A new clinical trial has shown that reducing the interval between successive doses of a commonly used chemotherapy regimen improves survival in women whose breast cancer has spread to the lymph nodes. While previous research has evaluated the use of various forms of “dose dense” chemotherapy, this is the first major controlled study to show a clear survival benefit for women with node-positive breast cancer.
Oncologists are testing a new technique called gene expression profiling that subtypes each breast cancer tumor by its genetic defects so that doctors can tailor their treatment to inhibit that particular tumor. The researchers believe the technique could spare millions of women from needlessly receiving toxic chemotherapy, and they are leading a national clinical trial to study gene profiling. “Currently, we have no predictive model to determine who will respond to hormonal therapies and who won’t, so we prescribe chemotherapy as a backup measure to ensure the cancer’s demise,” said Matthew Ellis, M.D., Ph.D., director of the breast cancer program at Duke. “This one-treatment-fits-all approach leads to a huge amount of over treatment, with up to 50 percent of women unnecessarily receiving chemotherapy.”
Researchers confirmed that a daily, combined dose of estrogen and progestin increases breast cancer risk in post menopausal women, but added that this risk begins to return to normal about six months after women stop taking the hormones. “It is reassuring that breast cancer risk begins to return to normal six months after women stop combined dose estrogen-progestin therapy,” said Duane Alexander, M.D., Director of the NICHD. “Women, in consultation with their physicians, need to make the most informed decision possible. The study authors have provided them with one more piece of important information.”
Excessive bleeding, a troublesome side-effect that causes many women to stop taking hormone replacement therapies (HRT), is less likely with progesterone than with more commonly used synthetic versions. Results from a national clinical trial published in the November issue of the Journal of Obstetrics and Gynecology, show that a combination of estrogen and micronized progesterone (MP) causes fewer days and less intense bleeding than the most commonly used combination. Previous studies have shown that unacceptable bleeding is the reason that most women discontinue HRT during the first year of therapy.
Dual use technology usually starts out with a military use that civilians find a way to commercialize. The U.S. Navy is hoping to turn that equation around with a $5 million program to improve breast cancer detection. As it happens, looking for a cancerous cell in a human breast relies on a lot of the same science as identifying targets in spy satellite photos. And since the Navy believes its current pick-’em-out technology has hit a ceiling, it hopes to develop advances in breast cancer screening that can be applied to spotting Osama bin Laden from space. Wired has a terrific story on this, and notes that real-world applications are already emerging.
