Latest research from the European Society for Medical Oncology conference
The impact of COVID-19 on breast cancer diagnosis
A few research groups reported on the effects of COVID-19 of the diagnosis and treatment of breast cancer. Many people, as here in New Zealand, had mammograms postponed due to lockdowns or overloaded healthcare systems, and people already diagnosed with breast cancer were faced with delays in accessing healthcare. One study found that there were 27% fewer breast cancer cases diagnosed in 2020 than in 2019, suggesting that women were going undiagnosed. Patients diagnosed in 2020 were likely to have later-stage cancers and were in generally worse health. A similar study in Brazil found that patients who were diagnosed and attended their first appointment during the pandemic had later stage breast cancers than those diagnosed pre-Covid.
Resistance training during chemotherapy can help to preserve muscle mass and strength
Sarcopenia (the progressive loss of skeletal muscle mass and strength) is common in patients having chemotherapy and appears to predict chemo side effects and whether breast cancer will spread. One clinical trial presented last weekend investigated whether resistance training could reduce sarcopenia in women having chemo for breast cancer. Forty-two women were recommended to undertake resistance training over three cycles of chemotherapy. Fourteen of the 42 women had sarcopenia at the start of the study – by the end, 13 of these no longer had sarcopenia and no one else had developed it.
Virtual reality can reduce depression and anxiety during chemotherapy
A study conducted in the Philippines showed that breast cancer patients who used immersive virtual reality (VR) experiences during their first cycle of chemotherapy reported less anxiety and depression than those who received only general standard-of-care treatment. Breast Cancer Foundation NZ has done some similar research here in New Zealand that we hope to be able to share with you soon!
Benefits of extended neratinib treatment after chemotherapy
Women with HER2+ breast cancer usually take Herceptin for a year after their cancer surgery. For women who are at a particularly high risk of relapse, one trial suggested that continuing to take a different anti-HER2 drug, neratinib (Nerlynx), for one year after completing chemo could help to lower this risk. HER2+/HR+ women thought to be at a higher risk of relapse took either neratinib or a placebo for an extra year following chemotherapy. Women taking neratinib were less likely to have relapsed after 2 years and 5 years than women taking the placebo. However, this study is currently small scale and is largely descriptive. Neratinib is Medsafe-approved in NZ for use after Herceptin, but isn’t funded by PHARMAC. There is a programme in place for New Zealanders to access neratinib at special pricing – talk to your oncologist, or phone our nurses for more info.
Taking letrozole for 5 years after tamoxifen may improve outcomes
Women taking tamoxifen for hormone-receptor positive breast cancer often switch to an aromatase inhibitor (AI) drug after treatment for 2-3 years to continue preventing the production of oestrogen. One clinical trial looked at whether AI treatment should be extended beyond 3 years after tamoxifen. Women initially diagnosed with stages 1-3 breast cancer who were treated with tamoxifen were then asked to take an AI called letrozole for either the recommended 2-3 years or for an extended 5 years. Twelve years later, disease-free and overall survival rates were 5% and 4% higher respectively in the group taking letrozole for 5 years than the group taking letrozole for 2-3 years.
New Enhertu drug reduces the risk of disease progression and death
Patients with advanced HER2+ breast cancer who were treated with the new drug Enhertu experienced a 72% reduction in their risk of disease progression or death compared to patients taking Kadcyla. The average progression-free survival rate for patients on Enhertu was 25.1 months, compared to 7.2 months for patients on Kadcyla. All patients had previously been treated with Herceptin and chemotherapy. The study is still ongoing, but there also seem to be positive effects on 12-month and overall survival rates.
In New Zealand, Perjeta is used before Kadcyla for advanced breast cancer. This study hasn't yet looked specifically at women who took Perjeta as well as Herceptin before taking Enhertu or Kadcyla, though they plan to do this next.
New oestrogen receptor degrader showing promise in inhibiting tumour growth
A next-generation oral selective oestrogen receptor degrader (SERD) called giredestrant has shown promise in reducing the growth of tumour cells in post-menopausal women with early breast cancer. The reduction in Ki67 (a protein that shows how fast cancer is likely to grow) after two weeks of taking giredestrant was 80% compared to 67% on anastrozole. Additionally, 25% percent of tumours completely stopped growing after patients took[AG10] the giredestrant, compared to 5% on anastrozole. Giredestrant showed a 10% reduction in reports of side effects.