Advanced Breast Cancer Treatment : 2014 Breast Cancer Symposium Guidelines

Key Research from the 2014 Breast Cancer Symposium,
Advances in Breast Cancer Prevention, Screening, and Therapy

During the 2014 Brest Cancer symposium, the American Society of Clinical Oncology – ASCO – has released updated guidelines for the treatment of the major form of advanced breast cancer.

HER2-negative breast tumors include cancers that don’t respond to drugs that target the HER2 protein, Almost 80 percent of women with advanced breast cancer have HER2-negative tumors, the group noted.


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ASCO is the American Society of Clinical Oncology. Making a world of difference in cancer care.

To identify optimal chemo- and targeted therapy for women with human epidermal growth factor 2 (HER2)– negative (or unknown) advanced breast cancer.

A systematic review of randomized evidence (including systematic reviews and meta-analyses) from 1993 through to current was completed. Outcomes of interest included survival, progression-free survival, response, quality of life, and adverse effects. Guideline recommendations were evidence based and were agreed on by the Expert Panel via consensus.

Seventy-nine studies met the inclusion criteria, comprising 20 systematic reviews and/or meta-analyses, 30 trials on first-line treatment, and 29 trials on second-line and subsequent treatment. These trials form the evidence base for the guideline recommendations.

Endocrine therapy is preferable to chemotherapy as first-line treatment for patients with estrogen receptor–positive metastatic breast cancer unless improvement is medically necessary (eg, immediately life-threatening disease). Single agent is preferable to combination chemotherapy, and longer planned duration improves outcome but must be balanced against toxicity. There is no single optimal first-line or subsequent line chemotherapy, and choice of treatment will be determined by multiple factors including prior therapy, toxicity, performance status, comorbid conditions, and patient preference. The role of bevacizumab remains controversial. Other targeted therapies have not so far been shown to enhance chemotherapy outcome in HER2-negative breast cancer.

Sources and More Information:
  • Chemotherapy and Targeted Therapy for Women With Human Epidermal Growth Factor Receptor 2–Negative (or unknown) Advanced Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline, American Society of Clinical Oncology, 10.1200/JCO.2014.56.7479, September 2, 2014.
  • New Guidelines for Treating Form of Advanced Breast Cancer, MedlinePlus, September 2, 2014.
  • #BCS14 meeting abstracts and daily news..

Cancer Treatment Disparities in HIV-Infected Individuals in the United States – @ASCO Study

HIV-infected individuals are less likely to receive treatment for some #cancers than uninfected people, which may affect survival rates.


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HIV patients less likely to get cancer treatment in the United States.
An ASCO American Society of Clinical Oncology study

HIV-infected individuals with cancer have worse survival rates compared with their HIV-uninfected counterparts. One explanation may be differing cancer treatment; however, few studies have examined this.

Patients and Methods
We used HIV and cancer registry data from Connecticut, Michigan, and Texas to study adults diagnosed with non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancers from 1996 to 2010. We used logistic regression to examine associations between HIV status and cancer treatment, adjusted for cancer stage and demographic covariates. For a subset of local-stage cancers, we used logistic regression to assess the relationship between HIV status and standard treatment modality. We identified predictors of cancer treatment among individuals with both HIV and cancer.

We evaluated 3,045 HIV-infected patients with cancer and 1,087,648 patients with cancer without HIV infection. A significantly higher proportion of HIV-infected individuals did not receive cancer treatment for diffuse large B-cell lymphoma (DLBCL; adjusted odds ratio [aOR], 1.67; 95% CI, 1.41 to 1.99), lung cancer (aOR, 2.18; 95% CI, 1.80 to 2.64), Hodgkin’s lymphoma (aOR, 1.77; 95% CI, 1.33 to 2.37), prostate cancer (aOR, 1.79; 95% CI, 1.31 to 2.46), and colorectal cancer (aOR, 2.27; 95% CI, 1.38 to 3.72). HIV infection was associated with a lack of standard treatment modality for local-stage DLBCL (aOR, 2.02; 95% CI, 1.50 to 2.72), non–small-cell lung cancer (aOR, 2.43; 95% CI, 1.46 to 4.03), and colon cancer (aOR, 4.77; 95% CI, 1.76 to 12.96). Among HIV-infected individuals, factors independently associated with lack of cancer treatment included low CD4 count, male sex with injection drug use as mode of HIV exposure, age 45 to 64 years, black race, and distant or unknown cancer stage.

HIV-infected individuals are less likely to receive treatment for some cancers than uninfected people, which may affect survival rates.

  • Cancer Treatment Disparities in HIV-Infected Individuals in the United States, the American Society of Clinical Oncology, 10.1200/JCO.2013.54.8644, June 30, 2014.
  • HIV Patients Less Likely to Get Cancer Treatment: Study, News.Health, July 1, 2014.