Update Breast Cancer 2020 Part 1 – Early Breast Cancer: Consolidation of Knowledge About Known Therapies

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Abstract

This review is intended to present the latest developments in the prevention and treatment of early breast cancer. The risk of breast cancer can be increasingly better characterised with large epidemiological studies on genetic and non-genetic risk factors. Through new analyses, the evidence for high-penetrance genes as well as for low-penetrance genes was able to be improved. New data on denosumab and atezolizumab are available in the neoadjuvant situation as is a pooled appraisal of numerous studies on capecitabine in the curative situation. There is also an update to the overall survival data of pertuzumab in the adjuvant situation with a longer follow-up observation period. Finally, digital medicine is steadily finding its way into science. A recently conducted study on automated breast cancer detection using artificial intelligence establishes the basis for a future review in clinical studies.

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ESMO recommendations on microsatellite instability testing for immunotherapy in cancer, and its relationship with PD-1/PD-L1 expression and tumour mutational burden: a systematic review-based approach

C. Luchini, F. Bibeau, M.J.L. Ligtenberg … (2019)

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Genomic analyses identify hundreds of variants associated with age at menarche and support a role for puberty timing in cancer risk

Felix Day, Deborah J Thompson, Hannes Helgason … (2017)

John Perry, Ken Ong and colleagues analyze genotype data on ∼370,000 women and identify 389 independent signals that associate with age at menarche, implicating ∼250 genes. Their analyses suggest causal inverse associations, independent of BMI, between puberty timing and risks for breast and endometrial cancers in women and prostate cancer in men.

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Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial.

Umberto Veronesi, Roberto Orecchia, Patrick Maisonneuve … (2013)

Intraoperative radiotherapy with electrons allows the substitution of conventional postoperative whole breast irradiation with one session of radiotherapy with the same equivalent dose during surgery. However, its ability to control for recurrence of local disease required confirmation in a randomised controlled trial. This study was done at the European Institute of Oncology (Milan, Italy). Women aged 48-75 years with early breast cancer, a maximum tumour diameter of up to 2·5 cm, and suitable for breast-conserving surgery were randomly assigned in a 1:1 ratio (using a random permuted block design, stratified for clinical tumour size [<1·0 cm vs 1·0-1·4 cm vs ≥1·5 cm]) to receive either whole-breast external radiotherapy or intraoperative radiotherapy with electrons. Study coordinators, clinicians, and patients were aware of the assignment. Patients in the intraoperative radiotherapy group received one dose of 21 Gy to the tumour bed during surgery. Those in the external radiotherapy group received 50 Gy in 25 fractions of 2 Gy, followed by a boost of 10 Gy in five fractions. This was an equivalence trial; the prespecified equivalence margin was local recurrence of 7·5% in the intraoperative radiotherapy group. The primary endpoint was occurrence of ipsilateral breast tumour recurrences (IBTR); overall survival was a secondary outcome. The main analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01849133. 1305 patients were randomised (654 to external radiotherapy and 651 to intraoperative radiotherapy) between Nov 20, 2000, and Dec 27, 2007. After a medium follow-up of 5·8 years (IQR 4·1-7·7), 35 patients in the intraoperative radiotherapy group and four patients in the external radiotherapy group had had an IBTR (p<0·0001). The 5-year event rate for IBRT was 4·4% (95% CI 2·7-6·1) in the intraoperative radiotherapy group and 0·4% (0·0-1·0) in the external radiotherapy group (hazard ratio 9·3 [95% CI 3·3-26·3]). During the same period, 34 women allocated to intraoperative radiotherapy and 31 to external radiotherapy died (p=0·59). 5-year overall survival was 96·8% (95% CI 95·3-98·3) in the intraoperative radiotherapy group and 96·9% (95·5-98·3) in the external radiotherapy group. In patients with data available (n=464 for intraoperative radiotherapy; n=412 for external radiotherapy) we noted significantly fewer skin side-effects in women in the intraoperative radiotherapy group than in those in the external radiotherapy group (p=0·0002). Although the rate of IBTR in the intraoperative radiotherapy group was within the prespecified equivalence margin, the rate was significantly greater than with external radiotherapy, and overall survival did not differ between groups. Improved selection of patients could reduce the rate of IBTR with intraoperative radiotherapy with electrons. Italian Association for Cancer Research, Jacqueline Seroussi Memorial Foundation for Cancer Research, and Umberto Veronesi Foundation. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Journal

Journal ID (nlm-ta): Geburtshilfe Frauenheilkd

Journal ID (iso-abbrev): Geburtshilfe Frauenheilkd

Journal ID (doi): 10.1055/s-00000020

Title: Geburtshilfe und Frauenheilkunde

Publisher: Georg Thieme Verlag KG (Stuttgart · New York )

ISSN (Print): 0016-5751

ISSN (Electronic): 1438-8804

Publication date (Print): March 2020

Publication date (Electronic): 04 March 2020

Volume: 80

Issue: 3

Pages: 277-287

Affiliations

[1 ]National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital and German Cancer Research Center, Heidelberg, Germany

[2 ]Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany

[3 ]Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany

[4 ]Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany

[5 ]Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Germany

[6 ]Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany

[7 ]Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

[8 ]ClinSol GmbH & Co KG, Würzburg, Germany

[9 ]Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany

[10 ]Agaplesion Markus Krankenhaus, Frauenklinik, Frankfurt, Germany

[11 ]Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany

[12 ]Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany

[13 ]Onkologie Aschaffenburg, Aschaffenburg, Germany

[14 ]OncoConsult Overkamp GmbH, Berlin, Germany

[15 ]Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany

[16 ]Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany

[17 ]Charité University Hospital, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany

Author notes

Correspondence/Korrespondenzadresse Peter A. Fasching, MD Erlangen University Hospital Department of Gynecology and Obstetrics Comprehensive Cancer Center Erlangen EMN Friedrich Alexander University of Erlangen–Nuremberg Universitätsstraße 21 – 2391054 ErlangenGermany peter.fasching@ 123456fau.de

Article

Publisher ID: 11112431

DOI: 10.1055/a-1111-2431

PMC ID: 7056401

SO-VID: 74b83a2e-8f07-46be-bf46-a28f9b69160b

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This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

History

Date received : 27 January 2020

Date revision received : 03 February 2020

Date accepted : 03 February 2020

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Update Breast Cancer 2020 Part 1 – Early Breast Cancer: Consolidation of Knowledge About Known Therapies Translated title: Update Mammakarzinom 2020 Teil 1 – frühes Mammakarzinom: Konsolidierung des Wissens über bekannte Therapien

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Most cited references 49

ESMO recommendations on microsatellite instability testing for immunotherapy in cancer, and its relationship with PD-1/PD-L1 expression and tumour mutational burden: a systematic review-based approach

Genomic analyses identify hundreds of variants associated with age at menarche and support a role for puberty timing in cancer risk

Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial.

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Cited by 9

Most referenced authors 3,725