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    <recommendedItem id="20090101_19_4075"
                     title="SABCS: Estrogen Again Implicated in Lung CA Prognosis (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SABCS/tb/17514?impressionId=1265807670169"
                     
      SAN ANTONIO  --  Tamoxifen and other anti-estrogen therapies may reduce lung cancer mortality in women, according to observational study findings presented here.&lt;br&gt;
&lt;br&gt;Women who took endocrine therapy for breast cancer were 87% less likely to die from lung cancer than the general population (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) despite similar lung cancer incidence, according to Elisabetta Rapiti, MD, MPH, of the University of Geneva, Switzerland, and colleagues.&lt;br&gt;
&lt;br&gt;But women with breast cancer who didn&apos;t take anti-estrogen therapy were no less likely to die from lung cancer than the general population (&lt;em&gt;P&lt;/em&gt;=0.158), they reported at the San Antonio Breast Cancer Symposium.&lt;br&gt;
&lt;br&gt;These results lend further support to the &quot;hypothesis that estrogen plays a role in lung cancer prognosis,&quot; Rapiti said at the conference.&lt;/p&gt;
&lt;p&gt;Earlier this year, an &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASCO/14459&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASCO/14459&quot; target=&quot;_blank&quot;&gt;analysis&lt;/a&gt; of the Women&apos;s Health Initiative in the&lt;em&gt; The Lancet&lt;/em&gt;, suggested that women who had taken postmenopausal estrogen and progestin replacement therapy as part of the study were 23% more likely to die from lung cancer than women who had taken placebo.&lt;/p&gt;
&lt;p&gt;While this overall difference was not significant (&lt;em&gt;P&lt;/em&gt;=0.16), it started Rapiti&apos;s group thinking about the implications in the opposite direction.&lt;/p&gt;
&lt;p&gt;&quot;If combined hormone therapy is associated with an increased lung cancer mortality risk,&quot; she said at the session, &quot;anti-estrogens may be associated with a decreased lung cancer mortality risk.&quot;&lt;/p&gt;
&lt;p&gt;So they analyzed the population-based Geneva Cancer Registry to link breast cancer patients  --  a population likely to have taken such drugs  --  to lung cancer.&lt;/p&gt;
&lt;p&gt;Of the 6,655 breast cancer patients included in the registry for 1980 through 2003, 46% had indeed received anti-estrogen therapy, which involved tamoxifen in most cases because the registry was weighted toward women treated in the pre-aromatase inhibitor era.&lt;/p&gt;
&lt;p&gt;When followed through 2007 for lung cancer incidence, rates tended to be lower for anti-estrogen users, with a standardized incidence ratio of 0.63 compared with age- and time period-adjusted rates in the general population of the canton of Geneva (12 observed versus 19.1 expected cases, &lt;em&gt;P&lt;/em&gt;=0.058).&lt;/p&gt;
&lt;p&gt;For women who didn&apos;t get that therapy for breast cancer, the rate was no different than in the general population with a standardized incidence ratio of 1.12 (28 observed versus 25.0 expected cases, &lt;em&gt;P&lt;/em&gt;=0.294).&lt;/p&gt;
&lt;p&gt;Lung cancer deaths were significantly less common in women who took anti-estrogen therapy than in the general Geneva population  --  two observed versus 15.3 expected  --  for a standardized mortality ratio of 0.13 (95% CI 0.02 to 0.47).&lt;/p&gt;
&lt;p&gt;But the group without endocrine therapy showed no such association, with 16 observed versus 21.1 expected cases (standardized mortality ratio 0.76, 95% CI 0.43 to 1.23).&lt;/p&gt;
&lt;p&gt;Not surprisingly, many characteristics differed significantly between the women who took hormonal therapy and those who didn&apos;t, including more recent diagnoses.&lt;/p&gt;
&lt;p&gt;A sensitivity analysis restricted to women diagnosed after 1990 showed results similar to those from the overall registry cohort.&lt;/p&gt;
&lt;p&gt;Although tamoxifen and other hormonal therapy users were less likely to have missing information on smoking status, those who did have that information available showed no difference in smoking status by anti-estrogen use.&lt;/p&gt;
&lt;p&gt;Rapiti cautioned that residual confounding was possible because of the study&apos;s observational design.&lt;/p&gt;
&lt;p&gt;That means the investigators could not show causation, noted Jennifer Litton, MD, of the M.D. Anderson Cancer in Houston, who was not part of the study.&lt;/p&gt;
&lt;p&gt;She also questioned whether the lung cancers found in the study were actually metastases to the lung, which might be expected to occur less often with better treatment.&lt;/p&gt;
&lt;p&gt;The lung is one of the top sites to which breast cancer metastasizes, Litton noted.&lt;/p&gt;
&lt;p&gt;Nevertheless, many types of cancer share common pathways, so what these findings mean for a shared mechanism is the part that is really interesting, she said.&lt;/p&gt;
&lt;p&gt;She and Rapiti agreed that further prospective study is needed to confirm the association.&lt;/p&gt;
&lt;p&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Litton reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_4078"
                     title="SABCS: Higher Dose of Fulvestrant Slows Breast Cancer (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SABCS/tb/17522?impressionId=1265807670169"
                     
      SAN ANTONIO  --  Women with metastatic breast cancer had a modest but statistically significant improvement in time to progression when treated with 500 mg of fulvestrant (Faslodex)  --  double the usual dose  --  data from a multinational Phase III trial showed.&lt;br&gt;
&lt;br&gt;The one-month delay in progression came with no increase in adverse effects, Angelo Di Leo, MD, of the Hospital of Prato in Prato, Italy, said at the San Antonio Breast Cancer Symposium.&lt;br&gt;
&lt;br&gt;The higher dose was also associated with a trend toward a reduced mortality risk. Other outcomes were similar between the two dose groups.&lt;br&gt;
&lt;br&gt;The benefits were consistent across all prespecified subgroups.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;Fulvestrant will continue to be used after tamoxifen and aromatase inhibitors, but I believe the 500-mg dose will become the standard,&quot; said Di Leo.&lt;/p&gt;
&lt;p&gt;A second study reported at the San Antonio meeting showed that adding the estrogen-receptor antagonist to an aromatase inhibitor did not improve time to progression compared with the aromatase inhibitor alone.&lt;/p&gt;
&lt;p&gt;Available for more than a decade, fulvestrant has been overshadowed by other endocrine therapies for breast cancer, C. Kent Osborne, MD, of Baylor College of Medicine in Houston, said at a press briefing.&lt;/p&gt;
&lt;p&gt;The lack of recognition can be traced, in part, to suboptimal use of the estrogen-receptor inhibitor, including an inadequate dose, he said.&lt;/p&gt;
&lt;p&gt;Di Leo reported findings from a randomized clinical trial designed to examine the fulvestrant dosing issue. The study involved 736 patients with estrogen receptor-positive advanced breast cancer. All patients had disease progression or recurrence after prior treatment with an antiestrogen agent or an aromatase inhibitor.&lt;/p&gt;
&lt;p&gt;Patients were randomized to 250 or 500 mg of fulvestrant monthly and assessed for tumor response every 12 weeks. The primary endpoint was time to progression, and secondary endpoints included overall response, clinical benefit (response plus stable disease &amp;#8805;24 weeks), duration of clinical benefit, overall survival, and safety and tolerability.&lt;/p&gt;
&lt;p&gt;The 500-mg dose led to a median time to progression of 6.5 months compared with 5.5 months for patients treated with the standard 250-mg dose (&lt;em&gt;P&lt;/em&gt;=0.006).&lt;/p&gt;
&lt;p&gt;Overall survival improved by 16% with the higher dose, but the difference was not significant from the improvement seen with the 250-mg group (HR 0.84, &lt;em&gt;P&lt;/em&gt;=0.091).&lt;/p&gt;
&lt;p&gt;Overall response rate was 14% to 15% in each group. Total clinical benefit was 45.6% with 500 mg of fulvestrant and 39.6% with 250 mg. The median duration of clinical benefit was 16.6 months with the higher dose and 13.9 months with the standard dose, neither of which differed significantly.&lt;/p&gt;
&lt;p&gt;Adverse-event rates and quality-of-life scores also were similar for the two groups.&lt;/p&gt;
&lt;p&gt;Results of another multinational study demonstrated no advantage for adding fulvestrant to anastrozole (Arimidex). Time to progression and overall survival were virtually identical in patients treated with anastrozole alone or with the combination.&lt;/p&gt;
&lt;p&gt;&quot;The fulvestrant and anastrozole combination offers no clinical efficacy advantage over anastrozole alone and should not be used,&quot; concluded Joseph Bergh, MD, of the Karolinska Institute in Stockholm, Sweden.&lt;/p&gt;
&lt;p&gt;Bergh reported data from a trial involving 514 patients in first relapse after adjuvant cytotoxic or hormonal therapy for locally advanced or metastatic breast cancer.&lt;/p&gt;
&lt;p&gt;All patients received anastrozole 1 mg/d and were randomized to a 500-mg loading dose of fulvestrant followed by 250 mg/month or no additional therapy. About two thirds of the patients had received adjuvant endocrine therapy.&lt;/p&gt;
&lt;p&gt;Analysis of the primary endpoint showed no difference in time to progression, 10.8 months with the combination and 10.2 months with anastrozole alone.&lt;/p&gt;
&lt;p&gt;The two groups also did not differ with respect to key secondary endpoints, including overall survival (37.8% with the combination and 38.2% with anastrozole alone), response rate (31.8% versus 33.6%), and clinical benefit rate (55.0% versus 55.1%).&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Both studies were supported by AstraZeneca.&lt;/p&gt;&lt;p&gt;Di Leo disclosed relationships with Bristol-Myers Squibb and sanofi-aventis.&lt;/p&gt;&lt;p&gt;Bergh disclosed relationships with Merck, Pfizer, AstraZeneca, sanofi-aventis, and Roche.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_362"
                     title="SABCS: Ki67 Level Two Weeks After Starting Arimidex Predicts Breast Cancer Relapse"
                     score="-0.005"
                     href="