Report-Back from the 2014 San Antonio Breast Cancer Symposium

We attended the San Antonio Breast Cancer Symposium in December 2014 to bring a patient-focused voice to the proceedings, to challenge the status quo, report findings back to you, and to push researchers and clinicians to do better for women at risk of and living with breast cancer. Below you’ll find a summary of the most significant information from the conference as well as some of our reflections on the state of breast cancer research. If you have questions about the content, you can contact us with questions at info@bcaction.org or by calling us toll-free at 877-278-6722.

The Advocate’s Abyss: Hope and Despair at SABCS 2014

Zoe Christopher, our Resource Liaison & Office Manager, writes about her second year at SABCS. “I didn’t find the same glimmer of hope this December. Instead, I came away with a heavy heart. I’m deeply frustrated by how the industry is driven by and dominated by Big Pharma – and their profit margins. And I believe that as long as we keep dumping toxins into our environment, we will keep everyone involved with this infrastructure in business.”

Immunotherapy and Breast Cancer

There was lots of buzz about immunotherapy going into the San Antonio Breast Cancer Symposium (SABCS) this year. Immunotherapy includes treatment to boost a patient’s immune system to fight diseases such as cancer as well as therapy to train the immune system to attack cancer cells specifically. We know that the immune system is important in cancer and recently there have been some advances using immunotherapy in other cancers (melanoma, lung, pancreatic, etc.)

Is Supplemental Screening Beneficial for Women With Dense Breasts?

The challenge with the “dense breast bills” that are cropping up across the country is that there’s no evidence-based action to take for those women who are notified of their breast density. In California, the breast density notification law advises women to “decide which options are right for you.” However, there is no evidence with which to make this decision. Should women undergo additional screening if they have dense breasts? What are the harms and benefits? Has any imaging tool been shown to benefit the health of women with dense breasts and do we know if supplemental screening saves women’s lives?

Comparing Chemotherapy Regimens for Node Negative Breast Cancer

This session reported on a prospective randomized trial that was trying to answer the question of whether women with node negative breast cancer can undergo a less onerous four cycle chemotherapy regimen of adriamycin and cyclophosphamide (AC) rather than the longer six cycles of 5-fluorouracil (5-FU), epirubicin, and cyclophosphamide (FEC).

What Have We Learned About Partial Breast Radiation Therapy?

Researchers presented data to help women and their doctors make decisions on using either whole breast irradiation or accelerated partial breast irradiation in the treatment of breast cancer. They discussed how to determine which patients are best suited for each therapy, the pros and cons of each treatment, and how to reduce toxicity without losing treatment efficacy.

Platinum-based Chemotherapy vs. Taxanes for Women with Triple Negative Breast Cancer

This study is the first to compare platinum-based chemotherapy with taxanes in women with metastatic breast cancer. As both of these drug classes are toxic, a study like this could be very helpful if the results could help direct therapy to reduce or minimize toxicity while still treating triple negative breast cancer (TNBC) effectively (in other words, could women take the less toxic of the two treatments and still get the same results?)

Impact of Low-Fat Diet on Breast Cancer Survival

The Women’s Intervention Nutrition Study (WINS) found that, on average, women who reduced their dietary fat intake through low-fat diets following an early-stage breast cancer diagnosis were not more likely to survive their breast cancer than women who did not modify their diet.

Paclitaxel and Pathological Complete Response

This session addressed the use of paclitaxel in two forms – the regular formulation (brand name Taxol) and protein bound (brand name Abraxane). This study illustrates how the use of surrogate markers such as pathological complete response (pCR) may reduce the actual clinical applicability of research findings.

What Can Mice Tell Us About Me?

This study explored the use of patient-derived xenograft (PDX) models in mice as pre-clinical (or co-clinical) models of metastasis. With this experimental tool, researchers are able to take a piece of a tumor directly from a patient and establish unique models of the tumor in the mammary fat pads of mice.

The patterns of metastasis in the mouse models (i.e., the locations they spread to) closely resemble the sites of metastasis found in the original patients. Could the tumors that successfully engraft and spread in mice help identify the bona fide “bad guys” (or genes) driving the primary tumor’s ability to metastasize to specific organs?

Contralateral Prophylactic Mastectomy

This series of talks focused on the clinical implications of the rising trend of Contralateral Prophylactic Mastectomy (CPM). The  data from 1998 – 2010 show a striking decrease in both unilateral mastectomy and breast conserving surgery  with a related increase in bilateral mastectomy.

Ovarian Suppression and Tamoxifen for Hormone Positive Breast Cancers

The majority of breast cancers are hormone positive. These breast cancers are generally considered lower risk compared to aggressive subtypes like triple negative and HER2+ breast cancers. But the risk of recurrence never goes away with hormone positive cancers, which can recur many years (even decades) later. While just 5% of women with breast cancer are under age 40, these women tend to have more aggressive disease. The question for women and their doctors remains how much treatment is enough for ER+ breast cancer? What is the role of chemotherapy, ovarian suppression, Aromotase Inhibitors (AI’s) (in this case exemestane ), and tamoxifen for women with hormone driven breast cancers? And are there particular groups of women, such as young women, who may benefit more from a specific treatment than others?

Chemoprevention: Still No Evidence That It Reduces Risk of Dying From Breast Cancer

Chemoprevention –  attempting to reduce a healthy woman’s risk of breast cancer through pharmacological drugs –  has been a contentious issue for many years. At SABCS 2014, researchers shared 20 year follow-up data from IBIS, expanding on the 10 year data that has already been published. The study randomized women to take tamoxifen vs. a placebo for five years. Half of these women were pre-menopausal and half were post-menopausal.

Tumor Sequencing and Genomic Changes

Breast cancer is an incredibly complex disease, and each new category of breast cancer contains any number of sub-categories which repeat—something like astrophysicists’ search for the smallest molecule. One of the General Sessions at SABCS 2014 focused on tumor sequencing and analyzing genomic changes in breast cancer tumors. The word of the morning was “heterogeneity,” or lack of uniformity.

What Markers Can Help With Targeted Treatment?

Recent trials in HER2-positive breast cancer demonstrate increased pathological complete response (pCR) using dual HER2-targeting in the neoadjuvant setting. This study aimed to further quantify the pathological complete response (pCR) rates of weekly paclitaxel (T) and trastuzumab (H) alone or combined HER2-blockade of H with lapatinib (L), and to identify biomarkers of sensitivity to these HER2-targeted agents.

ICE Study – Ibandronate with or without Capecitabine in Elderly Patients

This trial aimed to determine the role of adjuvant chemotherapy with capecitabine in patients age 65 and older. Although about 50% of new diagnoses of early breast cancer are made in patients over 65, this group is underrepresented in clinical trials (in the past this group was excluded from trials). Without trials for this age group, it is unclear what effect (positive or negative) adjuvant therapy might offer these patients. Because elderly patients have a high incidence of bone issues (including osteoporosis, factures and more) when using Aromatase Inhibitors, this study addresses a non-AI adjuvant chemotherapy.

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