Although many clinicians are already prescribing fulvestrant (Faslodex) at a dose of 500 mg, a phase 3 study presented at the meeting confirmed the superiority of this dose over 250 mg.

Eribulin mesylate (Halaven) is currently used in patients with metastatic breast cancer whose disease has progressed on other treatments, but the drug may be useful in earlier lines of therapy. Eribulin is especially promising when paired with trastuzumab (Herceptin), according to a phase 2 clinical trial presented at the meeting.

The Breast Cancer Index (BCI), a polymerase chain reaction–based assay, can predict late recurrences in estrogen receptor (ER)-positive patients, according to results from the translational arm of the Arimidex, Tamoxifen, Alone or in Combination (TransATAC) trial population.

In making decisions about adjuvant chemotherapy, biologic subtype has replaced nodal status and tumor size as parameters to consider, although subtype—and tests that define them—are still insufficient for the provision of optimal care, said Antonio C. Wolff, MD, Professor of Oncology at Johns Hopkins University School of Medicine, Baltimore. Dr Wolff spoke at an educational session devoted to molecular profiling.

Axillary lymph node dissection (ALND) may not be necessary after neoadjuvant chemotherapy in most patients, according to investigators who found that sentinel lymph node (SLN) dissection correctly staged more than 90% of patients.

A study of the American College of Surgeons Oncology Group, ACOSOG Z1071, evaluated whether SLN surgery may sufficiently substitute for ALND as a less invasive procedure.

Black women and other racial minorities are less likely than white women to receive sentinel lymph node (SLN) dissection as the standard of care for clinically node-negative breast cancer, and this has negative consequences, an analysis of the Surveillance, Epidemiology and End Results (SEER)/Medicare database suggested.

A comparison of letrozole (Fem­ara) with tamoxifen (Nolva­dex) demonstrated that the former may be superior for the treatment of postmenopausal estrogen receptor (ER)-positive patients who have lobular carcinoma, according to a subanalysis of patients in the phase 3 BIG 1-98 trial. This subanalysis further showed that for the 2 histologic subtypes of breast cancer, luminal B tumors were more responsive to treatment than luminal A tumors.

Observational studies have sug­gested that the antidiabetes agent metformin (Glucophage) may have anticancer effects. New studies have attempted to confirm this, but the results and their meaning still remain unclear.

Reviewing several studies presented at the meeting, Michael N. Pollak, MD, the Alexander Goldfarb Research Chair in Cancer Research and the Di­rec­tor, Division of Cancer Prevention, De­partment of Oncology, McGill Uni­versity, Montreal, Canada, said that there are many unanswered questions, but that “some of those questions have become clearer.”

More evidence is accumulating that vitamin D levels play a role in breast cancer outcomes. Investigators from the United Kingdom reported that postmenopausal women with sufficient vitamin D levels were significantly less likely to develop bone metastases when taking zoledronic acid (Zometa) compared with women with lower vitamin D levels.

The antidepressant venlafaxine (Effexor) is often prescribed to patients with breast cancer who are taking tamoxifen (Nolvadex) to help reduce the side effect of hot flashes. But according to research presented at the meeting, venlafaxine may reduce the effectiveness of tamoxifen.

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