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Case Studies in Breast Cancer Vol. 6, No. 9

Release Date: December 17, 2008
Expiration Date: December 17, 2009

Publication Overview

Authors

Medical writer: Tristin Abair, PhD; Reviewed by: Debu Tripathy, MD

Overview and Purpose

For patients with hormone receptor–positive early-stage breast cancer, both selective estrogen receptor modulators and aromatase inhibitors (AIs) have dramatically improved disease outcome. However, significant risk of recurrence continues to persist long after completion of standard adjuvant endocrine therapy, suggesting that there is room for improvement. Recent recommendations suggest the inclusion of an AI in the adjuvant treatment regimen for postmenopausal patients, although the optimal timing and duration of this therapy is still controversial. Extended adjuvant AI therapy beyond the standard 5 years is under investigation in postmenopausal patients with hormone receptor–positive early-stage breast cancer and has yielded improvements in disease outcome compared to 5 years of therapy with tamoxifen. However, efficacy benefits must be weighed against potential toxicity costs for each individual patient. Several ongoing studies seek to address these issues; further research is needed to maximize long-term benefit in patients with hormone receptor–positive breast cancer.

The purpose of this activity is to update physicians about current data on the safety and efficacy of extending adjuvant endocrine therapy beyond 5 years in patients with hormone receptor–positive early-stage breast cancer.

Target Audience

This activity is intended for medical oncologists involved in the care of patients with breast cancer. No specific skills or knowledge other than a basic training in oncology is required for successful participation in this activity.

Learning Objectives

Upon completion of this educational activity, you should be able to:

  • Discuss the risk of recurrence and natural history of hormone receptor–positive breast cancer
  • Assess the efficacy and safety of extended adjuvant AI therapy in hormone receptor–positive early-stage breast cancer
  • Identify ongoing clinical trials examining extended AI therapy in postmenopausal patients with hormone receptor–positive breast cancer

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Mohammad Jahanzeb, MD, FACP
Research Funding – eXagen DIAGNOSTICS, Inc.™; Genentech, Inc.; Merck & Co., Inc.; Pfizer Inc.
Paid Consultant – Abraxis Bioscience, LLC; AstraZeneca; Eisai Inc.; Eli Lilly and Company; Genentech, Inc.; GlaxoSmithKline; Novartis Pharmaceuticals Corporation; Pfizer Inc.; sanofi-aventis U.S.
Speaker’s Bureau – Abraxis Bioscience, LLC; AstraZeneca; Genentech, Inc.; GlaxoSmithKline; Roche Pharmaceuticals; sanofi-aventis U.S.

PER Editorial Staff
No relevant relationships to disclose

This CME activity might include discussion of investigational and/or unlabeled uses of drugs. If the activity includes discussion of investigational and/or unlabeled uses of a drug, specific information is located on the title page. Please refer to the full prescribing information for each drug discussed in this online newsletter for FDA-approved dosing, indications, and warnings.

Commercial Support
An educational grant for this activity was provided by Novartis Oncology.

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Illustration

Breast cancer growth and progression depends on multiple interactions between tumor cells, surrounding stromal cells and fibroblasts, and immune cells. COX-2, an enzyme that converts arachidonic acid to PGE2 and plays an important role in cell survival in many cell types, including inflammatory immune cells, is often overexpressed in breast cancers and correlates with poor prognosis and reduced survival, particularly in patients with hormone receptor–positive (HR+) disease. In vitro studies suggest that increased COX-2 expression and subsequent PGE2 production can stimulate aromatase activity and estrogen synthesis. Thus, upregulation of COX-2 activity in breast cancer cells and associated inflammatory cells can stimulate both cancer cell survival and estrogen production in surrounding breast fibroblasts, further stimulating hormone-sensitive tumor growth and survival. Aromatase inhibitors, which have demonstrated substantial efficacy in patients with HR+ breast cancer, block the conversion of androgens to estrogen, thus preventing stimulation of estrogen-sensitive tumor cells. Inhibition of COX-2 could have a complimentary effect by further reducing stimulation of aromatase activity and estrogen production.

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The views and opinions expressed in this activity are those of the authors and do not necessarily reflect the views of the sponsor, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this activity to ensure accuracy, the authors and Physicians’ Education Resource and its servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this activity, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

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Editor, Case Studies in Breast Cancer
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E–mail: editor@cancerlearning.com