OBR Daily Commentary

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Protection From Trastuzumab Cardiotoxicity in Breast Cancer

(Medscape Medical News) June 23, 2016 - A new attempt at cardioprotection has failed. The first trial testing the angiotensin II-receptor blocker candesartan (Atacand, AstraZeneca) found that it did not prevent or help neutralize the cardiotoxic effects of trastuzumab (Herceptin, Genentech) in patients with early breast cancer.

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Debu Tripathy, MD (Posted: June 26, 2016)

quotesThis sobering report shows that angiotensin blockade, long postulated to protect the heart from trastuzumab-related cardiomyopathy did not do so in a placebo-controlled randomized trial. The angiotensin II antagonist candesartan did not lower the primary endpoint - rate of ejection fraction drop of more than 15% or a decrease below the absolute value 45% in a Dutch study of 206 patients receiving adjuvant trastuzumab and anthracycline/taxane-based chemotherapy. In fact, there were more events in the candesartan group, but not statistically significant. However, in a smaller study present at San Antonio in 2015 (MANTICORE Trial), both angiotensin converting enzyme inhibitor perindopril and beta blocker bisoprolol lowered the number of patients who had to discontinue trastuzumab due to EF drops, but did not significantly change EF drop itself. Further studies targeting more vulnerable patients (either genetic predisposition, which remains a subject of study, or those who are older or with low-normal EFs) are needed. These should probably include the intervention during all of the chemotherapy phase including anthracycline (which was not the case in either of the studies described). We have to remember that late cardiac events from trastuzumab exposure are still possible as we have just passed the 10th anniversary of its approval in the adjuvant setting. In addition, 5-20% may not complete therapy due to transient subclinical cardiac dysfunction, and of the rarer patients who develop clinical cardiomyopathy, up to a quarter do not recover. quotes

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Breast Cancer Study Shows Benefit To Extended Treatment With Aromatase Inhibitors

(STAT/In the Lab) June 5, 2016 - Older women being treated for the most common form of breast cancer who took drugs called aromatase inhibitors for 10 years rather than the usual five had a lower risk of their cancer returning, particularly in the opposite breast, physicians reported Sunday at the annual meeting of the American Society of Clinical Oncology.

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Debu Tripathy, MD (Posted: June 07, 2016)

quotesThis is the first study that has shown that prolonged aromatase inhibitor hormonal therapy (more than 5 years) can lower the risk of recurrence. However, the increase in fracture rate seen, as expected with the known decrease in bone mineral density caused by suppression of estrogen production, has to be balanced against this benefit. This is especially true since most of the reduction was seen in locoregional recurrence and only about a 1% difference in distant recurrence and no impact on survival. Therefore, higher risk patients might be considered for extended AI therapy, and attention to bone health (which may not have been as well understood and followed when this MA17R trial was carried out) is important.quotes

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Shedding New Light On Breast Cancer Metastasis

(Fred Hutch News) Feb 1, 2016 - Study reveals how cancer cells travel together, like ‘a gang of thugs’.

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Debu Tripathy, MD (Posted: February 16, 2016)

quotesThis important finding reminds us that cancer cells and their metastases do not act alone, but rather as part of a community, in communication with other cancer cells as well as host cells (also known as the microenvironment). While much research focuses on the cell as an entity, we must incorporate community activity both in research of basic mechanisms, but also as an avenue to new diagnostics and therapeutics.quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...