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Male Breast Cancer Guidelines

18 February 2020

The American Society of Clinical Oncology recently published a guideline for the management of male breast cancer* (and I was proud to serve on the guideline consensus panel).

Breast cancer in men accounts for approximately 1% of all breast cancer cases. Outcomes are known to be worse compared with those in women, in part due to later diagnosis. Unfortunately, men are often excluded from breast cancer clinical trials, so they are most often treated using the protocols approved for women. However, it is unclear if this is the best option in every situation. The US FDA has recently called to include men in studies of breast cancer treatment, even if anticipated enrollment is low. This is a necessary step so that progress can be made.

*If a copy of the full guideline is desired, please reach out: contact at drattai dot com

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A New Option to Treat Metastatic Breast Cancer

4 June 2019

Encouraging news for patients with metastatic estrogen receptor-positive (ER+), Her2/neu negative breast cancer was presented at the 2019 American Society of Clinical Oncology annual meeting, and published in the New England Journal of Medicine.

The MONALEESA-7 Phase III trial evaluated the use of ribociclib in combination with endocrine therapy. Patients who received ribociclib and endocrine therapy were found to have improved overall survival rates compared to those who received endocrine therapy alone. Prior studies demonstrated improved progression free survival, but this was the first demonstration of an improvement in overall survival. Patients enrolled in this study were pre- or peri-menopausal.

Ribociclib is an oral medication belonging to the CDK 4/6 inhibitor class of targeted agents. The CDK 4/6 pathway is important for cell division. CDK 4/6 inhibitors block progression through the normal cell cycle, so cancer cells are “arrested” in a resting phase and cannot divide. This study found that at 42 months, patients treated with ribociclib had a 70% overall survival rate, compared to 46% for the patients who received endocrine therapy alone. In absolute numbers, there were 26 fewer deaths (83 or 337 versus 109 of 335) in the treatment group. Because patients who develop metastatic breast cancer after a diagnosis of early-stage disease are not re-staged, it is not possible to determine with certainty how many patients this medication may be appropriate for. Approximately 40,000 women and 500 men die from metastatic breast cancer every year. ER+ is the most common breast cancer subtype.

Prior studies have evaluated a similar drug, palbociclib, which has been approved for use in women and men with metastatic breast cancer. There are ongoing studies evaluating all 3 of the “ciclib” agents to get a better sense of whether the results will be similar across all patient populations or if a particular drug will be better for a particular subset of patients. All 3 agents are oral (pills). While side effects may be an issue for some patients, these medications are much better tolerated compared to traditional chemotherapy. Unfortunately, cost and insurance coverage may be an issue in some situations.

In addition, I do think that it is important to point out that in the current study, the majority of patients (67% in the ribociclib arm and 73% in the endocrine therapy alone arm) went on to receive other therapy – meaning that the disease progressed. We are still a long way from a “cure” despite improvements in overall survival, and we’re a long way from single-agent therapy in patients with metastatic breast cancer. Patients with metastatic breast cancer are still expected to need more than one, and in some cases multiple, agents over time as the cancer finds ways to mutate and continue to grow. The findings of this study are a step in the right direction, but much more research is needed.

Additional Information:
ASCO Post – 2019 ASCO: MONALEESA 7
NBC News – Breast Cancer Treatment Shows Hope for Younger Women

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Breast Cancer Updates from ASCO 2018

14 August 2018

I was honored to participate in a Sharsheret national webinar, where breast cancer research that had been presented at the June 2018 meeting of the American Society of Clinical Oncology was reviewed. The webinar video and transcript are linked below. Dr. Sharyn Lewin, a gynecologic oncologist, presented ovarian cancer research updates.

Transcript Link

Additional Sharsheret Symposia Transcripts

This post has not been endorsed by the American Society of Clinical Oncology

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Cancer Risk Factors and Financial Impact of Cancer Treatment

24 October 2017

A national survey performed by the American Society of Clinical Oncology showed that many Americans are unaware of key cancer risk factors, including obesity, alcohol, lack of exercise, tobacco use and sun exposure. While doing “everything right” certainly is no guarantee of a healthy life (for example, many patients who develop lung cancer do not smoke) being aware of the lifestyle factors associated with cancer may lead to better health choices. In addition, all of these lifestyle factors are also associated with a lower likelihood of heart disease, diabetes, and other illness.

An additional finding of the survey was that 27% of respondents noted that either they or an immediate family member (who has / had cancer) took specific actions to decrease treatment costs including skipping appointments, postponed or didn’t fill prescriptions, skipped cancer medication doses, or cut cancer medications in half. We cannot hope to improve cancer outcomes without addressing the issues of cost of care and disparities in access to care.

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