Reporting from:
– San Antonio Breast Cancer Symposium, December 8-11, 2004
– European Society for Medical Oncology Congress, October 29-November 10, 2004, Vienna

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, Peter Goodwin
Correspondents: Peter Goodwin, Peter Beer, Derek Thorne
In this edition:

Raimund Jakesz discusses the results from a combined Austrian and German study, examining the effects of switching from tamoxifen to an aromatase inhibitor in approximately 3,000 women with breast cancer.

Tony Howell talks about latest results from the ATAC trial, designed to find out whether single-agent tamoxifen or single-agent anastrazole is better at five years. Dr. Howell reports on study results at 68 months of follow-up for more than 9,000 postmenopausal women.

Thomas B. Julian gives the latest findings from the large American NSABP B-32 trial, which compared sentinel node biopsy with conventional axillary dissection.

Robert Mansel reports results from the British ALMANAC study involving 1,031 patients. This longest-running study of sentinel node biopsy comparing the method with standard axillary treatment closed in 2003.

Ivo Olivotto addresses the question of which patients having mastectomy should receive radiation, particularly if a woman has one to three positive nodes. His group analyzed data on approximately 820 women referred between 1989 and 1997, treated with mastectomy.

Abstract 2
Raimund Jakesz, University of Vienna

A combined Austrian and German study has data on around 3000 patients who’d spent two years on tamoxifen and were then randomised to either continuing on tamoxifen or switching to anastrozole.

Abstract 1
Tony Howell, University of Manchester

The ATAC trial was designed to find out whether single agent tamoxifen or single agent anastrazole is better for five years. San Antonio Delegates heard what 68 months of follow up has discovered in this large multi-centre trial involving over 9000 postmenopausal women.

Abstract 6
Michael Gnant, University of Vienna

Data on the benefits of giving zoledronic acid to patients on hormone therapy – whether anastrozole or tamoxifen have emerged from a new study. This used the bisphosphonate following treatment with the LH-RH agonist, goserelin in nearly 400 patients.

Abstract P1
Paul Goss, Harvard Medical School, Boston

Delegates heard the state of the art as far as hormonal treatment with aromatase inhibitors is concerned at the plenary session in San Antonio.

Abstract 14
Thomas B. Julian, Allegheny General Hospital, Pittsburgh

Over the last five years or so, two large multi-center trials have been investigating prognosis, regional control and survival relating to sentinel node biopsy – and both these studies reported their latest findings to the San Antonio meeting. First, delegates heard from the large American NSABP B-32 trial, which compared sentinel node biopsy with conventional axillary dissection.

Abstract 18
Robert Mansel, Cardiff University

The British ALMANAC study is the longest running study of sentinel node biopsy and closed in 2003. Since then, the investigating team has been working through the data generated from the 1031 patients on the trial. The comparison was against standard axillary treatment and the latest data were presented in San Antonio.

Abstract 37
Kathy Albain, Loyola University, Chicago

Guidance on what you should do with your node positive, ER positive postmenopausal breast cancer patient was on hand in San Antonio. An update on the phase three SWOG inter-group trial of nearly 1500 patients, which had three arms: tamoxifen alone, tamoxifen scheduled sequentially with the CAF regimen of cyclophosphamide, doxorubicin and 5-FU, and finally CAF with concurrent tamoxifen.

Abstract 26
Harry Bear, Virginia Commonwealth University, Richmond

One of the big phase three trials reporting its latest results at the San Antonio meeting was NSABP B-27, which was investigating neoadjuvant docetaxel given to women with operable breast cancer. In the trial, nearly two and a half thousand women were randomized to receive either the AC regimen – doxorubicin and cyclophosphamide – alone, or AC followed by docetaxel before surgery, or AC given before surgery with docetaxel given afterwards.

Abstract 28
David Loesch, Central Indiana Cancer Centers, Indianapolis

In high risk breast cancer, paclitaxel has been under analysis. The objective of this two armed phase three trial in just over 1800 women was to compare AC followed by paclitaxel to an experimental arm of doxorubicin and paclitaxel followed by weekly paclitaxel.

Abstract 4
Trevor Powles, Parkside Oncology Clinic, London

The MORE trial showed that taking raloxifene for 4 years is effective in treating osteoporosis among postmenopausal women. It also showed a reduction of breast cancer incidence. Now an extension of MORE, called CORE, has looked specifically at this anti-cancer effect. As well as confirming previous findings it has shown that raloxifene prevents breast cancer regardless of whether the patient has previously received hormone replacement therapy.

COMMENTS: Jack Cuzick, Wolfson Institute, London

Abstract 4061
Charles Kunos, Case Western Reserve University, Cleveland

Given advances in chemotherapy and radiotherapy in recent years, how wide should margins be in breast conservation therapy? In particular, is 2mm sufficient these days? Or less? the team in Cleveland Ohio has been poring through data on just over 300 women treated with conservative surgery between 1996 and 2002.

Abstract 4066
Ivo Olivotto, British Columbia Cancer Agency, Victoria

One of the poster presentations in San Antonio attempted to address the issue of which mastectomy patients you should give radiation to – especially if the woman has one to three positive nodes. The Canadian group has analyzed around 820 women referred between 1989 and 1997, treated with mastectomy.

Controversy session, ESMO
Michael Baum, University of London
Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York

At the Vienna conference there was a debate on breast adjuvant therapy. The motion was: “For the majority of hormone receptor positive breast cancer patients in the adjuvant setting, the addition of chemotherapy to best endocrine therapy adds nothing to patient benefit”.