TOP - February 2013 VOL 6, NO 1

First, it has been awhile since my last column and I want to apologize for the hiatus. So, you are then probably wondering what possibly could have coaxed me back into writing another column? Well, the mother lode of all controversial topics has risen to the top of the gossip and Internet chatter lists: a too expensive cancer drug!

An investigational oral proteasome inhibitor known as MLN9708 had such promising results in phase 1 and 2 trials that it is currently in phase 3 testing. If results are positive, the drug is expected to be approved as soon as 2014.

In August 2012, vincristine sulfate LIPOSOME injection (VSLI) (Marqibo) was granted accelerated approval by the US Food and Drug Administration (FDA) for the treatment of adult patients with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) in second or greater relapse or whose disease has progressed after 2 or more regimens.

The antidepressant venlafaxine is often prescribed to patients with breast cancer who are taking tamoxifen, to help reduce the side effect of hot flashes. But according to research presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, venlafaxine may reduce the effectiveness of the drug.

Young women with triple-negative and luminal-type breast cancer were more likely to respond to neoadjuvant chemotherapy than were older women with these cancers, and improved outcomes were observed for young women with luminal-A–like tumors who achieved a pathologic complete response (pCR) versus those who did not.

“Sexual and intimacy issues are the white elephant in the room for women with breast cancer,” stated Susan W. Rafte, of the Pink Ribbons Project, Houston, Texas. Rafte, an 18-year survivor of metastatic breast cancer, introduced an expert in sexuality to discuss approaches to sexual problems in breast cancer patients at the first session to be planned and moderated by a patient advocate (herself) at the San Antonio Breast Cancer Symposium.

A 500-mg dose of fulvestrant improved survival compared with a 250-mg dose in women with estrogen receptor–positive (ER+) metastatic breast cancer with no increase in toxicity, according to an update of the Comparison of Faslodex in Recurrent or Metastatic Breast Cancer (CONFIRM) trial.

Extending tamoxifen treatment for 10 years reduced the risk of dying by 29% compared with the standard 5 years of tamoxifen for estrogen receptor–positive (ER+) breast cancer, but these benefits of longer-duration tamoxifen did not emerge until the second decade after diagnosis, according to results of the international Adjuvant Tamoxifen—Longer Against Shorter (ATLAS) study.

Two years of trastuzumab provide no benefit over the standard of 1 year of trastuzumab therapy for human epidermal growth factor receptor 2–positive (HER2+) breast cancer, according to an 8-year follow-up of the Herceptin Adjuvant (HERA) trial reported by Martine Piccart, MD, president of the European Society for Medical Oncology and chair of the Breast International Group, Institut Jules Bordet, Brussels, Belgium. “One year of trastuzumab should remain the standard of care,” she said.

Bevacizumab (Avastin; Genentech) received FDA approval on January 23, 2013, for use in combination with fluoropyrimidine-irinotecan–based or fluoropyrimidine-oxaliplatin–based chemotherapy for treating patients with metastatic colorectal cancer (mCRC) with disease that has progressed on a regimen containing first-line bevacizumab.