The honor of delivering the William I. McGuire Memorial Lecture at this year’s meeting went to Gabriel N. Hortobagyi, MD, FACP, Professor of Breast Medical Oncology and Nellie B. Connally Chair in Breast Cancer at the University of Texas M.D. Anderson Cancer Center, Houston. Dr McGuire cofounded the San Antonio Breast Cancer Symposium in 1977.

Neoadjuvant Systemic Therapy: Promising Experimental Model or Improved Standard of Care?

Chemotherapy may not necessarily be the reason that patients with breast cancer often complain of “fuzzy thinking” and difficulty solving problems, according to research showing that cognitive changes are present in some patients at baseline, and may be related to fatigue and anxiety.

Two studies presented in San Antonio reached conflicting conclusions regarding the value of dose-dense chemotherapy in patients with early breast cancer.

The phase 3 UK TACT2 trial compared standard chemotherapy with epirubicin plus CMF (cyclophosphamide/methotrexate/fluorouracil) with accelerated (dose-dense) epirubicin in node-positive or in high-risk, node-negative early breast cancer. The current report focused on the impact of accelerating epirubicin chemotherapy; the capecitabine/CMF comparison is premature.

Adjuvant chemotherapy should be recommended for patients with completely resected, isolated local or regional recurrence (ILRR) of breast cancer, and the argument is strongest for women with estrogen receptor (ER)-positive tumor recurrences, according to the results of the international Chemotherapy as Adjuvant for Locally Recurrent Breast Cancer (CALOR) trial.

Fewer than 0.5% of patients with breast cancer develop leukemia associated with chemotherapy, but this is 60% higher than the proportion documented in a previous analysis, according to a report based on the National Comprehensive Cancer Network (NCCN) database.

“Adjuvant chemotherapy was associated with a cumulative 10-year incidence of leukemia of about 0.5%, which appears to be higher than previously reported,” said Antonio Wolff, MD, Professor of Oncology at the Sidney Kimmel Comprehensive Can­cer Center, Johns Hopkins Medicine, Baltimore, MD.

Oncology pharmacists receive numerous questions regarding the sequence of chemotherapy administration. Several chemotherapy agents (eg, doxorubicin, docetaxel, paclitaxel) are extensively metabolized through the cytochrome P450 pathway, and many chemotherapy agents (eg, taxanes, platinum agents) have high degrees of protein binding. In addition, many chemotherapy agents have cell cycle–specific mechanisms of action that may increase the cytotoxicity or antagonize the mechanism of the second agent.

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