Dawn Hershman, MD, MS, professor of medicine and epidemiology, leader of the Breast Cancer Program of the Herbert Irving Comprehensive Cancer Center at Columbia University, discusses the use of endocrine therapy in premenopausal women with early-stage hormone receptor (HR)—positive, HER2-negative breast cancer.

The phase III SOFT and TEXT trials demonstrated the benefit of ovarian function suppression (OFS) plus an aromatase inhibitor (AI) versus tamoxifen alone in premenopausal women with early-stage HR-positive, HER2-negative disease. However, the combination is very toxic, says Hershman.

Research shows that only about half of patients are taking their therapy 80% of the time after 5 years. Reasons for discontinuation often include depression, hot flashes, difficulty sleeping, severe bone pain, and mood problems. Additionally, AIs can increase the risk for osteoporosis and sometimes cardiovascular disease, adds Hershman.

Investigators have designed risk prediction models to predict which patients need more intensive treatment and spare those who do not. At Dana-Farber Cancer Institute, researchers led by Meredith M. Regan, ScD, created a risk prediction model based on age, tumor characteristics, grade, and lymph node involvement to determine a patient’s risk profile. If the patient is young and falls into the high-risk category, OFS plus an AI should be given; the same is true if the patient has HER2-positive disease, says Hershman. However, if the patient has a smaller, low-grade cancer with no lymph node involvement, tamoxifen alone may suffice, concludes Hershman.

Videos

Dawn Hershman, MD, MS, professor of medicine and epidemiology, leader of the Breast Cancer Program of the Herbert Irving Comprehensive Cancer Center at Columbia University, discusses the use of endocrine therapy in premenopausal women with early-stage hormone receptor (HR)–positive, HER2-negative breast cancer.

Dr. Hershman on the Use of Endocrine Therapy in Premenopausal HR+/HER2- Breast Cancer

Dawn Hershman, MD, MS, professor of Medicine and Epidemiology, Columbia University Medical Center, leader of the breast cancer program at NewYork-Presbyterian/Columbia University Irving Medical Center, discusses the association between cardiovascular medication and cardiovascular events following a diagnosis of early-stage breast cancer during the 2018 San Antonio Breast Cancer Symposium.

When women are diagnosed with breast cancer, it supersedes their other healthcare priorities, explains Hershman. In a study of women with comorbidities over the age of 65, researchers looked at adherence rates to patients’ non-cancer medications. Medications included hypertensives, diabetes medications, and cholesterol medications. These were examined prior to diagnosis and following the patient’s breast cancer treatment.

Results from this study revealed that approximately 20% to 30% of women—depending on the type of medication&mdash;stopped taking their medications regularly. This may be due to the patient’s overestimation of breast cancer and underestimation of cardiovascular disease, says Hershman. Women who stopped taking their medications had a higher risk of having a cardiovascular event. Since the prognosis for many patients with breast cancer is good, Hershman explains that it is important to acknowledge and manage a patient’s comorbidities throughout their course of treatment.

Dr. Hershman on Adherence to Cardiovascular Medication and Cardiovascular Events in Breast Cancer

Dawn Hershman, MD, MS, professor of Medicine and Epidemiology, Columbia University Medical Center, discusses the use of acupuncture to treat joint pain caused by aromatase inhibitors in patients with breast cancer.

While aromatase inhibitors are effective in treating the disease, many patients end up discontinuing treatment because of the side effects —arthralgia being the most common.

So, a multicenter randomized trial was organized throughout 11 institutions, where 226 women with breast cancer were randomized to true acupuncture, sham acupuncture (which had some differences than true acupuncture, such as shorter needles that did not puncture skin as deeply), and a waitlist control group. Participants receiving acupuncture received it twice a week until the primary endpoint of 6 weeks. Then they had maintenance acupuncture once a week for another 6 weeks, and were followed up for 12 weeks so researchers could see the duration of the treatment.

True acupuncture was reduced pain more than both the sham acupuncture and the control group. Not only did it reduce pain over a 24-hour period, but it also had positive effects on stiffness, knee pain, hip pain, and hand pain.

Hershman believes that the positive results of this study may help in laying the groundwork for acupuncture to become a lager playing in the treatment strategy for cancer.

Dawn Hershman, MD, MS

Articles

Dr. Hershman on the Use of Endocrine Therapy in Premenopausal HR+/HER2- Breast Cancer

Dr. Hershman on Adherence to Cardiovascular Medication and Cardiovascular Events in Breast Cancer

Dr. Hershman Discusses Acupuncture for Arthralgia