Breast Cancer

Pembrolizumab improves response rates in the phase 2 I-SPY 2 trial of women with various subtypes of high-risk breast cancer.
For the first time, a PARP inhibitor used as monotherapy has proved superior to standard chemotherapy in the treatment of women with metastatic breast cancer with a germline BRCA mutation.
Palbociclib may reverse acquired resistance to endocrine therapy in women with hormone receptor‒positive, HER2-negative breast cancer.
An updated analysis of PALOMA-1 shows no significant survival advantage when palbociclib is added to letrozole in women with estrogen receptor–positive breast cancer.
CDK4/CDK6 inhibitors are a promising addition to the armamentarium for the treatment of patients with breast cancer. At the 42nd annual meeting of the Oncology Nursing Society, 2 experts discussed the role of these new drugs, and how to factor them into treatment decisions.

Data suggest that greater than one-fourth of patients with estrogen receptor–positive metastatic breast cancer who are treated with an aromatase inhibitor (AI) will develop a mutation in the ESR1 gene, conferring resistance to the AI. Response after AI failure is poor, leading to a search for better therapeutic options.

Fulvestrant was found to extend progression-free survival compared with anastrozole in postmenopausal women with hormone receptor–positive locally advanced or metastatic breast cancer who have not received previous endocrine therapy.
The use of the investigational CDK4/6 inhibitor abemaciclib, in combination with an aromatase inhibitor or with fulvestrant, or as monotherapy, has demonstrated efficacy in patients with HER2-negative/hormone receptor–positive breast cancer in multiple settings.
Updated National Comprehensive Cancer Network guidelines for the management of breast cancer address the use of genomic expression profiling in predicting distant recurrence as well as the benefit of adjuvant endocrine therapy and adjuvant chemotherapy.
New guidance from the National Comprehensive Cancer Network (NCCN) defines appropriate radiation treatment targets, noting that individualizing radiation therapy based on risk is important, and that hypofractionation is now the preferred method of delivery to achieve local control and acceptable breast cosmesis.
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