Dr Nicholas Zdenkowski is a medical oncologist and Clinical Research Fellow at the Calvary Mater Hospital Newcastle and Hunter New England Local Health District. The Beacon spoke with Nick about the latest breast cancer research presented at the American Society of Clinical Oncology (ASCO) Annual Meeting held in Chicago in June.
What are some of the standout findings from the research presented at ASCO?
One highly publicised result this year was from the OlympiAD study, a clinical trial comparing the drug olaparib (a PARP inhibitor) to standard chemotherapy for women with a BRCA gene mutation who have developed metastatic HER2-negative breast cancer.
These women, who are in great need of new treatment options, lived on average three months longer without a worsening of their cancer, and they had better quality of life despite having had multiple prior chemotherapy treatments. Olaparib is available in Australia for women with advanced ovarian cancer and a BRCA gene mutation, but is not yet available for women with metastatic breast cancer.
The SOLE study, which included 370 Australian and New Zealand women, found that after five years of hormone therapy women with higher risk early breast cancer who had a three-month break from letrozole each year had the same risk of a breast cancer recurrence as those who took letrozole continuously. Importantly, those who had a break had fewer side effects and it was safe to do so. This opens up a new treatment option for some women on extended hormone therapy.
For women with HER2-positive early breast cancer, the Short-HER study found that 12 months of trastuzumab (Herceptin) remains ideal, compared with nine weeks of treatment. Women who had the shorter nine-week treatment still did well, which is reassuring for those who need to stop early due to side effects or for other reasons.
What other research presented may be of interest to women in Australia?
One issue many young women grapple with after a diagnosis of breast cancer is whether pregnancy is safe. A study reported at ASCO showed that pre-menopausal women who became pregnant after a diagnosis of early breast cancer did just as well as those who did not become pregnant, irrespective of the hormone receptor status of their cancer.
Fear of cancer recurrence impacts on the lives of many breast cancer survivors. Australian researchers presented the results of a study showing that a psychological treatment program, called Conquer Fear, reduces the severity of fear of cancer recurrence compared with relaxation training. More work needs to be done to make this sort of program available to all who might benefit.
The MONARCH2 study showed that the CDK4/6 inhibitor abemaciclib is effective for women with metastatic hormone receptor positive breast cancer. The study is discussed in more detail in the article Latest research: CDK inhibitors. There are now three drugs in this class at advanced stages of development, including palbociclib and ribociclib. This introduces healthy competition in making these drugs available to Australians.
A randomised study found that yoga helped reduce cancer-related fatigue and improved sleep quality in a group of cancer patients, most of whom were breast cancer survivors. This is a practice that can be taken up immediately and that can also help with fitness, strength and flexibility. An Australian researcher presented encouraging findings suggesting that exercise starting six weeks post surgery for early breast cancer may help prevent breast cancer recurrence and death. This is consistent with larger, observational studies showing that women who exercise have lower rates of breast cancer and overall mortality.
Who can women talk to about whether the findings are relevant to them?
You can discuss these findings with your cancer specialist, being mindful that new treatments need to be assessed and approved by regulatory and funding bodies such as the Therapeutic Goods Administration (TGA) before they are available to Australian patients.
How can women find out more about clinical trials that might be relevant to them?
Clinical trials are a very important part of improving outcomes for people diagnosed with breast cancer but, for one reason or another, many women are not able to participate in a trial. Ask your cancer specialist about trial opportunities, and look at websites such as clinicaltrials.gov, anzctr.org.au and clintrial.org.au.
Is there anything else you think would be valuable for women to know?
Improvements in breast cancer outcomes from individual studies might seem modest, apart from the occasional major breakthrough. However, over the last 30 years better detection and treatment have improved survival by a significant 30 per cent.