Posted by: bcconnections | July 19, 2012

Diane M. Heditsian reports from the 2012 American Society of Cancer Oncology (ASCO) Annual Meeting

First in new class of drug is shown to be more effective and less toxic in treating Her2+ Breast Cancer

T-DM1 is the first in a new class of drugs called antibody drug conjugates that we’ll be hearing a lot more about. This drug combines a very powerful chemotherapy (emtansine) with Herceptin (trastuzumab) using a sophisticated chemical linker. This so-called “smart bomb” is targeted right to the HER2-positive cancer cell and then unlinks, dropping the chemotherapy right inside the cell. This maximizes efficacy and minimizes toxicity.

The EMILIA study, reported at ASCO, looked at 991 women with locally advanced or metastatic HER2-positive breast cancer that had progressed on Herceptin plus taxane chemotherapy. Half the women in the study received Tykerb (lapatinib), a drug that targets the HER2 pathway, and Xeloda (capecitabine), an oral chemotherapy drug. The other half of the women in the study received T-DM1. Progression-free survival was 9.6 months in women treated with T-DM1 compared to 6.4 months in women treated with Tykerb/Xeloda. After one year of therapy,  84.7% of women who received T-DM1 were alive,  compared to 77% who got the Tykerb/Xeloda combination. Sixty-give percent  of women on T-DM1 were alive after 2 years compared to 47.5% who were on the Tykerb/Xeloda combination. Forty-one of women who received T-DM1 had severe side effects compared to 57% of women who received the Tykerb/Xeloda combination.

The results are promising, but the women need to be followed longer to assess whether overall survival will be better with T-DM1. T-DM1 is currently available through clinical trials and will likely be approved by the FDA late this year. Kimberly L. Blackwell  Abstract: LBA1 Source

First therapeutic to provide relief for chemotherapy-induced peripheral neuropathy

Peripheral neuropathy is nerve damage in the hands, feet, arms, or legs caused by taxane and platinum-based chemotherapies. Symptoms include burning, tingling, or numbness in the toes, feet, fingers and hands. For some patients the sensation is just uncomfortable, but approximately 30% experience pain for months, or even years after treatment is stopped, and for some it worsens over time. A double-blind, placebo-controlled crossover study of 231 patients was conducted with one group of sufferers receiving the anti-depressant, Cymbalta (duloxetine), followed by placebo and the other group receiving placebo followed by Cymbalta. Investigators saw a clinically significant 30% or greater reduction in pain scores in 33% of Cymbalta-treated patients compared with 17% of placebo-treated patients. Cymbalta was effective for 59% of the patients in the study. However, fatigue, the most commonly reported side effect , was significantly higher in the Cymbalta arm as compared to placebo (11% versus 3%).  The study authors concluded that 60mg of Cymbalta given daily is an efficacious and well-tolerated intervention for the treatment of taxane or platinum chemotherapy-induced  peripheral neuropathy. Ellen M. Lavoie Smith  Abstract: CRA9013 Source

Vitamin D shows promise in reducing joint pain during aromatase inhibitor (AI) therapy 

Joint pain and fatigue are a common complaint of women on adjuvant AIs and often lead to discontinuation of therapy before the recommended five years. Pilot studies suggested a positive impact of vitamin D on musculoskeletal pain and disability from AIs, so a multi-center, double-blind, placebo-controlled, randomized trial was conducted to study the impact of 30,000 IU/week of vitamin D3 in preventing joint pain and fatigue in women beginning AI therapy. At 24 weeks, a higher proportion of women taking placebo (51%) versus Vitamin D (37%) had worsening of joint pain, disability from joint pain, or discontinuation of the AI. A significantly higher proportion of women taking placebo (72%) versus Vitamin D (42%) had an adverse quality of life event such as worsening of pain, disability or fatigue.  The conclusions reported at ASCO are that 30,000 IU/week of vitamin D3 is safe and results in decreased adverse quality of life events from adjuvant aromatase inhibitors in women with breast cancer. Qamar J. Khan Abstract: 9000 Source

 

Diane M. Heditsian is an Advocate Institute and National Breast Cancer Coalition-trained research advocate serving on UCSF’s NIH-funded Bay Area Breast Cancer Specialized Program of Research Excellence (SPORE), as well as a research advocate and patient advocate to newly diagnosed women at Breast Cancer Connections in Palo Alto. She attended the ASCO 2012 Annual Meeting as a Research Advocacy Network “Focus on Research Scholar” thanks to a scholarship from ASCO’s Conquer Cancer Foundation.

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