Breast Cancer

SALT LAKE CITY—Bisphosphonates may have a role as an adjuvant breast cancer treatment, cisplatin-based neoadjuvant chemotherapy should be considered for treating bladder cancer, and dose-dense chemotherapy may add benefit for patients with pediatric Ewing sarcoma, according to 3 presentations at the “Controversies in Care” session at the annual meeting of the Hematology/Oncology Pharmacy Association.

Bisphosphonates in Breast Cancer

The US Food and Drug Administration (FDA) has approved Inform Dual ISH (Ventana Medical Systems), a genetic test that allows for measurement of the number of copies of the HER2 gene in tumor tissue. This method of identification of women with breast cancer who are HER2-positive pinpoints who is, and who is not, a candidate for Herceptin (trastuzumab).


Blocking miR-21 overexpression was found to retrieve trastuzumab sensitivity in trastuzumab-resistant breast cancer cells, in a study of cell lines derived from HER2-postive breast carcinomas. This theory was derived from identification of overexpression of miR-21 in HER-positive, trastuzumab-resistant cells. The researchers also found that miR-21 upregulation in trastuzumab-resistant cells led to PTEN reduction.


Breast cancer is the most common cancer among women. In 2010, there were an estimated 207,090 new cases and 39,840 deaths.1 Despite many improvements in the treatment of breast cancer, about 20% to 30% of women with the disease will progress to metastatic breast cancer (MBC). Although MBC remains incurable, a variety of treatment options are available. The US Food and Drug Administration (FDA) recently approved eribulin (Halaven), providing an exciting new option for women with heavily pretreated MBC.

Poly(ADP-ribose) polymerase (PARP) are a group of enzymes that are essential for base excision repair.1 There are several members of the PARP family, of which PARP1 is the most extensively studied.1,2 PARP1 only detects single-stranded DNA breaks and initiates repair; without PARP1, a single-stranded break is converted into a double-stranded break and repaired by homologous repair.1 PARP inhibition shows promise in BRCA1/2- deficient tumors, which lack homologous repair capability, causing synthetic lethality (decrease in repair of both single- and double-st

The evidence backing the use of myeloid growth factors in patients at high risk for febrile neutropenia is solid, according to Jeffrey Crawford, MD, of Duke Cancer Institute, Durham, North Carolina.

Myeloid growth factors are the primary means of preventing chemotherapy-induced neutropenia. This often leads to febrile neutropenia, which can be fatal in 10% of patients, according to a database of more than 40,000 individuals. Concerns recently have been raised, however, that their use is associated with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).

Data published in the Lancet in March support the effectiveness of eribulin mesylate (Halaven)—a microtubule inhibitor— in women with advanced breast cancer that has progressed after several treatments.

Investigators of a phase 2 study comparing 2 dosing schedules of sunitinib (Sutent) as first-line therapy for patients with advanced renal cell carcinoma (RCC) concluded that clinicians should stay with the currently approved dosing regimen of 50 mg daily for 4 weeks followed by a 2-week break. Robert Motzer, MD, attending physician, Memorial Sloan-Kettering Cancer Center, New York, who presented the findings, said the data add to a growing body of evidence favoring the dosing regimen that the US Food and Drug Administration approved for sunitinib.

Data published in the Journal of the American Medical As sociation in March indicate that for 20% of women with early-stage breast cancer, removing malignant lymph nodes from the armpit does not improve survival or prevent recurrence. Women in the phase 3 trial who underwent complete axillary lymph node dissection (ALND) had higher rates of lymphedema than those who had sentinel lymph node dissection (SLND) alone (P <.001). They also had higher rates of wound infection, axillary seromas, and paresthesias (70% vs 25%, respectively; P <.001).

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