U.S. Preventive Services Task Force Updates Cancer Screening Recommendations
The U.S. Preventive Services Task Force (USPSTF) released updated recommendations for skin cancer and breast cancer screenings in spring 2023. Regarding skin cancer, the USPSTF found that because of insufficient evidence, “the balance of benefits and harms for visual skin examination by a clinician to screen for skin cancer in asymptomatic adolescents and adults cannot be determined.” For breast cancer, the draft recommendation from USPSTF stated that all women should get screened every other year, starting at age 40.
Platinum Chemo Improves TNBC Survival for Patients Younger Than 50
Adding carboplatin to standard neoadjuvant chemotherapy for patients with triple-negative breast cancer improves complete response, event-free survival, and overall survival, researchers reported in study findings presented in abstract GS5-01 during the 2022 San Antonio Breast Cancer Symposium.
FDA Updates Mammography Regulations to Promote Better Screenings and Communication for Patients
The U.S. Food and Drug Administration updated its mammography regulations in March 2023 to require institutions to notify patients about their breast density. The updated regulations strengthen FDA’s oversight and enforcement of institutions and help healthcare providers better categorize and assess mammograms.
FDA Expands Early Breast Cancer Indication for Abemaciclib With Endocrine Therapy
On March 3, 2023, the U.S. Food and Drug Administration approved abemaciclib (Verzenio®) in combination with endocrine therapy (tamoxifen or an aromatase inhibitor) for the adjuvant treatment of adult patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, early breast cancer who are at high risk for recurrence.
FDA Approves Sacituzumab Govitecan-Hziy for HR-Positive Breast Cancer
On February 3, 2023, the U.S. Food and Drug Administration approved sacituzumab govitecan-hziy (Trodelvy®) for unresectable locally advanced or metastatic hormone receptor–positive, human epidermal growth factor receptor 2–negative (IHC 0, IHC 1+, or IHC 2+/ISH–) breast cancer who have received endocrine-based therapy and at least two additional systemic therapies in the metastatic setting.
Black Patients With Metastatic Breast Cancer Are Less Informed About Their Clinical Trial Options
Healthcare providers are less likely to talk to Black patients with metastatic breast cancer about opportunities to enroll in clinical trials than they are with patients from other racial or ethnic backgrounds, researchers reported at the 2022 ASCO Annual Meeting.
FDA Approves Elacestrant for ER-Positive, HER2-Negative, ESR1-Variant Advanced or Metastatic Breast Cancer
On January 27, 2023, the U.S. Food and Drug Administration approved elacestrant (Orserdu®) for postmenopausal women or adult men with estrogen receptor-positive, human epidermal growth factor receptor 2-negative, ESR1-variant advanced or metastatic breast cancer with disease progression following at least one line of endocrine therapy.
Cancer Hits Home for NCI Director Bertagnolli
In a December 2022 statement, Monica M. Bertagnolli, MD, National Cancer Institute director, announced that she was diagnosed with hormone receptor-positive, HER2-negative breast cancer and that her prognosis is favorable. She said she is enrolled in a clinical trial centered around her diagnosis to contribute to the cancer knowledge base and advance care.
Biomarkers Are Associated With Frailty After Chemo for Breast Cancer
High levels of interleukin-6 (IL-6) and C-reactive protein before chemotherapy for breast cancer may predict a patient’s propensity to develop clinical decline and frailty after treatment, according to study findings that researchers reported in the Journal of Clinical Oncology.
What Is HER2-Low Breast Cancer?
Human epidermal growth factor receptor 2 (HER2) proteins are involved in normal cellular growth and are found on the surface of all breast cells. Approximately 20% of breast cancers are HER2 positive, meaning they have high levels of HER2 protein, and those cancers typically grow and metastasize more quickly than other types of breast cancer.
Tumor-Infiltrating Lymphocytes Activate Immune Response to Metastatic Breast Cancer
More than two-thirds of patients with hormone receptor–positive metastatic breast cancer respond to personalized immunotherapy with tumor-infiltrating lymphocytes and more than half of those treated experience measurable tumor shrinkage, according to study findings published in the Journal of Clinical Oncology.
FDA Approves Fam-Trastuzumab Deruxtecan-Nxki for HER2-Low Breast Cancer
On August 5, 2022, the U.S. Food and Drug Administration (FDA) approved fam-trastuzumab deruxtecan-nxki (Enhertu®) for use in adult patients with unresectable or metastatic HER2-low (IHC 1+ or IHC 2+/ISH‑) breast cancer who have received prior chemotherapy in the metastatic setting or developed disease recurrence during or within six months of completing adjuvant chemotherapy.
FDA Grants Regular Approval to Fam-Trastuzumab Deruxtecan-Nxki for Breast Cancer
On May 4, 2022, the U.S. Food and Drug Administration (FDA) approved fam-trastuzumab deruxtecan-nxki (Enhertu®) for adult patients with unresectable or metastatic HER2-positive breast cancer who have received a prior anti-HER2–based regimen in the metastatic setting as well as those in the neoadjuvant or adjuvant setting who developed disease recurrence during or within six months of completing therapy.
Breast-Conserving Surgery Leads to Better QOL for Young Breast Cancer Survivors
Patients younger than 40 who elected to have breast-conserving surgery instead of mastectomy to remove breast cancer reported having better quality of life (QOL) more than five years after diagnosis, according to study findings reported in JAMA Surgery.
FDA Approves Olaparib for Adjuvant Treatment of High-Risk Early Breast Cancer
On March 11, 2022, the U.S. Food and Drug Administration (FDA) approved olaparib (Lynparza®) for adult patients with deleterious or suspected deleterious germline BRCA variant (gBRCAm) human epidermal growth factor receptor 2 (HER2)-negative high-risk early breast cancer who have been treated with neoadjuvant or adjuvant chemotherapy. Patients are selected for therapy based on an FDA-approved companion diagnostic for olaparib.
Genetic Disorder Reference Sheet: PALB2
PALB2 refers to partner and localizer of BRCA2. The gene was isolated in 2007 and is the third most common gene associated with breast cancer risk. Both men and women are at increased risk for developing multiple cancers if they have a pathogenic PALB2 variant (see sidebar).
Specialized Risk Calculator May Reduce Disparities for Black Patients With Breast Cancer
A new risk model tailored for Black patients predicts their risk of developing breast cancer as accurately as current models for White patients, researchers reported in the Journal of Clinical Oncology. Because Black patients are more likely to be younger at diagnosis, present with aggressive or advanced cancer, and die from the disease than other racial and ethnic groups, using the new model to personalize prevention and screening recommendations may reduce those disparities.
How Liquid Biopsies Are Used in Cancer Treatment Selection
Biomarker testing is an essential tool when choosing the right treatment for many advanced solid cancers. However, tissue-based testing may take weeks to get results with a chance that not enough tissue was collected to complete the entire biomarker panel. Blood draw–based liquid biopsies may be a useful alternative to identify a tumor’s biomarker details and can be performed by testing for circulating tumor DNA (ctDNA).
Combination CDK4/6 and Fulvestrant Has Survival Benefits in Late-Stage Breast Cancer
Combining a CDK4/6 inhibitor and fulvestrant improves overall survival consistently among patients with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer, according to a U.S. Food and Drug Administration (FDA) analysis. The agency reported the findings in Lancet Oncology.
FDA Approves Abemaciclib With Endocrine Therapy for Early Breast Cancer
On October 12, 2021, the U.S. Food and Drug Administration (FDA) approved abemaciclib (Verzenio®) with endocrine therapy (tamoxifen or an aromatase inhibitor) for adjuvant treatment of adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-positive, early breast cancer at high risk for recurrence and a Ki-67 score ≥ 20%, as determined by an FDA-approved test. This is the first CDK4/6 inhibitor approved for adjuvant treatment of breast cancer.
Oncology Drug Reference Sheet: Sacituzumab Govitecan-Hziy
Initially marketed in April 2020 for treatment of adults with metastatic triple negative breast cancer, sacituzumab govitecan-hziy (Trodelvy®) received an additional approval in 2021 for the treatment of patients with locally advanced or metastatic urothelial cancer with prior treatments.
The Case of the Triple-Negative Breast Cancer Targeted Treatment
Ophelia is a 42-year-old patient who has been diagnosed with triple-negative breast cancer (TNBC). She completed neoadjuvant chemotherapy with dose-dense doxorubicin and cyclophosphamide, followed by paclitaxel and carboplatin. Her postsurgical pathology shows residual disease in the tumor (3.5 cm down from 4 cm) and 12 out of 18 lymph nodes that are positive for cancer. Ophelia tells you that she is very discouraged and expected a better treatment outcome.
U.S. Senators Introduce Metastatic Breast Cancer Access to Care Act
In April 2021, U.S. Senators Chris Murphy (D-CT) and Joni Ernst (R-IA) introduced the Metastatic Breast Cancer Access to Care Act, legislation that would waive the five-month waiting period for social security disability insurance (SSDI) and the 24-month waiting period for eligible Medicare benefits.
FDA Approves Pembrolizumab for High-Risk, Early-Stage, Triple-Negative Breast Cancer
On July 26, 2021, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) for high-risk, early-stage, triple-negative breast cancer (TNBC) in combination with chemotherapy as neoadjuvant treatment and continued as a single agent as adjuvant treatment after surgery.
Imaging Test Identifies Treatment Choices for ER-Positive Breast Cancer
Using positron-emission tomography with a radioactive tracer identifies levels of progesterone receptor in patients with estrogen receptor-positive breast cancer, researchers reported in Nature Communications. The diagnostic tool would help clinicians determine which patients are most likely to respond to hormone therapies for breast cancer.
HER2 Status Has Implications for Breast Cancer Treatment and Nursing Care
Breast cancer is classified by several factors, including the presence of human epidermal growth factor receptor 2 (HER2), a type of growth-promoting protein found on the surface of cells. All breast cells have HER2 receptors, but some breast cancers have more HER2 receptors than normal, which may promote tumor growth. About 60% of breast cancers have some level of HER2 expression, and approximately one in five patients has high levels of the HER2 protein, which is considered HER2-positive.
FDA Approves Sacituzumab Govitecan for Triple-Negative Breast Cancer
On April 7, 2021, the U.S. Food and Drug Administration (FDA) granted regular approval to sacituzumab govitecan (Trodelvy®) for patients with unresectable locally advanced or metastatic triple-negative breast cancer who received two or more prior systemic therapies, at least one of which for metastatic disease.
FDA Issues Safety Communication for ADM Products Used in Implant-Based Breast Reconstruction
On March 31, 2021, the U.S. Food and Drug Administration (FDA) issued a safety communication informing patients, caregivers, and healthcare providers that certain acellular dermal matrix (ADM) products used in implant-based breast reconstruction may have a higher chance for complications or problems.
Manage Adverse Events From PI3K Inhibitors for Breast Cancer
In 2019, PI3K inhibitors became a new treatment option for postmenopausal women and men with HR-positive, HER2-negative, PIK3CA-mutated, advanced or metastatic breast cancer with the U.S. Food and Drug Administration’s approval of alpelisib in combination with fulvestrant. Although alpelisib remains the only PI3K inhibitor approved today, others are in clinical trials, and the new class of agents has a unique safety profile.
Nursing Considerations for Breast Cancer Survivorship Care
More than 3.5 million people in the United States are living with a breast cancer diagnosis. Despite their large number, patients often report they do not receive appropriate follow-up care after completing treatment—and the situation is worsening, with pandemic-related delays in care affecting approximately half of breast cancer survivors.
FDA Approves Margetuximab-cmkb for Metastatic HER2-Positive Breast Cancer
On December 16, 2020, the U.S. Food and Drug Administration (FDA) approved margetuximab-cmkb (Margenza™) in combination with chemotherapy for the treatment of adult patients with metastatic HER2-positive breast cancer who previously received two or more anti-HER2 regimens, at least one of which was for metastatic disease.
FDA Grants Accelerated Approval to Pembrolizumab for Locally Recurrent Unresectable or Metastatic TNBC
On November 13, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pembrolizumab in combination with chemotherapy for the treatment of patients with locally recurrent unresectable or metastatic triple negative breast cancer (TNBC) whose tumors express PD-L1 (combined positive score [CPS] ≥ 10) as determined by an FDA-approved test. FDA also approved the PD-L1 IHC 22C3 pharmDx as a companion diagnostic for selecting patients with TNBC for pembrolizumab.
Breast Cancer Prevention, Screening, Diagnosis, Treatment, Side Effect, and Survivorship Considerations
In the United States, breast cancer is the most commonly diagnosed cancer in women. One in eight women will develop invasive disease in their lifetime with approximately 270,00 new cases diagnosed in the United States in 2019. Caucasian women have the highest incidence rate, whereas African American women are most likely to die from the disease. The five-year survival rate is 91%, with an estimated 3.8 million breast cancer survivors living in the United States.
FDA Rejects Atezolizumab in Combination With Paclitaxel as Treatment for Breast Cancer
On September 8, 2020, the U.S. Food and Drug Administration (FDA) announced it did not approve atezolizumab (Tecentriq®) in combination with paclitaxel for treatment of breast cancer after a clinical trial studying the use of atezolizumab and paclitaxel in patients with previously untreated inoperable locally advanced or metastatic triple negative breast cancer (mTNBC) showed the drug combination did not work to treat the disease.
ACA Led to Higher Rates of Early Breast Cancer Diagnoses
Thanks to expanded Medicaid coverage from the Affordable Care Act (ACA), women diagnosed with breast cancer—and in particular, African American women who are more likely to experience breast cancer disparities—are getting their cancers found at earlier stages, according to researchers. The study findings were reported in JAMA Surgery.
Insulin Resistance May Explain Racial Disparity in Breast Cancer
Black women with breast cancer typically have a worse prognosis than white women, and the results of a new study suggest that insulin resistance may be a factor in the disparity. Findings from the study were reported in Breast Cancer Research.
Dietary Supplements May Affect Breast Cancer Chemo Outcomes
Antioxidant supplements are associated with increased disease recurrence and statistically nonsignificant increased risk of mortality in patients with breast cancer who were receiving cyclophosphamide, doxorubicin, and paclitaxel, according to findings from a study reported in the Journal of Clinical Oncology.
FDA Approves First New Drug Under International Collaboration, a Treatment Option for Patients With HER2-Positive Metastatic Breast Cancer
On April 17, 2020, as part of Project Orbis, the U.S. Food and Drug Administration (FDA) approved tucatinib (Tukysa™) in combination with chemotherapy (trastuzumab and capecitabine) for the treatment of adult patients with advanced forms of HER2-positive breast cancer that can’t be removed with surgery or have spread to other parts of the body, including the brain, and who have received one or more prior treatments.
New Treatments Show Promise for Metastatic HER2-Positive Breast Cancer
Two new drugs in clinical trials are extending survival for women with metastatic HER2-positive breast cancer that had progressed with previous treatment. One of the drugs was effective for brain metastasis, which is particularly difficult to treat. Results from both studies were reported in the New England Journal of Medicine.
Genomic Classifier Predicts Breast Cancer Radiation Benefit, Recurrence Risk
The Adjuvant Radiotherapy Intensification Classifier (ARTIC) predicts which women with early-stage breast cancer will benefit the most from radiotherapy, as well as their risk for locoregional recurrence after radiation, researchers reported in study findings published in the Journal of Clinical Oncology.
Latinas’ Breast Cancer Genetic Disparities Require More Focused Counseling and Testing
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in Latina women. Compared to all patients with breast cancer, Latinas are the second most common ethnic group to carry BRCA1 deleterious mutations, after Ashkenazi Jewish women. However, Latinas are less likely to receive genetic counseling education, referrals, and testing services and have the least awareness of genetic testing compared to non-Hispanic whites and other minority populations. Research indicates that despite their low awareness, Latinas have high interest in participating in genetic counseling and testing.
FDA Approves Neratinib for Metastatic HER2-Positive Breast Cancer
On February 25, 2020, the U.S. Food and Drug Administration (FDA) approved neratinib (Nerlyn®) in combination with capecitabine for adult patients with advanced or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2 based regimens in the metastatic setting.
Breast Cancer Is More Fatal in Men Than Women
Men have higher death rates than women across all stages of breast cancer, study findings reported in JAMA Oncology show. In the study, five-year overall survival after a breast cancer diagnosis was 77.6% for men and 86.4% for women.
Multigene Testing Is Cost Effective for All Women With Breast Cancer
According to findings from a new analysis published in JAMA Oncology, multigene testing should be expanded to all women with breast cancer and not just those with certain family histories or clinical factors.
Research Guides the Transition of PEP Resources to ONS Guidelines
Lymphedema is one of the most common treatment side effects in patients with breast cancer. Estimates suggest that approximately 40% of all breast cancer survivors are at risk to develop lymphedema at some point in their lives. But as far back as 1998 and even before, some healthcare experts were predicting that lymphedema would be eliminated as a side effect from breast cancer treatment. Twenty-one years later, it’s still prevalent among breast cancer survivors, requiring careful management recommendations from oncology nurses to help patients live with this chronic issue.
CDK4/6 Plus AI Is Effective for Older Women With Breast Cancer
Combination treatment with a CDK4/6 inhibitor and aromatase inhibitor (AI) results in similar progression-free survival (PFS) rates in women with hormone receptor-positive, HER2-negative metastatic breast cancer who are aged 70 or older compared to younger women, according to study findings published in the Journal of Clinical Oncology.
USPSTF Updates Recommendations on Breast Cancer Prevention
Certain groups of women who are at increased risk for carrying BRCA1 or BRCA2 genes should be assessed for the need for genetic testing, and women at increased risk for breast cancer and low risk of adverse events should be offered risk-reducing medications, the U.S. Preventive Services Task Force (USPSTF) recommended.
Getting the Right Treatment at the Right Time Reduces Inequities in Breast Cancer Survival
Although death rates from breast cancer have been falling, the trend has not been equal among all women. Looking at breast cancer survival on a population level can tell us how effective our public health and healthcare systems are at early diagnosis, delivery of evidence-based treatment, and management of follow-up care.