A Little Exercise is Better than None

A 57-year-old Wichita man lost 223 pounds in a year and, to maintain his loss, spends 1.5 hours at the gym in the morning and adds another walk at lunch. According to the USA Today story, he eats 1800 calories “or more” a day. He is 5-foot 8 and-inches and now weighs 170 pounds.

This story was meant to be inspiration, as part of USA Today’s Annual Weight-Loss Challenge.

I think it backfires.

I mean 1.5 hours a day at the gym? Who does that? Who CAN do that? He apparently is a mortgage banker with his own business, so he has latitude in his schedule. But so do I and I cannot imagine spending that amount of time a day at the gym.

Messages like this, which are supposed to inspire, just make readers sigh and say, “I can’t do that, so why even try?”

I suspect the writer got caught up in some Rah Rah Journalism and didn’t think through the fact that using somebody whose exercise is, frankly, a little excessive, sends the wrong message. What’s more, I would challenge this impressive man—I mean, losing 223 pounds in a year is remarkable no matter how you cut it—whether he really does spend 1.5 every day actually exercising at the gym. I suspect he does not, and that his real pattern might be more like 3-4 days for an hour a so. This is still a serious commitment, but a little more accessible for the average person.

No doubt he needed that level of exercise and low calorie counts to lose the weight to begin with, but not to maintain it.

At 5-foot-8, he could consume 2000 calories a day and still maintain his weight, with moderate exercise, according to Web MD’s online fitness planner. Moderate exercise is 30 minutes a day walking at 3 miles an hour.

I don’t want to discourage anybody who has the time, energy, and commitment to handle this level of exercise. I do want to make the point that you don’t need to do so much to actually make a difference.

You do need some activity, as studies regularly show that physical activity can be a cancer-fighter.

Twenty minutes a day will help a great deal. The more the better. And once you start, you might keep going and increase your level to an hour or more. But research shows that people get discouraged easily when they set their sights too high. Be honest with what you can do, and do at least something. One step at a time.

HRT, Lack of Activity Biggest Breast Cancer Risk Factors

What can postmenopausal women do to reduce their risk of breast cancer? Avoid hormone-replacement therapy and increase physical activity. Both are more important than weight loss and reducing alcohol consumption. And both have about as much influence as factors beyond our control, such as early menstruation and late menopause.

This is from a new study from Germany of 10,000 postmenopausal women, 3,074 with breast cancer and 6,386 in a control group. And while HRT and inactivity were risk factors across the board for all types of breast cancer, hormone-positive tumors were more strongly affected. According to a news release on the study:

Of the modifiable lifestyle factors, it is primarily hormone replacement therapy and a lack of physical activity which increase a woman's risk of developing breast cancer. Alcohol consumption and overweight were found to have less influence on breast cancer risk. Thus, 19.4 percent of invasive postmenopausal breast cancer are attributed to hormone replacement therapy; 12.8 percent to a lack of physical activity. Both factors together are responsible for 29.8 percent of breast cancer cases. When the investigators took a separate look at the group of patients whose tumors have receptors for sex hormones (hormone receptor-positive breast tumors), they determined an even higher value of 37.9 percent.

The study leaders emphasize that these results reflect the situation in Germany with our typical lifestyle and may differ in countries with other lifestyles.

Non-modifiable factors such as family history or age at first and last menstrual period account for 37.2 percent in total of all malignant postmenopausal breast cancers. "That means that two factors which each woman has in her own hands are responsible for a similar number of postmenopausal breast cancer cases as the non-modifiable factors," Karen Steindorf [researcher and associate professor at the German Cancer Research Center] says. "If behavioral changes in these two areas could be brought about, almost 30 percent of breast cancers after menopause could be prevented." Therefore, the DKFZ researchers recommend women to take more exercise and to refrain from hormone replacement therapy, unless it is absolutely necessary.

Could Vitamin C Infusions Work for TNBC?

The Windsor (Ontario) Star has a thorough piece on Vitamin C infusions in the treatment of triple-negative breast cancer. Forty-four-year old Sandra Quattrin, diagnosed last year with TNBC, has chosen the infusions over the chemo that was making her ill. Local doctors have mixed reactions, with some completely disregarding the treatments as quackery while others say they are a valid option. Treatments are available at the Canadian Clinic for Integrative Medicine in Windsor. Read the entire story here.

As part of my research for the book I am writing, I interviewed a six-year survivor who chose vitamin C infusions rather than chemo. She is going strong, driving around the country with her husband in their new RV.

Four rounds of chemo just as good as six for early-stage breast cancer

For tumors with zero to three affected lymph nodes, regardless of hormone receptor status, four cycles of chemotherapy are as effective as six, according to results from the Cancer and Leukemia Group B 40101 trial of 3,173 patients. Relapse-free survival at 4.6 years for those with four rounds was 91.8 percent. For those with six rounds, it was 91.6 percent. For just two-tenths of a percentage point improvement, women might endure four more weeks of chemo and all its side effects. Those studied were either treated with Adriamycin and Cytoxan or paclitaxel. Results so far cover only the duration of treatment, not the effectiveness of specific regimens. Researchers say six rounds might eventually pay off in the longer run. Internal Medicine News has the story.

Receptor status can change in breast cancer recurrence or metastases

Receptor status in breast cancer that has recurred or metastasized may be different from the original tumor, according to research presented at the 2010 ASCO meeting in San Antonio. Estrogen-receptor status changed in 33 percent of breast cancer patients; Her2 status changed in ten percent, in a study of 459 patients by Swedish researchers. Twenty-six percent of tumors changed from positive to negative and seven percent changed from negative to positive. In previous research, published in the journal Breast Cancer Research, ten percent of all tumors changed receptor status. Internal Medicine News has the story.

Geneva, Illinois, Coach Returns to Bench After TNBC Treatment

The Chicago Tribune has run a profile of 42-year old Gina Nolan, a Spanish teacher and basketball coach, who spent this summer and fall in treatment for triple-negative breast cancer. It is a good piece on what sounds like an amazing woman. Of course, the writer defines TNBC as "aggressive," which has become shorthand for this disease. While it can be aggressive, it is not always so, and it is absolutely survivable--most women do survive it. That qualifier, however, seldom makes it into stories.

Nolan told her students: "This is what happened to me over the summer. It can take away my hair. It can wear me down physically, but it won't change my mind, it won't change my heart and it won't change who I am as a teacher." Read more here.

PARP inhibitor Iniparib decreases tumors, increases survival time

The PARP inhibitor iniparib (BSI-201) boosted overall survival by nearly five months when used with chemotherapy for metastatic triple-negative breast cancer compared with chemotherapy alone, according to results from a phase II trial of 123 patients published online in the New England Journal of Medicine. The median overall survival was 12.3 months for those on the PARP inhibitor-plus-chemo regimen and 7.7 for chemo alone. The drug combination shrank tumors and increased the time they took to progress.

Below is a news release from Sanofi-Aventis, maker of iniparib:

BRIDGEWATER, N.J., Jan. 5, 2011 /PRNewswire/ -- Sanofi-aventis (EURONEXT: SAN and NYSE: SNY) and its wholly-owned subsidiary, BiPar Sciences, today announced that The New England Journal of Medicine (NEJM) published the final phase II data for the investigational drug iniparib* (BSI-201) demonstrating significant clinical benefit in women with metastatic triple negative breast cancer (mTNBC) when iniparib was administered in combination with chemotherapy agents gemcitabine/carboplatin. Although not a pre-specified endpoint, overall survival also was significantly increased in women who received iniparib. The study, "Iniparib plus Chemotherapy in Metastatic Triple-Negative Breast Cancer," was published in the January 5, 2011, online version of the NEJM and will be published in the January 20, 2011, print edition. These findings were presented at the 35th European Society for Medical Oncology (ESMO) Congress in Milan, Italy.

"These published data show that the addition of iniparib to gemcitabine and carboplatin provided a significant improvement in clinical benefit in women with metastatic triple negative breast cancer, an aggressive form of breast cancer with no approved standard treatments that target this particular tumor subtype," said Joyce O'Shaughnessy, M.D., lead investigator of the study and co-chair of the Breast Cancer Research Program, Baylor-Charles A. Sammons Cancer Center, Texas Oncology, US Oncology in Dallas.

According to the study results, 56 percent of patients in the iniparib (BSI-201) group showed a clinical benefit – defined as a complete or partial response or stable disease of at least six months – compared with 34 percent (P=0.01) of patients in the chemotherapy group alone. Median progression-free survival in the iniparib (BSI-201) group was 5.9 months compared with 3.6 months in the chemotherapy group (95% CI (0.39-0.90) HR=0.59, P=0.01). The overall response rate was 52 percent in the iniparib (BSI-201) group versus 32 percent (P=0.02) in the chemotherapy group alone. Although it was not a pre-specified endpoint of the trial, median overall survival among women who received iniparib (BSI-201) was 12.3 months, compared with 7.7 months among women who received chemotherapy alone – translating to a 43 percent reduction in the risk of death (95% CI, (0.36-0.90) HR=0.57, P=0.01).

In the phase II iniparib (BSI-201) study, the most common any grade adverse events in the iniparib (BSI-201) arm were neutropenia, anemia, thrombocytopenia, fatigue/asthenia, nausea and constipation. The most common grade 3/4 adverse events in the iniparib treatment arm were neutropenia, anemia, thrombocytopenia, leukopenia and fatigue/asthenia. There were two fatal adverse events (3.4%) in the chemotherapy-alone group and three (5.3%) in the iniparib (BSI-201) group, all attributed to disease progression within 30 days of receiving study treatment. A large phase III study is ongoing and results are expected in 2011.

"The positive iniparib phase II data in this difficult to treat form of breast cancer is encouraging and underscores the innovative science and approach we have taken as we continue to investigate iniparib's potential to address this unmet medical need," said Atul Dhir M.D., CEO, BiPar Sciences, a wholly- owned subsidiary of sanofi-aventis.

About the Phase II Iniparib Study

This multicenter, open-label, randomized study included 123 women with mTNBC. The primary endpoints were safety and tolerability and clinical benefit rate of iniparib (BSI-201) defined as a complete or partial response or stable disease of at least six months. Secondary endpoints included overall response rate and progression-free survival. Overall survival also was assessed, although it was not a pre-specified endpoint of the trial. Patients received gemcitabine/carboplatin alone (chemotherapy group) or in combination with iniparib (BSI-201) until disease progression or unacceptable toxicity. Patients in the chemotherapy group whose disease progressed were allowed to cross over to the iniparib (BSI-201) plus chemotherapy group. Efficacy analyses were conducted on the intent-to-treat (ITT) population.

About Iniparib

Iniparib (BSI-201) is a novel investigational anti-tumor agent with poly (ADP-ribose) polymerase (PARP) inhibitory activity in preclinical models. Iniparib (BSI-201) is in phase III trials for patients with mTNBC and squamous non-small cell lung cancer, as well as in phase II trials for patients with ovarian, uterine and brain cancers.

The U.S. Food and Drug Administration (FDA) granted Fast Track designation to iniparib (BSI-201) for mTNBC. The regulatory submissions are planned for Q1 2011 in the United States and Q2 2011 in the European Union.

About Triple-Negative Breast Cancer (TNBC)

When patients are diagnosed with breast cancer, their tumors are routinely tested for the presence of estrogen and progesterone receptors and for the over-expression of HER2. However, 15 to 20 percent of all breast cancers lack over-expression of all three proteins – giving rise to the term "triple negative breast cancer" or TNBC. Research has shown TNBC can be difficult to treat, leading the disease to be associated with poorer outcomes than other types of breast cancer. Women with TNBC are not candidates for hormonal therapy such as tamoxifen or the targeted therapy Herceptin, leaving chemotherapy as the standard treatment.

About sanofi-aventis Oncology

Sanofi-aventis Oncology is targeting cancer on many fronts in an effort to address unmet medical needs for a broad range of patients. Starting with a deep understanding of the mechanisms by which cancer develops, grows and spreads, as well as identifying the right science early in the discovery process, the company employs innovative approaches to bring the right medicines to the right patients. There are currently more than 10 investigational compounds in development across a broad scientific platform, including cytotoxic, antimitotic, anti-angiogenic agents, antivascular agents as well as supportive care therapies. Three of these compounds are now being investigated in phase III clinical studies aimed at multiple solid and hematologic tumors.

About sanofi-aventis

Sanofi-aventis U.S. is an affiliate of sanofi-aventis, a leading global pharmaceutical company that discovers, develops and distributes therapeutic solutions to help improve the lives of patients. Sanofi-aventis is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY).

For more information, www.sanofi-aventis.us or www.sanofi-aventis.com.

About BiPar Sciences

BiPar Sciences is a biopharmaceutical organization dedicated to pioneering novel tumor-selective therapies designed to address urgent unmet needs of cancer patients. Located in South San Francisco, California, BiPar is a wholly-owned subsidiary of sanofi-aventis. For more information, please visit www.biparsciences.com.

Medpage Today has an article on the findings, as does Internal Medicine News, and Medscape Today.

Giving Thanks in My Seventh Decade

I turned 65 last week and I am not sure what to make of it. Yes, getting older is better than the alternative, as my bout with cancer made extremely clear. Still, that’s old. Medicare old. If I got robbed, the news story could very well describe me as elderly.

I was diagnosed with cancer when I was 60, and that certainly stopped my whining about getting old. I need no reruns of that scenario, so I am embracing my advancing age.

Not that I have a choice.

Seriously, I am embracing it. I am fortunate enough to have everything that matters, plus the perspective to appreciate all these gifts. So, in this new year of my life, as I welcome expanded wrinkles and joint pain, I am stopping to celebrate what I have with humility and gratitude.

I have love. Not just received, which is beautiful, but love given. I love my husband, son, daughter, grandson, son-in-law, brothers, sisters, nieces, nephews, and friends. The other night I started counting all the people in my life who truly matter to me. Not Facebook-level friends, but friends with whom I regularly share long talks, friends who were with me when I was sick and would be with me again. Not acquaintances. Friends. I reached 74 before I fell asleep. Nice.

I have my health. Sure, I still worry that every bump and pain means cancer is back, but it’s been 4.5 years since I was diagnosed, and with hormone-negative, the rate of recurrence falls off the cliff after three years. What’s more, since that diagnosis, I have eaten far more healthily, exercised more, and taken up yoga and meditation. Getting sick forced me to get healthy.

I have meaningful work. I was blessed with a talent for writing and have been given the opportunity to nourish and share that talent. And I was doubly blessed that this turned into an academic career that was way beyond fulfilling and that I have been able to continue after retirement. I see no need to retire from writing. I love that I can use that talent to help many beautiful women when they are struggling with a new diagnosis.

I have home. My house is sunny and warm and big enough for me and my husband but small enough to make sense. We are comfortable here.

I have happiness. I often wake up with a smile on my face.

Five years ago, I would not have made the same list. Five years ago, I would not have thought of making a list at all. I was too busy, too consumed with where I was going and what I was doing to see where I actually was, what I was actually doing, what actually mattered.

Cancer stopped my in my tracks and made me pay attention. As did hearing the stories of other women who have faced problems accessing and paying for proper healthcare, who have had husbands and partners leave them in their illness, who have lost jobs and security because of their illness, whose response to treatment was harsh, who don't know where to go next, who are terrified and confused.

I am lucky. Sixty-five, eighty-five, thirty-five, whatever the age, I am blessed. Yeah, I have those aching bones, and graying hair, and wrinkles, and a growing list of friends who are sick or who I have already lost to death. That comes with the benefit of age.

Sure, the Big C lurks in my consciousness like a cobra hiding in my brain, with worry that strikes whenever I let my guard down. But I am living a great life. And I am enormously thankful for it.

Best Wishes in the New Year

I wish you all a healthy and blessed 2011.

Pat

Healthy Eating: Fiber in Whole Wheat

I have been taught to avoid breads—they mean fat, right? But whole grains also mean high fiber, which translates to a healthy heart. Whole grains actually soak up cholesterol, especially LDL, or bad, cholesterol. It’s a strong image. For most of my life, I have imagined bread soaking up only the bad things on my plate—gravy, for example. So, when I try to eat healthy, I avoid it. Instead, I should have been imagining what bread was doing inside my body—soaking up bad cholesterol. And I should have been eating it.

Based on my age, I am supposed to have five ounces of grains a day, at least half of which should be whole grains, according to the food pyramid. What’s in an ounce? One slice of bread, a cup of ready-to-eat cereal, a half cup of cooked cereal, or a half cup of cooked rice.

So, in a day, I should have, something like:

A cup of ready-to-eat cereal (1 oz)

Two slices of bread (2 oz)

A cup of cooked rice (2 oz)

Of course, you have to eat your whole grains in a healthy way. Pass up the high-fat butter and margarine as a topping and go instead for heart-healthy olive oil. But keep that low as well. (A tablespoon has 119 calories, all from fat. While that is good fat—monounsaturated—it still can add up.)

I have discovered Sara Lee’s whole wheat bread with 45 calories a slice and five grams of dietary fiber, or 18 percent of your daily value. It’s good, healthy, and filling. Nice work, Sara.

Even knowing this, I recently ate a quick lunch-on-the-go with my family after a funeral. To keep my calories down, I skipped the bread and ate the cold cuts. Good grief. Seriously? Was my nutritional brain born yesterday? Apparently. I ate the unhealthy part of the meal—the cold cuts—and passed up the cholesterol sponges—whole wheat bread. Next time, if I screw my head on, I will do it the opposite.

Lumpectomy Better for Early-Stage Hormone-Negative

From the San Antonio Breast Cancer Symposium via WebMD

Women with early-stage hormone-negative breast cancer who undergo a lumpectomy—often called breast-conserving therapy—fare slightly better than those who undergo a mastectomy, according to research presented today. And women from both groups do well, with the great majority alive after four years.

Specifically, those under 50 with lumpectomies were 13 percent to 29 percent less likely to die from their cancer than women with mastectomies. Women over 50 with hormone-negative who underwent a lumpectomy were 17 percent less likely to die than those with a mastectomy. The variation in percentages relates to variations in tumor sizes.

Data on 114,277 women from the California Cancer Registry were evaluated; 62,770 of these had a lumpectomy followed by radiation and 51,507 had a mastectomy. Ninety-three percent of the lumpectomy group and 87 percent of the mastectomy group were alive four years after diagnosis.

Read Charlene Laino’s report on the study in WebMD.

Avastin and TNBC: Let's Refocus the Research

Recent research has shown that Avastin can be effective against triple-negative when paired with standard chemo; when used with the chemo drug Xeloda; and when paired with taxanes. It has shown special promise for metastatic triple-negative. As a targeted therapy, it offers a way of treating cancer that goes beyond typical chemo. Still, the drug's effects are usually limited to triple-negative, extending patients lives by several months. And the numbers are small, because the percentage of women with triple-negative in any study of overall breast cancer tends to be fewer than 20 percent, usually between 15 percent and 18 percent.

Yesterday the FDA said the evidence of the drug's effectiveness in treating breast cancer was weak and it began the process of pulling its approval for use of Avastin in breast cancer. The cost, they say—some $8,000 a treatment—outweighs the benefits. It is still allowed for other forms of cancer, such as brain, colon, kidney, and lung.

Once again, the experts lump all breast cancers together. The drug was not effective for hormone-positive, so its use is pulled for all breast cancer. I hope this does not stop research on Avastin and other biologic agents, which may ultimately be the future of triple-negative treatment.

The side-effects of Avastin can be significant, including high blood pressure and internal bleeding. And its benefits are usually limited to an average of a few months. Plus, there is some indication that keeping women on the drug too long can actually cause a recurrence. So much remains to be learned about the drug.

Yet, there are plenty of stories of women who have done extremely well on Avastin. Josh Turnage of Mississippi wrote eloquently about how the drug saved his mother. And Stacey Singer, writing in Palm Beach Post Health offers another excellent patient story plus a good perspective on why some doctors and patient advocates think the FDA made the wrong move.

More research is needed specifically on Avastin and triple-negative. This requires a change in focus, but that focus might ultimately yield enough evidence to demonstrate the drug's effectiveness--or lack thereof--for this important and specific subgroup.

Rather than triple-negative being an add-on, it should be the focus of research on Avastin.

FDA Removes Approval of Avastin As Breast Cancer Drug

FDA NEWS RELEASE

For Immediate Release: Dec. 16, 2010
Media Inquiries: Erica Jefferson, 301-796-4988, erica.jefferson@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA begins process to remove breast cancer indication from Avastin label
Drug not shown to be safe and effective in breast cancer patients

The U.S. Food and Drug Administration announced today that the agency is recommending removing the breast cancer indication from the label for Avastin (bevacizumab) because the drug has not been shown to be safe and effective for that use.

The agency is making this recommendation after reviewing the results of four clinical studies of Avastin in women with breast cancer and determining that the data indicate that the drug does not prolong overall survival in breast cancer patients or provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients. These risks include severe high blood pressure; bleeding and hemorrhage; the development of perforations (or “holes”) in the body, including in the nose, stomach, and intestines; and heart attack or heart failure.

In July 2010, after reviewing all available data an independent advisory committee, composed primarily of oncologists, voted 12-1 to remove the breast cancer indication from Avastin’s label.

“After careful review of the clinical data, we are recommending that the breast cancer indication for Avastin be removed based on evidence from four independent studies,” Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “Subsequent studies failed to confirm the benefit observed in the original trial. None of the studies demonstrated that patients receiving Avastin lived longer and patients receiving Avastin experienced a significant increase in serious side effects. The limited effects of Avastin combined with the significant risks led us to this difficult decision. The results of these studies are disappointing. We encourage the company to conduct additional research to identify if there may be select groups of patients who might benefit from this drug.”

Removing the breast cancer indication from the Avastin label will be a process. This is the first step. The drug itself is not being removed from the market and today’s action will not have any immediate impact on its use in treating breast cancer. Today’s action will not affect the approvals for colon, kidney, brain, and lung cancers.

Oncologists currently treating patients with Avastin for metastatic breast cancer should use their medical judgment when deciding whether a patient should continue treatment with the drug or consider other therapeutic options.

The agency has informed Genentech, Avastin’s manufacturer, of its proposal to withdraw marketing approval of the drug for breast cancer. Genentech has not agreed to remove the breast cancer indication voluntarily, so the agency has issued a Notice of Opportunity for a Hearing, which permits Genentech to request a public hearing if it wishes to contest the agency’s determination. The company has 15 days to request a hearing; if it does not do so, the hearing will be waived, and FDA will begin proceedings to remove the breast cancer indication.

Avastin, in combination with chemotherapy (paclitaxel), was approved in February 2008 under the FDA’s accelerated approval program, based on the results of a clinical trial known as “E2100,” which evaluated the drug in patients who had not received chemotherapy for their metastatic HER2-negative breast cancer. Under the accelerated approval program, a drug may be approved based on clinical data that suggest the drug has a meaningful clinical benefit, with more information being needed to confirm this. The program provides earlier patient access to promising new drugs to treat serious or life-threatening conditions while confirmatory clinical trials are conducted.

After the accelerated approval of Avastin for breast cancer, Genentech completed additional clinical trials and submitted the data from those studies to the FDA. These data showed only a small effect on “progression-free survival” without evidence of an improvement in overall survival or a clinical benefit to patients sufficient to outweigh the risks. The small increase in “progression-free survival” reflects a small, temporary effect in slowing tumor growth.

Avastin has also been associated with several other serious and potentially life-threatening side effects including the risk of stroke, wound healing complications, organ damage or failure; and the development of a neurological condition called reversible posterior leukoencephalopathy syndrome (RPLS), characterized by high blood pressure, headaches, confusion, seizures, and vision loss from swelling of the brain.

On the basis of all available data relating to the use of Avastin to treat metastatic breast cancer, the agency has determined that the risks of the drug outweigh the benefits for this use.

FDA is open to working with Genentech on any proposals to conduct additional studies of Avastin in patients with metastatic breast cancer designed to identify a population of patients in which the drug’s benefits exceed the risks.

For more information:

FDA: Bevacizumab (marketed as Avastin) Information
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm193900.htm

NCI: Breast Cancer
http://www.cancer.gov/cancertopics/types/breast

A Young Man's Testimonial for Avastin

Later this week, on December 17, the FDA will reconsider its approval of the cancer drug Avastin (bevacizumab )because of concerns that it has not been effective against most breast cancers. It has, however, had success as treatment for triple-negative. Josh Turnage, a sophomore at Mississippi State University, says the drug saved his mother, and he has lobbied for its continuance. His essay about his mother's experience has appeared in media all around the country. The SF Gate version is here. He also created a video to help make his case.

Dose Dense Chemo Better for Hormone-Negative

Dose-dense chemotherapy—chemo every two weeks—yields better results than standard chemo for hormone-receptive negative breast cancer, according to a meta-analysis using The Cochrane Cancer Network register of trials, The Cochrane Library, and LILACS and MEDLINE databases from January 1966 to January 2010. Researchers, however, say the studies they analyzed were inconsistent and they recommend randomized control trials. Read the full article, in the December 15, 2010 Journal of the National Cancer Institute.

Abdominal Fat Related to Estrogen-Negative Risk in Premenopausal Women

Abdominal fat is associated with risk of estrogen-negative breast cancer in premenopausal women, according to a study published in the December 15, 2010 issue of Journal of the National Cancer Institute. Because this type of fat distribution is also associated with pre-diabetes, researchers say these findings may point to a role of insulin in the risk of estrogen-negative.

The news release is below:

Body fat distribution does not play an important role in the incidence of every subtype of premenopausal breast cancer, but is associated with an increased risk for estrogen receptor (ER)–negative breast cancer, according to a study published December 15 in The Journal of the National Cancer Institute.

Previous studies have shown that the association between body mass index (BMI) and the risk of breast cancer varies with menopausal status: a higher BMI is positively associated with risk of postmenopausal breast cancer but inversely associated with risk of premenopausal breast cancer. Intra-abdominal fat that surrounds organs has been associated with metabolic and hormonal changes that have been associated with premenopausal breast cancer risk, although prospective studies have produced conflicting results, and none have examined the role of hormone receptor status.

To determine the relation between body fat distribution and premenopausal breast cancer risk, Holly R. Harris, Sc.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues, conducted a prospective analysis among women in the Nurses' Health Study II, a cohort of 116,430 women who have been followed up since 1989. In 1993 the researchers sent women in that study a questionnaire in which the women were asked to measure and report their waist and hip circumference.

The researchers found no statistically significant associations between waist circumference, hip circumference, or the waist to hip ratio and overall risk of breast cancer. But they did find that abdominal adiposity, or waist circumference and the waist to hip ratio, was more strongly associated with risk of ER-negative breast cancer than with the risk of ER-positive breast cancer.

Furthermore, the fact that body fat distribution was more strongly associated with ER-negative breast cancer than with ER-positive breast cancer suggests that body fat may influence breast cancer risk through sex hormone–independent pathways. Specifically, the researchers note that abdominal fat is associated with hyperinsulinemia, or pre-diabetes, and that insulin receptors are expressed in most breast cancers and have been shown to stimulate the growth of breast cancer cells in vitro.

"These findings may suggest that an insulin-related pathway of abdominal adiposity is involved in the etiology of premenopausal breast cancer," the authors write.

New Research Links Obesity to HR+, but not HR-

Obesity is linked to worse survival rates for hormone-positive, but not for hormone-negative breast cancers, according to research presented at the San Antonio Breast Cancer Symposium. Preliminary results of three studies were presented. One study showed no relationship between obesity and survival rates. MedPage Today covered the story.

Brazil Sees Nearly Twice the TNBC Cases as Ten Years Ago

From the San Antonio Breast Cancer Symposium, Via the Peer Review Media Guide:

TNBC cases in Brazil have nearly doubled in the past ten years. Researchers analyzed data of 439 women diagnosed with breast cancer at the Núcleo Mama Moinhos breast cancer clinic from 2000 to 2010 and compared patient characteristics in two 5-year periods: 2000 to 2005 and 2006 to 2010. They discovered that cases of hormone-positive had decreased, while triple-negative had increased. TNBC cases in women older than 50 increased and tumors were larger at diagnosis.

"We have no idea why we are seeing more of these cases," said Maira Caleffi, MD, PhD, Associação Hospitalar Moinhos de Vento, Porto Alegre, Brazil, on December 10. "The increase in triple-negative and hormone-negative tumours in women older than 50 is worrisome and does not reflect the common sense that the large majority of cases in this age group are hormone sensible."

Read the entire article here.

HRT Increases risk of TNBC

Combined hormonal replacement therapy—using estrogen plus progestin—is associated with a 78 percent increase in triple-negative cancers, a twofold increase in HER2-positive tumors, and a 37 percent increase in HER2-negative tumors, according to Women’s Health Initiative results presented at the San Antonia Breast Cancer Symposium. And it nearly doubles the risk of death from breast cancer. In the past, HRT was associated strongly with hormone-positive cancers, but not hormone-negative.

Data were from WHI randomized trials after 11 years of follow-up.

Read the entire story from Internal Medicine News.

More Good News on PARP Inhibitors for TNBC

From the San Antonio Breast Cancer Symposium, via Medpage Today:

A novel agent that inhibits DNA repair in cancer cells appears to be promising for safety and efficacy given along with chemotherapy using irinotecan (Camptosar), according to early-phase clinical trial results reported here.

The phase Ib trial conducted among 34 metastatic breast cancer patients found that the experimental drug iniparib yielded partial or complete responses in up to 31.8% of the patients when combined with irinotecan, Stacy Moulder, MD, MSCI, of MD Anderson Cancer Center in Houston, and colleagues found. Read more.