Younger women with advanced breast cancer needlessly excluded from treatment trials

November 04, 2017

Lisbon, Portugal: Pre-menopausal women with the most common type of advanced breast cancer are usually excluded from medical research unnecessarily, according to an expert panel at the Advanced Breast Cancer Fourth International Consensus Conference (ABC 4).

In new guidelines for treating advanced breast cancer agreed today (Saturday), the panel said that the majority of clinical trials for hormone-dependent advanced breast cancer either explicitly exclude pre-menopausal women, or deter them by means of unnecessarily restrictive inclusion criteria. The panel has called for future trials to be designed to enable both pre- and post-menopausal women to be enrolled.

Chair of the ABC 4 conference, Professor Fatima Cardoso, Director of the Breast Unit of the Champalimaud Cancer Centre in Lisbon, Portugal, said: "At present, not only are younger women denied the opportunity to take part in clinical trials, but also clinicians lack the evidence on how best to treat these patients who have advanced breast cancer with limited therapies available."

Globally, hundreds of thousands of women are being treated for advanced breast cancer, where the tumour has begun to spread to other parts of the body, and around a third of these cancers are in pre-menopausal women. The majority are oestrogen receptor positive (ER positive), meaning that tumour growth is fuelled by the female hormone oestrogen. This subtype of advanced breast cancer has recently seen a major advance with the introduction of drugs called CDK inhibitors

A key treatment for pre-menopausal women with ER positive advanced breast cancer is to shut down their bodies' production of oestrogen, either permanently by removing the ovaries, or temporarily with drugs. Professor Cardoso said: "This 'induced menopause' means that including these younger women in trials alongside older women is unlikely to hamper the research. On the contrary, it might make it easier to recruit women on to the trial and it might give us more information on how best to treat women of all ages.

"There is no sense in excluding these women from these trials or running separate trials of new treatments for them. The treatment we give them will make them menopausal anyway, so why exclude them in the first place?"

Professor Bella Kaufman treats pre-menopausal patients at the Sheba Medical Center, Tel Hashomer, Israel, and is herself an advanced breast cancer patient. She said: "Although breast cancer is less common in pre-menopausal women, this is an important group of patients who have a complicated set of needs. To understand and address these needs, it's vital that pre-menopausal women take part in clinical trials. Younger patients, for example, may have additional concerns about their fertility, their ability to work, or their body image."

This issue was one of several addressed by 1,300 experts and patients from 88 countries around the world as they agreed new guidelines for the treatment of advanced breast cancer. Other recommendations included clearer advice on the use of complementary medicine.

The guidelines state that alternative therapies used instead of scientifically-based medicines are not recommended at any stage of cancer treatment, but that some complementary therapies, such as exercise, mindfulness and acupuncture, have the potential to reduce symptoms or treatment side-effects.

They said that some alternative treatments show "no effect at best, or even association with worse outcome". Examples of these include antioxidant supplements, Chinese herbal medicine, oxygen and ozone therapy and high doses of vitamins such as C, D and E.

Dr Eric Winer, Director of Breast Oncology at the Dana-Farber Cancer Institute (Boston, USA) and co-chair of the conference, said: "This new set of guidelines offers clarity on the vast amount of research and information available to women with advanced breast cancer and the people who treat and care for them. What sets them apart is that they are produced by a partnership of patients and researchers.

"In the end, it is all about listening to our patients and communicating clearly. Whether we are talking about standard therapies or complementary approaches, we need to ensure that all lines of communication are wide open."
-end-


European School of Oncology

Related Breast Cancer Articles from Brightsurf:

Oncotarget: IGF2 expression in breast cancer tumors and in breast cancer cells
The Oncotarget authors propose that methylation of DVDMR represents a novel epigenetic biomarker that determines the levels of IGF2 protein expression in breast cancer.

Breast cancer: AI predicts which pre-malignant breast lesions will progress to advanced cancer
New research at Case Western Reserve University in Cleveland, Ohio, could help better determine which patients diagnosed with the pre-malignant breast cancer commonly as stage 0 are likely to progress to invasive breast cancer and therefore might benefit from additional therapy over and above surgery alone.

Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.

Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.

More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.

Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.

Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.

Blood test can effectively rule out breast cancer, regardless of breast density
A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue.

Study shows influence of surgeons on likelihood of removal of healthy breast after breast cancer dia
Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published by JAMA Surgery.

Young breast cancer patients undergoing breast conserving surgery see improved prognosis
A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery.

Read More: Breast Cancer News and Breast Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.