The First day of the Symposium

There were several interesting presentations today. Some studies have clinical applications while others have a more general effect.
It does feel, however, that many of the molecular biology studies of the past are finally moving into the clinic.

Clinical Highlights:

1. An international study of Inflammatory Breast Cancer (IBC). This type of breast cancer is not common and it has therefore been difficult to do studies. This international approach allowed for a very interesting study of neoadjuvant (before surgery) treatment with a new drug called lapatinib alone or with chemotherapy (paclitaxel).

Lapatinib blocks both epidermal growth factors (1 and 2) and showed benefit when it was used alone. It had even more benefit when used with chemotherapy in women who have IBC and are HER2-neu positive. This drug offers, for the first time, a targeted therapy for IBC. You can read more about IBC here.

2. Researchers presented follow-up data from a study that compared two different regimens for treating HER2-positive breast cancer. One regimen was the chemotherapy regimen ACT with Herceptin. The other was TC with Herceptin. The study found that ACTH was as good as TCH but had more toxicity. This leaves open the question that Dr. Dennis Slamon posed at the end of his presentation: What is the role of adriamycin in breast cancer?

Even more provocative was Dr. Ken Osbourne’s question: Does chemotherapy add anything to targeted therapy, such as its hormone therapy for ER--positive cancers or Herceptin for Her2-positive cancers? We may be seeing the beginning of the end of chemotherapy for breast cancer, although more studies will be needed to prove it.

3. Researchers presented an update from a radiation study that showed that a boost added to whole breast radiation decreases local recurrence (by a little) for everyone but also adds to fibrosis. A second study showed that in women over 70 with early breast cancer there was only a very small advantage in decreasing recurrence and no survival advantage at all.

Big Picture Highlights:

1. There was a sudden dramatic (7%) decrease in breast cancer in 2003 corresponding with the equally dramatic decrease in women who stopped taking HRT after the WHI study found it appeared to do more harm than good. The study found 14,000 less breast cancers in one year! In my mind this is the final proof we need that taking hormonal therapy after menopause for the prevention of the diseases of aging makes no sense.

2. A very interesting study showing that as much as 30 percent of breast cancers had evidence of the Human Mammary Tumor Virus (HMTV) related to a similar virus in the mouse. The correlation of the geography of a particular species of mouse and the rates of breast cancer was very intriguing. If this is true then there is indeed the possibility that breast cancer is caused by a virus and for the potential for us to one day have a vaccine for breast cancer as we now have for cervical cancer.

3. Researchers discussed the importance of the local environment around the tumor cells and the role that these cells—immune cells and fibroblasts--play in determining whether a tumor will become invasive. Also discussed was some very intriguing work on the immune system’s role in treatment.


4. Research that indicates that much of breast cancer is not caused by genetic mutations but rather is due to temporary suppression of a gene. Like a switch these “temporary” mutations (epigenomics) can be turned on and off. This helps explain why identical twins with the exact same genes and mutations do not have the same incidence of breast cancer.