San Antonio Breast Cancer Symposium 2012 Helen K. Chew, MD, FACP Professor of Medicine

Objectives

1. Adjuvant tamoxifen duration (S1-2)

2. Adjuvant trastuzumab duration (S5-2)

3. Adjuvant chemotherapy for isolated local regional recurrence (S3-2)

4. Role of bevacizumab? (S1-7, S6-5)

Figure 5 Effects of about 5 years of tamoxifen on the 15-year probabilities of recurrence and of breast cancer mortality, for ER-positive disease Outcome by allocated treatment in trials of about 5 years of adjuvant tamoxifen. Event rate ratio (...

Early Breast Cancer Trialists' Collaborative Group (EBCTCG)

Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

The Lancet Volume 378, Issue 9793 2011 771 - 784

http://dx.doi.org/10.1016/S0140-6736(11)60993-8

ATLAS

• Very large, pragmatic study (1996-2005)• No restrictions on age, hormone receptor

status, nodal status or other treatments• No protocol-defined visits or evaluations

except for yearly MD questionnaire• Protocol amended in 2000 when 5 years

of tamoxifen was superior to 2 years

Published online Lancet 12/5/12

Table 1, ER+ tumorsTamoxifen x 5 years

n=3418Tamoxifen x 10 years

N=3428

Age, years %

<45 18 19

45-54 32 32

55-69 40 40

>70 10 9

Nodal status %

N0 54 53

1-3 nodes 26 27

>4 nodes 16 16

Tumor size %

T1 47 48

T2 39 38

T3 7 7

Menopausal status %

Premenopausal 9 10

Postmenopausal 89 89

Figure 3 Recurrence (A) and breast cancer mortality (B) by treatment allocation for 6846 women with ER-positive disease Bars show SE. Recurrence rates are percentage per year (events/patient-years of follow-up). Death rates (overall rate???rate ...

Christina Davies , Hongchao Pan , Jon Godwin , Richard Gray , Rodrigo Arriagada , Vinod Raina , Mirta Abraham , V...

Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial

The Lancet null 2012 null

http://dx.doi.org/10.1016/S0140-6736(12)61963-1

Figure 2 Treatment compliance (A) and proportion of patients in follow-up (B) by year since randomisation for 6846 women with ER-positive disease (54% node-negative) *&gt;99% tamoxifen.

Christina Davies , Hongchao Pan , Jon Godwin , Richard Gray , Rodrigo Arriagada , Vinod Raina , Mirta Abraham , V...

Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial

The Lancet null 2012 null

http://dx.doi.org/10.1016/S0140-6736(12)61963-1

How does this impact clinical care?

• For patients who are appropriate candidates for tamoxifen therapy, 10 years of tamoxifen is recommended.

• This trial cannot be compared to any strategies that have incorporated aromatase inhibitors.

How does this impact clinical care?

• One year of adjuvant trastuzumab remains the standard of care.

• PHARE trial (abstract #S5-3) was a subset analysis of non-inferiority of 6 versus 12 months of adjuvant trastuzumab.

How does this impact clinical care?

• A course of adjuvant chemotherapy after an isolated local regional recurrence improves DFS and OS.

• The benefits appear less convincing for hormone receptor positive disease.

• Sites of recurrence (ipsilateral breast versus chest wall) and timing of recurrence and their correlation with outcomes were not reported in detail.

How does this impact clinical care?

• The addition of bevacizumab to first-line endocrine therapy in hormone-receptor positive MBC did not improve PFS.

• This addition of bevacizumab to first-line chemotherapy for early stage triple negative breast cancer did not improve DFS.

• The role of bevacizumab in breast cancer is not well defined and bevacizumab should not be used outside of a clinical trial.

Thank you.Questions?