Reporting from:
San Antonio Breast Cancer Symposium 2005
Scientific Editors:
George Canellos, Dana-Farber Cancer Institute, Boston
Gordon McVie, European Institute of Oncology, Milan
Pat Price, Christie Hospital, Manchester
Gianni Bonadonna, Istituto Nazionale Tumori, Milan
Producer: Derek Thorne

In this edition:

The targeted drug trastuzumab may be used in place of anthracyclines for breast adjuvant chemotherapy regimens, according to the findings of Dennis Slamon, who announced the BCIRG 006 study findings to the San Antonio conference. Norman Wolmark commented.

Kathy Miller gave the Breast Cancer conference early data showing that the anti-vascular endothelial growth factor agent, bevacizumab, has improved survival among patients with metastatic breast cancer.

Dose-dense chemotherapy should be considered mainly in hormone receptor negative breast cancer patients, so said Clifford Hudis, while Martine Piccart warned against over-enthusiasm for cytotoxic chemotherapy among patients who could benefit more from endocrine treatment.

Switching from tamoxifen to anastrozole brought clear benefits according to a meta-analysis presented in San Antonio by Walter Jonat. And ductal carcinoma in situ should be treated with radiation according to Nina Bijker’s report to the conference.

Dennis Slamon, UCLA School of Medicine, Los Angeles

It may be reasonable to replace the anthracycline component of adjuvant chemotherapy with carboplatin in HER-2 positive patients with early breast cancer - provided agents such as docetaxel and trastuzumab are also included, according to the findings of the BCIRG 006 trial reported at the San Antonio breast cancer symposium.

COMMENT: Norman Wolmark, NSABP foundation, Pittsburg

Richard Gelber, Harvard Medical School, Boston

Latest findings from the HERA study show that Trastuzumab (Herceptin) gave significantly lower rates of local recurrence among patients with breast cancer in whom this targeted agent was added after standard adjuvant therapy.

Edith Perez, Mayo Clinic, Jacksonville

In a study of some 3 000 patients the use of trastuzumab in adjuvant therapy for breast cancer gave significant benefits with acceptable cardiac toxicity.

Kathy Miller, Indiana University School of Medicine, Indianapolis

Adding the anti-vascular endothelial growth factor (VEG-F) inhibitor, bevacizumab, gave a marked improvement of survival among women with recurrent or metastatic breast cancer.

Stephen Jones, US Oncology Research, Houston

Docetaxel did better than doxorubicin when added to cylcophosphamide therapy for patients with early breast cancer.

Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York

Patients with estrogen-receptor negative breast cancer derived some benefit from dose dense schedules of chemotherapy.

Joseph Sparano, Albert Einstein College of Medicine, New York

No difference was found between the benefit of regimens including paclitaxel as compared with docetaxel among patients with early breast cancer receiving adjuvant chemotherapy.

Martine Piccart, Jules Bordet Cancer Institute, Brussels

Adjuvant therapy needs to be individualised for each patient, and the use of cytotoxic chemotherapy may often be avoided in favour of endocrine therapy among patients whose tumours have been shown to be sensitive to hormone modulators.

Ivo Olivotto, University of British Columbia, Victoria

Three decades of cancer statistics show that adjuvant therapy has greatly benefited patients with breast cancer since the 1970s.

Paul Goss, Massachusetts General Hospital, Boston

Post menopausal patients with breast cancer whose endocrine therapy was switched from tamoxifen to letrozole showed a benefit in the NCIC MA17 study among 5 000 women.

Lois Shepherd, Queen’s University, Kingston, Ontario

The NCIC trial of the aromatase inhibitor, letrozole, has also shown that patients whose tumours are positive for both oestrogen and progesterone receptors benefit from letrozole, whereas those with ER positive and PGR negative do less well and could be considered for other therapies after initially receiving 5 years of tamoxifen.

Walter Jonat, University of Kiel

A meta-analysis of patients switching after 2 years from tamoxifen to treatment with aromatase inhibitors (including letrozole and anastrozole) showed benefits over patients remaining on tamoxifen therapy.

Michael Gnant, University of Vienna

Among patient who receive conservative surgery for their low risk endocrine-responsive breast cancer there is still a benefit locally from using adjuvant radiation.

Nina Bijker, Netherlands Cancer Institute, Amsterdam

Patients who had excision of ductal carcinoma in situ (DCIS) gained longer freedom from recurrence if they received radiotherapy, according to findings from an EORTC trial. All sub-groups of patients benefited from radiation.

Amit Agrawal, Nottingham City Hospital

The epidermal growth factor receptor (EGFR) inhibitor gefitinib brought benefit to patients with advanced or metastatic breast cancer. Curiously, those with more modest expression of EGFR had the best responses.

Reporting from:
European Society of Cardiology Congress, Munich, August 28-1 September, 2004
Scientific Editors:
Michael Petch, Papworth Hospital, Cambridge
Man Fai Shiu, Walsgrave Hospital, Coventry
James Tcheng, Duke University, Durham
Harvey White, Green Lane Hospital, Auckland
Producer: Derek Thorne
Correspondents: Richard Black, Graham Easton & Peter Goodwin

In this edition:

Philip Poole-Wilson has the latest results from the ACTION trial, which looked at the safety and efficacy of nifedipine in the treatment of angina. Michael Petch comments.

The cannabinoid receptor blocker rimonabant can help people with risk factors related to the metabolic syndrome that’s according to Alain Golay, who presented findings from the RIO-LIPIDS trial at the ESC annual congress in Munich.

Robert Kiss talks about a large prospective study from Hungary, which appears to show that aspirin resistance represents a higher risk of mortality among cardiovascular patients continuing to take aspirin for secondary prevention. Richard Conti gives his thoughts on the trial.

The ARTS trial, the largest study comparing bypass surgery to percutaneous intervention in patients with multi-vessel disease, is now five years old. Patrick Serruys describes the latest findings.

Philip Poole-Wilson, Royal Brompton Hospital, London

The ESC meeting saw the results of a major trial on the safety and efficacy of nifedipine in the treatment of angina. The ACTION trial enrolled eight thousand people with chronic angina, and randomised them to either placebo or the long-acting GITS formulation of nifedipine.

COMMENT: Michael Petch, Papworth Hospital, Cambridge

Robbert de Winter, University of Amsterdam

The early use of Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting in the majority of high risk unstable angina patients was not endorsed by a new trial from Amsterdam called ICTUS.

Marc Brouwer, University of Nijmegen

A meta-analysis from Nijmegen has produced similar findings to the ICTUS trial - that early invasive therapy may not always bring a better outcome in acute coronary syndromes.

Robert Kiss, University of Budapest

A large prospective study from Hungary appears to show that aspirin resistance represents a higher risk of mortality among cardiovascular patients continuing to take aspirin for secondary prevention.

COMMENT: Richard Conti, University of Florida, Gainesville

John McMurray, Western Infirmary, Glasgow

New data presented in Munich suggests that cardiologists may not be paying enough attention to glucose status in their patients. John McMurray says that it may now be time to consider checking glycaemic status in all patients with cardiovascular disease or even just risk factors.

Caroline Daly, Royal Brompton Hospital, London

In a session on intensive treatment for diabetes, delegates heard about a study that sheds some light on the impact of metabolic syndrome on patients with coronary disease.

COMMENT: Man Fai Shiu, Walsgrave Hospital, Coventry

Michael Petch, Papworth Hospital, Cambridge

One of the big studies presented at the Munich conference was the Interheart Study - a massive investigation of the risk factors for heart disease with some important clinical implications.

Alain Golay, University Hospital, Geneva

One option for helping people with risk factors related to the metabolic syndrome would appear to be the cannabinoid receptor blocker rimonabant. The RIO-LIPIDS investigated the effect of the drug in 1000 overweight or obese patients.

Chaime Lotan, Hadassah Hospital, Jerusalem

Drug-eluting stents have proved their worth in a number of lesion types but how effective are they in chronic total occlusion? Drawing on data from the e-CYPHER registry, researchers from Jerusalem have been aiming to find out.

Patrick Serruys, Erasmus University, Rotterdam

The ARTS trial, the largest study comparing bypass surgery to percutaneous intervention in patients with multi-vessel disease, is now five years old. It randomised around 1200 subjects eligible for either treatment, and in Munich, delegates heard the latest results.

Tony Barnett, Birmingham Heartlands Hospital

For the growing number of patients with type 2 diabetes, hypertension and early neuropathy, should physicians be using angiotensin converting enzyme inhibitors, or angiotensin receptor blockers? The 5-year DETAIL study provided the first comparative evidence, and suggests that an ARB, telmisartan, is equivalent to enalapril in providing renal protection in these patients.

Anselm Gitt, Heart Centre, Ludwigshafen

A number of studies in the last few years have indicated the primacy of primary PCI over thrombolysis. But there may be a reluctance to give this invasive procedure to elderly patients. According to data from a German registry, MITRA-plus, it’s well worthwhile.