT and no PMRT (P  =  .61), and PMRT was not significantly associated with LRR in the overall population (P  =  .305).

Study details: Findings are from a retrospective, cohort study including 8914 patients with pT1-2 BC tumors and 1-3 lymph node metastases who received PMRT (n = 492) or no PMRT (n = 8422) after undergoing mastectomy and axillary lymph node dissection.

Disclosures: This study was supported by the Japanese Breast Cancer Society. Some authors declared receiving speaker’s fees, consulting fees, research funds, or honoraria from several sources.

Source: Yamada A et al. Prognostic impact of postoperative radiotherapy in patients with breast cancer and with pT1-2 and 1–3 lymph node metastases: A retrospective cohort study based on the Japanese Breast Cancer Registry. Eur J Cancer. 2022;172:32-40 (Jun 22). Doi: 10.1016/j.ejca.2022.05.017

Key clinical point: Postmastectomy radiotherapy (PMRT) did not influence locoregional recurrence (LRR) in patients with pT1-2 and 1-3 node-positive breast cancer (BC).

Major finding: Rate of LRR at 5 years was similar in patients receiving PMRT and no PMRT (P  =  .61), and PMRT was not significantly associated with LRR in the overall population (P  =  .305).

Study details: Findings are from a retrospective, cohort study including 8914 patients with pT1-2 BC tumors and 1-3 lymph node metastases who received PMRT (n = 492) or no PMRT (n = 8422) after undergoing mastectomy and axillary lymph node dissection.

Disclosures: This study was supported by the Japanese Breast Cancer Society. Some authors declared receiving speaker’s fees, consulting fees, research funds, or honoraria from several sources.

Source: Yamada A et al. Prognostic impact of postoperative radiotherapy in patients with breast cancer and with pT1-2 and 1–3 lymph node metastases: A retrospective cohort study based on the Japanese Breast Cancer Registry. Eur J Cancer. 2022;172:32-40 (Jun 22). Doi: 10.1016/j.ejca.2022.05.017

Key clinical point: Postmastectomy radiotherapy (PMRT) did not influence locoregional recurrence (LRR) in patients with pT1-2 and 1-3 node-positive breast cancer (BC).

Major finding: Rate of LRR at 5 years was similar in patients receiving PMRT and no PMRT (P  =  .61), and PMRT was not significantly associated with LRR in the overall population (P  =  .305).

Study details: Findings are from a retrospective, cohort study including 8914 patients with pT1-2 BC tumors and 1-3 lymph node metastases who received PMRT (n = 492) or no PMRT (n = 8422) after undergoing mastectomy and axillary lymph node dissection.

Disclosures: This study was supported by the Japanese Breast Cancer Society. Some authors declared receiving speaker’s fees, consulting fees, research funds, or honoraria from several sources.

Source: Yamada A et al. Prognostic impact of postoperative radiotherapy in patients with breast cancer and with pT1-2 and 1–3 lymph node metastases: A retrospective cohort study based on the Japanese Breast Cancer Registry. Eur J Cancer. 2022;172:32-40 (Jun 22). Doi: 10.1016/j.ejca.2022.05.017

Key clinical point: Addition of atezolizumab vs placebo to pertuzumab-trastuzumab (PH)+chemotherapy did not improve pathological complete response (pCR) rates in patients with high-risk, human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC).

Major finding: The rate of pCR was similar with atezolizumab and placebo in the intention-to-treat (62.4% and 62.7%, respectively; P  =  .9551) and programmed cell death-ligand 1-positive (64.2% and 72.5%, respectively; P  =  .1846) populations. The atezolizumab vs placebo group reported 5 vs 0 grade 5 adverse events, respectively.

Study details: Findings are from the phase 3 IMpassion050 study including 454 patients with high-risk, HER2+ early BC who were randomly assigned to receive atezolizumab or placebo with PH+chemotherapy in the neoadjuvant setting and continued atezolizumab or placebo with PH in the adjuvant phase.

Disclosures: This study was sponsored by F. Hoffmann-La Roche Ltd. Six authors declared being employees or stockowners at Roche, and the other authors reported ties with various sources, including Roche.

Source: Huober J et al. Atezolizumab With Neoadjuvant anti–human epidermal growth factor receptor 2 therapy and chemotherapy in human epidermal growth factor receptor 2–positive early breast cancer: Primary results of the randomized phase III IMpassion050 trial. J Clin Oncol. 2022 (Jun 28). Doi:  10.1200/JCO.21.02772

Key clinical point: Addition of atezolizumab vs placebo to pertuzumab-trastuzumab (PH)+chemotherapy did not improve pathological complete response (pCR) rates in patients with high-risk, human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC).

Major finding: The rate of pCR was similar with atezolizumab and placebo in the intention-to-treat (62.4% and 62.7%, respectively; P  =  .9551) and programmed cell death-ligand 1-positive (64.2% and 72.5%, respectively; P  =  .1846) populations. The atezolizumab vs placebo group reported 5 vs 0 grade 5 adverse events, respectively.

Study details: Findings are from the phase 3 IMpassion050 study including 454 patients with high-risk, HER2+ early BC who were randomly assigned to receive atezolizumab or placebo with PH+chemotherapy in the neoadjuvant setting and continued atezolizumab or placebo with PH in the adjuvant phase.

Disclosures: This study was sponsored by F. Hoffmann-La Roche Ltd. Six authors declared being employees or stockowners at Roche, and the other authors reported ties with various sources, including Roche.

Source: Huober J et al. Atezolizumab With Neoadjuvant anti–human epidermal growth factor receptor 2 therapy and chemotherapy in human epidermal growth factor receptor 2–positive early breast cancer: Primary results of the randomized phase III IMpassion050 trial. J Clin Oncol. 2022 (Jun 28). Doi:  10.1200/JCO.21.02772

Key clinical point: Addition of atezolizumab vs placebo to pertuzumab-trastuzumab (PH)+chemotherapy did not improve pathological complete response (pCR) rates in patients with high-risk, human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (BC).

Major finding: The rate of pCR was similar with atezolizumab and placebo in the intention-to-treat (62.4% and 62.7%, respectively; P  =  .9551) and programmed cell death-ligand 1-positive (64.2% and 72.5%, respectively; P  =  .1846) populations. The atezolizumab vs placebo group reported 5 vs 0 grade 5 adverse events, respectively.

Study details: Findings are from the phase 3 IMpassion050 study including 454 patients with high-risk, HER2+ early BC who were randomly assigned to receive atezolizumab or placebo with PH+chemotherapy in the neoadjuvant setting and continued atezolizumab or placebo with PH in the adjuvant phase.

Disclosures: This study was sponsored by F. Hoffmann-La Roche Ltd. Six authors declared being employees or stockowners at Roche, and the other authors reported ties with various sources, including Roche.

Source: Huober J et al. Atezolizumab With Neoadjuvant anti–human epidermal growth factor receptor 2 therapy and chemotherapy in human epidermal growth factor receptor 2–positive early breast cancer: Primary results of the randomized phase III IMpassion050 trial. J Clin Oncol. 2022 (Jun 28). Doi:  10.1200/JCO.21.02772

Key clinical point: The prophylactic use of etoricoxib reduced the incidence and severity of taxane-associated acute pain syndrome (T-APS) and potentially attenuated docetaxel-induced peripheral neuropathy in patients receiving docetaxel-based chemotherapy for breast cancer (BC).

Major finding: Incidence rates of all T-APS (57.1% vs 91.5%) and severe T-APS (11.4% vs 54.9%; both P < .001) were significantly lower in the etoricoxib vs no treatment group. At 3 months follow-up after 4 cycles of docetaxel chemotherapy, the etoricoxib vs no treatment group showed a significantly higher mean Functional Assessment of Cancer Treatment Neurotoxicity subscale score (38.46 vs 34.59; P < .001).

Study details: Findings are from a phase 2 study including 144 adult women with stage I-III BC who received 4 cycles of docetaxel-based chemotherapy and were randomly assigned to receive prophylactic etoricoxib or no treatment.

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

Source: Zhang J et al. Prevention of taxane-associated acute pain syndrome with etoricoxib for patients with breast cancer: A phase II randomised trial. Eur J Cancer. 2022;171:150-160 (Jun 17). Doi: 10.1016/j.ejca.2022.05.019

Key clinical point: The prophylactic use of etoricoxib reduced the incidence and severity of taxane-associated acute pain syndrome (T-APS) and potentially attenuated docetaxel-induced peripheral neuropathy in patients receiving docetaxel-based chemotherapy for breast cancer (BC).

Major finding: Incidence rates of all T-APS (57.1% vs 91.5%) and severe T-APS (11.4% vs 54.9%; both P < .001) were significantly lower in the etoricoxib vs no treatment group. At 3 months follow-up after 4 cycles of docetaxel chemotherapy, the etoricoxib vs no treatment group showed a significantly higher mean Functional Assessment of Cancer Treatment Neurotoxicity subscale score (38.46 vs 34.59; P < .001).

Study details: Findings are from a phase 2 study including 144 adult women with stage I-III BC who received 4 cycles of docetaxel-based chemotherapy and were randomly assigned to receive prophylactic etoricoxib or no treatment.

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

Source: Zhang J et al. Prevention of taxane-associated acute pain syndrome with etoricoxib for patients with breast cancer: A phase II randomised trial. Eur J Cancer. 2022;171:150-160 (Jun 17). Doi: 10.1016/j.ejca.2022.05.019

Key clinical point: The prophylactic use of etoricoxib reduced the incidence and severity of taxane-associated acute pain syndrome (T-APS) and potentially attenuated docetaxel-induced peripheral neuropathy in patients receiving docetaxel-based chemotherapy for breast cancer (BC).

Major finding: Incidence rates of all T-APS (57.1% vs 91.5%) and severe T-APS (11.4% vs 54.9%; both P < .001) were significantly lower in the etoricoxib vs no treatment group. At 3 months follow-up after 4 cycles of docetaxel chemotherapy, the etoricoxib vs no treatment group showed a significantly higher mean Functional Assessment of Cancer Treatment Neurotoxicity subscale score (38.46 vs 34.59; P < .001).

Study details: Findings are from a phase 2 study including 144 adult women with stage I-III BC who received 4 cycles of docetaxel-based chemotherapy and were randomly assigned to receive prophylactic etoricoxib or no treatment.

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

Source: Zhang J et al. Prevention of taxane-associated acute pain syndrome with etoricoxib for patients with breast cancer: A phase II randomised trial. Eur J Cancer. 2022;171:150-160 (Jun 17). Doi: 10.1016/j.ejca.2022.05.019

Key clinical point: First-line treatment with nivolumab, bevacizumab, and paclitaxel showed promising efficacy with a tolerable safety profile in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (BC).

Major finding: The objective response rate was 70% (95% CI 55.9%-81.2%) in the overall cohort of patients with HER2-negative metastatic BC, 74% in patients with hormone receptor-positive BC, and 59% in patients with triple-negative BC. Grade 3/4 adverse drug reactions were reported by 58% of patients.

Study details: Findings are primary results from the phase 2 NEWBEAT study including 57 women with invasive, metastatic, or inoperable HER2-negative BC who received the first-line triple therapy with nivolumab, bevacizumab, and paclitaxel.

Disclosures: This study was supported by Ono Pharmaceutical Company. The authors declared receiving research funds, grants, personal fees, lecture fees, honoraria, or consulting fees from several sources, including Ono Pharmaceuticals.

Source: Ozaki Y et al. Safety and efficacy of nivolumab plus bevacizumab, paclitaxel for HER2-negative metastatic breast cancer: Primary results and biomarker data from a phase 2 trial (WJOG9917B). Eur J Cancer. 2022;171:193-202 (Jun 18). Doi: 10.1016/j.ejca.2022.05.014

Key clinical point: First-line treatment with nivolumab, bevacizumab, and paclitaxel showed promising efficacy with a tolerable safety profile in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (BC).

Major finding: The objective response rate was 70% (95% CI 55.9%-81.2%) in the overall cohort of patients with HER2-negative metastatic BC, 74% in patients with hormone receptor-positive BC, and 59% in patients with triple-negative BC. Grade 3/4 adverse drug reactions were reported by 58% of patients.

Study details: Findings are primary results from the phase 2 NEWBEAT study including 57 women with invasive, metastatic, or inoperable HER2-negative BC who received the first-line triple therapy with nivolumab, bevacizumab, and paclitaxel.

Disclosures: This study was supported by Ono Pharmaceutical Company. The authors declared receiving research funds, grants, personal fees, lecture fees, honoraria, or consulting fees from several sources, including Ono Pharmaceuticals.

Source: Ozaki Y et al. Safety and efficacy of nivolumab plus bevacizumab, paclitaxel for HER2-negative metastatic breast cancer: Primary results and biomarker data from a phase 2 trial (WJOG9917B). Eur J Cancer. 2022;171:193-202 (Jun 18). Doi: 10.1016/j.ejca.2022.05.014

Key clinical point: First-line treatment with nivolumab, bevacizumab, and paclitaxel showed promising efficacy with a tolerable safety profile in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (BC).

Major finding: The objective response rate was 70% (95% CI 55.9%-81.2%) in the overall cohort of patients with HER2-negative metastatic BC, 74% in patients with hormone receptor-positive BC, and 59% in patients with triple-negative BC. Grade 3/4 adverse drug reactions were reported by 58% of patients.

Study details: Findings are primary results from the phase 2 NEWBEAT study including 57 women with invasive, metastatic, or inoperable HER2-negative BC who received the first-line triple therapy with nivolumab, bevacizumab, and paclitaxel.

Disclosures: This study was supported by Ono Pharmaceutical Company. The authors declared receiving research funds, grants, personal fees, lecture fees, honoraria, or consulting fees from several sources, including Ono Pharmaceuticals.

Source: Ozaki Y et al. Safety and efficacy of nivolumab plus bevacizumab, paclitaxel for HER2-negative metastatic breast cancer: Primary results and biomarker data from a phase 2 trial (WJOG9917B). Eur J Cancer. 2022;171:193-202 (Jun 18). Doi: 10.1016/j.ejca.2022.05.014

Key clinical point: The risk for hemorrhage was not significantly different in patients with breast cancer (BC) aged ≥ 66 years who received direct oral anticoagulants (DOAC) concurrently with tamoxifen vs aromatase inhibitors (AI).

Major finding: During a median follow-up of 166 days, the risk for major hemorrhage requiring an emergency department visit or hospitalization (2.5% vs 3.3%; weighted hazard ratio [HR] 0.68; 95% CI 0.44-1.06) or any hemorrhage (4.9% vs 4.6%; weighted HR 1.04; 95% CI 0.75-1.43) was not higher with tamoxifen+DOAC compared with AI+DOAC.

Study details: Findings are from a population-based, retrospective cohort study including 4753 patients aged ≥ 66 years with BC who were prescribed tamoxifen or AI concurrently with a DOAC.

Disclosures: This study was supported by Canadian Institutes of Health Research and ICES. Some authors declared serving on advisory boards of or receiving grants, personal fees, or travel expenses from several sources.

Source: Wang T-F et al. Hemorrhage risk among patients with breast cancer receiving concurrent direct oral anticoagulants with tamoxifen vs aromatase inhibitors. JAMA Netw Open. 2022;5(6):e2219128 (Jun 28). Doi: 10.1001/jamanetworkopen.2022.19128

Key clinical point: The risk for hemorrhage was not significantly different in patients with breast cancer (BC) aged ≥ 66 years who received direct oral anticoagulants (DOAC) concurrently with tamoxifen vs aromatase inhibitors (AI).

Major finding: During a median follow-up of 166 days, the risk for major hemorrhage requiring an emergency department visit or hospitalization (2.5% vs 3.3%; weighted hazard ratio [HR] 0.68; 95% CI 0.44-1.06) or any hemorrhage (4.9% vs 4.6%; weighted HR 1.04; 95% CI 0.75-1.43) was not higher with tamoxifen+DOAC compared with AI+DOAC.

Study details: Findings are from a population-based, retrospective cohort study including 4753 patients aged ≥ 66 years with BC who were prescribed tamoxifen or AI concurrently with a DOAC.

Disclosures: This study was supported by Canadian Institutes of Health Research and ICES. Some authors declared serving on advisory boards of or receiving grants, personal fees, or travel expenses from several sources.

Source: Wang T-F et al. Hemorrhage risk among patients with breast cancer receiving concurrent direct oral anticoagulants with tamoxifen vs aromatase inhibitors. JAMA Netw Open. 2022;5(6):e2219128 (Jun 28). Doi: 10.1001/jamanetworkopen.2022.19128

Key clinical point: The risk for hemorrhage was not significantly different in patients with breast cancer (BC) aged ≥ 66 years who received direct oral anticoagulants (DOAC) concurrently with tamoxifen vs aromatase inhibitors (AI).

Major finding: During a median follow-up of 166 days, the risk for major hemorrhage requiring an emergency department visit or hospitalization (2.5% vs 3.3%; weighted hazard ratio [HR] 0.68; 95% CI 0.44-1.06) or any hemorrhage (4.9% vs 4.6%; weighted HR 1.04; 95% CI 0.75-1.43) was not higher with tamoxifen+DOAC compared with AI+DOAC.

Study details: Findings are from a population-based, retrospective cohort study including 4753 patients aged ≥ 66 years with BC who were prescribed tamoxifen or AI concurrently with a DOAC.

Disclosures: This study was supported by Canadian Institutes of Health Research and ICES. Some authors declared serving on advisory boards of or receiving grants, personal fees, or travel expenses from several sources.

Source: Wang T-F et al. Hemorrhage risk among patients with breast cancer receiving concurrent direct oral anticoagulants with tamoxifen vs aromatase inhibitors. JAMA Netw Open. 2022;5(6):e2219128 (Jun 28). Doi: 10.1001/jamanetworkopen.2022.19128

Key clinical point: Digital breast tomosynthesis (DBT) reduced the likelihood of advanced breast cancer (BC) diagnosis compared with digital mammography in women with extremely dense breasts and a high risk for BC.

Major finding: Overall screening outcomes per 1000 examinations were similar with DBT vs digital mammography for interval invasive cancer (difference −0.04; 95% CI −0.14 to 0.06); however, the advanced cancer detection rate was lower in women with extremely dense breasts and a high BC risk (difference −0.53; 95% CI −0.97 to −0.10).

Study details: Findings are from a cohort study including 504,427 women with no history of BC or mastectomy who underwent 1,003,900 digital mammography screening examinations or 374,002 DBT screening examinations.

Disclosures: This study was funded by Patient-Centered Outcomes Research Institute, National Cancer Institute, and other sources. Some authors declared receiving grants, consulting fees, or royalties from or serving as consultants or on the editorial board for several sources.

Source: Kerlikowske K et al. Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer. JAMA. 2022;327(22):2220–2230 (Jun 14). Doi: 10.1001/jama.2022.7672

Key clinical point: Digital breast tomosynthesis (DBT) reduced the likelihood of advanced breast cancer (BC) diagnosis compared with digital mammography in women with extremely dense breasts and a high risk for BC.

Major finding: Overall screening outcomes per 1000 examinations were similar with DBT vs digital mammography for interval invasive cancer (difference −0.04; 95% CI −0.14 to 0.06); however, the advanced cancer detection rate was lower in women with extremely dense breasts and a high BC risk (difference −0.53; 95% CI −0.97 to −0.10).

Study details: Findings are from a cohort study including 504,427 women with no history of BC or mastectomy who underwent 1,003,900 digital mammography screening examinations or 374,002 DBT screening examinations.

Disclosures: This study was funded by Patient-Centered Outcomes Research Institute, National Cancer Institute, and other sources. Some authors declared receiving grants, consulting fees, or royalties from or serving as consultants or on the editorial board for several sources.

Source: Kerlikowske K et al. Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer. JAMA. 2022;327(22):2220–2230 (Jun 14). Doi: 10.1001/jama.2022.7672

Key clinical point: Digital breast tomosynthesis (DBT) reduced the likelihood of advanced breast cancer (BC) diagnosis compared with digital mammography in women with extremely dense breasts and a high risk for BC.

Major finding: Overall screening outcomes per 1000 examinations were similar with DBT vs digital mammography for interval invasive cancer (difference −0.04; 95% CI −0.14 to 0.06); however, the advanced cancer detection rate was lower in women with extremely dense breasts and a high BC risk (difference −0.53; 95% CI −0.97 to −0.10).

Study details: Findings are from a cohort study including 504,427 women with no history of BC or mastectomy who underwent 1,003,900 digital mammography screening examinations or 374,002 DBT screening examinations.

Disclosures: This study was funded by Patient-Centered Outcomes Research Institute, National Cancer Institute, and other sources. Some authors declared receiving grants, consulting fees, or royalties from or serving as consultants or on the editorial board for several sources.

Source: Kerlikowske K et al. Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer. JAMA. 2022;327(22):2220–2230 (Jun 14). Doi: 10.1001/jama.2022.7672