What is metastatic breast cancer?

Metastatic breast cancer is breast cancer that has spread beyond the breast and lymph nodes, to other parts of the body. Metastatic breast cancer is also referred to as stage IV or advanced breast cancer. Most diagnoses are made early, before the cancer has spread to the lymph nodes and other parts of the body. But it’s important to keep in mind that an estimated three in four of the women living with metastatic breast cancer were initially diagnosed with stage I-III breast cancer.

Ovarian suppression imporves 8-year breast cancer survival

The addition of ovarian suppression to tamoxifen lengthened overall survival (OS) and disease-free survival (DFS) among premenopausal women with breast cancer, according to updated findings from the TEXT and SOFT trials published in The New England Journal of Medicine.

Results — which were published in correspondence with a presentation at the ASCO Annual Meeting on freedom from distant metastases data from the trials — also showed exemestane plus ovarian suppression resulted in higher rates of freedom from recurrence.

The researchers performed a prespecified updated analysis of the SOFT and TEXT trials. In the SOFT trial, researchers randomly assigned women to receive tamoxifen alone (n = 1,021), tamoxifen plus ovarian suppression (n = 1,024), or exemestane plus ovarian suppression (n = 1,021). In the TEXT trial, researchers randomly assigned patients to tamoxifen (n = 1,334) or exemestane (n = 1,338), both with ovarian suppression. In both studies, women received treatment for 5 years.

Eight-year OS was 93.3% with tamoxifen plus ovarian suppression group compared with 91.5% in the tamoxifen group (HR = 0.67; 95% CI, 0.48 to 0.92). The difference with exemestane plus ovarian suppression compared with tamoxifen alone did not reach statistical significance (92.1%; HR = 0.85; 95% CI, 0.62-1.15).

Among women who remained premenopausal after chemotherapy, 8-year OS was 89.4% with tamoxifen plus ovarian suppression compared with 85.1% with tamoxifen alone (HR = 0.59; 95% CI, 0.42 to 0.84). For exemestane plus ovarian suppression, 8-year OS was 87.2% (HR vs. tamoxifen alone = 0.79; 95% CI, 0.57-1.09).

Among women with HER-2-negative disease who underwent chemotherapy, 8-year OS was 85.2% among patients assigned tamoxifen alone, 87.7% among those assigned tamoxifen plus ovarian suppression (HR vs. tamoxifen = 0.7; 95% CI, 0.48-1.02), and 88.7% among those assigned exemestane plus ovarian suppression (HR vs. tamoxifen = 0.71; 95% CI, 0.49-1.05).

The 8-year rate of freedom from distant recurrence was 91.8% for exemestane plus ovarian suppression and 89.7% for tamoxifen plus ovarian suppression (HR = 0.8; 95% CI, 0.66-0.96).

 “Longer follow-up is planned for SOFT and TEXT, data regarding survival to confirm the findings"

https://www.healio.com/hematology-oncology/breast-cancer/news/in-the-journals/%7B100ab2b5-a5a5-4a0f-813a-ca612ceeca0b%7D/ovarian-suppression-improves-8-year-breast-cancer-survival

What it is ovarian ablation/suppresion in breast cancer patients

Cancer survivors at increased risk for endocrine diseases

Jensen MV, et al. JAMA Network Open. 2018;doi:10.1001/jamanetworkopen.2018.0349.
Marjerrison S and RD Barr. JAMA Network Open. 2018;doi:10.1001/jamanetworkopen.2018.0350.

Adolescent and young adult cancer survivors had a higher than expected rate of hospital contact for endocrine diseases, including thyroid disease, testicular dysfunction and diabetes, according to a Danish population-based study.

Adolescent and young adult cancer survivors — defined as those who had a cancer diagnosis when aged 15 to 39 years — differ from younger and older patients with cancer in terms of biology, epidemiology and clinical outcomes. This population also is at risk for long-term morbidity associated with their cancer or cancer treatment.

Danish investigators followed 32,548 adolescent and young-adult 1-year cancer survivors (43.1% male) from the Danish Patient Registry for a median of 10 years (range, 0-34). For a control cohort, the investigators also assessed 188,728 cancer-free participants (43.8% male) for a mean of 15 years (range, 0-34).

Overall, 6.5% of cancer survivors had at least one hospital contact for an endocrine disease, whereas researchers expected a hospitalization rate of 3.8% (rate ratio [RR] = 1.73; 95% CI, 1.65-1.81).

Male survivors appeared to be at a higher risk for an endocrine disease than female survivors (RR = 2.41; 95% CI, 2.23-2.61 vs. RR = 1.46; 95% CI, 1.38-1.55).

Researchers observed the highest RRs among cancer survivors for testicular hypofunction (75.12; 95% CI, 45.99-122.7), ovarian hypofunction (14.65; 95%CI, 8.29-25.86) and pituitary hypofunction (11.14; 95% CI, 8.09-15.34).

When evaluated as the proportion of absolute excess risks, the leading reasons for hospital contacts included thyroid disease (38%), testicular dysfunction (17.1%) and diabetes (14.4%).

Survivors of leukemia had the highest risk for any endocrine disease (RR = 3.97; 95% CI, 3.1-5.09), followed by survivors of Hodgkin lymphoma (RR = 3.06; 95% CI, 2.62-3.57) and survivors of brain cancer (RR = 3.03; 95% CI, 2.53-3.64).

Hodgkin lymphoma survivors had the highest risk for hypothyroidism (absolute excess risk, 362 per 100,000 person-years; 95% CI, 280-443).

This knowledge can help clinicians and patients with the highest risk to be more aware of symptoms so that endocrine diseases can be diagnosed early. Thus, patients will receive the right treatment earlier and hopefully prevent more severe sequelae.

https://www.healio.com/hematology-oncology/practice-management/news/in-the-journals/%7B3b51ff75-2ea4-491d-ada0-b675a5ea4bb5%7D/cancer-survivors-at-increased-risk-for-endocrine-diseases

Metformin, a medication used to treat Diablete Mellitus type 2, inproves the response of new immunotherapies in patients with diseminated melanoma.

This was the results of of the retropsective analysis of 55 metastatic melanoma patients. the progression free of disease was extended more thna 3 times and the survival almost the double in patients who were taken metformin are recieved the immune check-point inhibitors. . Propective clinical triasl are now planned to get mor data related to this finding.

Brief information about a subtype of breast cancer: HER2-Positive.

Approximately 20% to 25% of breast cancer tumors over-express the HER2 protein. HER2-positive breast cancer is often more aggressive than other types of breast cancer, increasing the risk of disease progression and death. Although research has shown that trastuzumab can reduce the risk of early stage HER2-positive breast cancer returning after surgery, up to 25% of patients treated with trastuzumab experience recurrence.

What is Diffuse Intrinsic Pontine Glioma (DIPG)

Diffuse intrinsic pontine glioma, or DIPG, is a rare, aggressive brain tumor found in the brain stem that almost exclusively affects children. Every year in the United States, approximately 200-400 children, ages ranging from 4 to 11, are diagnosed with DIPG. As the tumor grows, it puts pressure on the nerves that control essential bodily functions. Children experience symptoms including, but not limited to: vision issues, arm and leg weakness and difficulty speaking, breathing and heartbeat resulting in death. The median survival time is 9 months, with only 1% of all children diagnosed with DIPG surviving more than 5 years.

If you are a cancer survivor, please complete the following survey. It takes just 2 minutes to complete it. The information is totally anonymous and it will be used for a research purpose. Many thanks. Doctor Mendoza

https://www.surveymonkey.com/r/QJQND6M