Breast Equity

Finally, clinical research you can use…

Gwen — Thu, 10 May 2012 00:16:41 +0000

It’s been a while since I last posted. My latest project has been taking up my free time – I’m working on an online crowd-sourced research database for those with metastatic breast cancer.

Many of us involved in the breast cancer world are too familiar with the shortcomings of clinical research. It takes too long (6 – 10 years), costs too much (millions) and almost never studies the integrative approaches used by many (especially herbs, supplements, alternative medicine etc.).

With the help of the breast cancer community, I aim to change this. I propose a patient-run project that will train those with metastatic breast cancer to enter treatment and outcome information into a freely-available online database. If we get enough folks participating (and it will take a lot), then we can produce statistically relevant, hypothesis-generating information from which to design clinical trials that will be relevant to our interests. Importantly, we will have a clear signal for drug or herb efficacy without having to wait 6 – 10 years for clinical trials (wouldn’t it be great to know if for example Metformin is effective and if so, in what type of breast cancer?).

Towards this end, I am seeking to form two groups: one, a focus group of those whose lives have been affected by breast cancer to help define the scope and design of the database; secondly, a group of statisticians to find the best statistical model to achieve our aims.

For more information, please check out the blog I have dedicated to the project, MBC iResearch.

I look forward to hearing from you!

Everolimus: The New Miracle Breast Cancer Drug?

Gwen — Fri, 10 Feb 2012 07:41:29 +0000

Please see my original post on everolimus here

Today, the prestigous New England Journal of Medicine published results of the eagerly anticipated BOLERO 2 clinical trial[1]. It showed that adding everolimus (brand name Afinitor) to exemestane (brand name Aromasin, an aromatase inhibitor) greatly improved outcomes for women with metastatic and advanced hormone-positive (ER+ and/or PR+) breast cancer.

A couple of red flags immediately popped up for me though. First, there was a discrepancy between what the independent (“central”) radiologists reported and what the radiologists on the research team reported. There was a whopping increase of 7 months in the progression-free survival (PFS) period for those who added everolimus according to the independent radiologists. Contrast this with a much more modest increase of 4 months reported by the local researchers. Usually you see the opposite, with the researchers giving more glowing reports than independent reviewers. When this paper was presented at the San Antonio Breast Cancer Symposium in December 2011, I fully expected one of the esteemed professors in the audience to ask about this unusual disagreement but amazingly, no one did so.

That discrepancy and the fact that this research was funded by the company that manufactures everolimus (Novartis), make me a little leery of this report’s findings. It took me a while to chase down the authors’ conflicts of interest and, not surprisingly, there were lots.

Only 6 of the 21 authors did not have a financial relationship of some sort with Novartis. 5 of the authors are Novartis employees and own stock in the company. The other 10 were consultants, authored presentations, received travel and accommodations to medical conferences such as the SABCS and/or received grants from Novartis. Dr. Baselga, the lead author is a Novartis board member. Needless to say, I would love to see an independent research team corroborate this group’s findings.

The report also identified adverse effects of the everolimus/exemestane combination: mouth sores (stomatatis), rash, and diarrhea were the most common (less than 15% risk of each). Fortunately, life-threatening (grade 4) reactions were rare (~1%) .

Based on the symposium presentation, many hormone-positive metastatic breast cancer patients have been very interested in trying this combination. However, to date no oncologist has been comfortable doing so since there wasn’t even a report in a peer-reviewed journal to bolster their argument.

That changed with publication of this research paper. Right on cue, I recently found out that an oncologist (this one is at a highly respected academic breast oncology department) has prescribed everolimus. Of course, the insurance company denied coverage. Now I am helping the patient strategize an appeal for this very expensive drug (approximately $9,000/month!). If our strategy works, I will post it on this blog, so stay tuned…

Bottom line: the BOLERO 2 report, red flags not withstanding, suggests that adding everolimus to exemestane improves outcome for those with metastatic breast cancer. Of note, there is gathering clinical data that suggests everolimus is likely to similarly improve outcomes when combined with other anti-estrogen therapies. If I had advanced or metastatic ER+ or PR+ breast cancer, I would certainly discuss this report with my oncologist.

Please see references below.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

*Information on the Breast Equity blog is provided on an “as is” basis for general information only. It is not intended as medical advice and should not be relied upon as a substitute for consultation with a qualified health professional.*

References:

[1] Everolimus in Postmenopausal Hormone-Receptor-Positive Advanced Breast Cancer, Baselga et al

Gwen’s best of SABCS 2011: Don’t be a victim of HER2 errors!

Gwen — Wed, 25 Jan 2012 04:37:10 +0000

You can find an overview of the most important presentations of the 2011 San Antonio Breast Cancer Symposium here.

A couple of weeks ago, a client of mine was diagnosed with ER-positive, HER2-negative breast cancer. At the time of our consultation, I could not find the report that gave any details – only that she was HER2-negative.

I encouraged her to get a copy of the full HER2 report. With difficulty, her second opinion oncologist managed to obtain it – he found that my client was actually HER2-equivocal (a.k.a. HER2-borderline). This is absolutely critical since trastuzumab (Herceptin, an anti-HER2 receptor antibody) works just as well in HER2-equivocal cases as it does in those that are strongly HER2-positive.

There are roughly 250,000 new cases of breast cancer diagnosed every year in the US. About 1/4 are HER2-positive. By some accounts, up to 5% of the specimens could be falsely labeled as HER2-negative. When you think of the number of women who may be missing out on potentially life-saving anti-HER2 treatment, it really does boggle the imagination.

The science behind HER2 measurement is simple: when there is an excessive number of HER2 genes in a breast cancer specimen, the chance for cancer cure goes up dramatically when trastuzumab, is administered.

There was a San Antonio Breast Cancer Symposium (SABCS) session this year that explained the discrepancy in HER2 reporting. Read on to peek behind the scenes of gene copy measurement. Once you see how this “sausage” is made, you will have a healthy respect for the limitations of this science. But don’t worry – at the end of my post, there are several tips to help you avoid being erroneously labeled as HER2-negative.

One the first day of the conference Angelo Di Leo, an MD PhD from Italy, gave a riveting talk on the measurement of HER2. Basically, he had three points to make:

1) We don’t really know what to measure

2) We really don’t know how to measure it

3) And more controversially, we don’t really know if we need to measure it in the first place

Let’s review Dr. Di Leo’s talk. Hold on to your hat! This story has a few twists and turns.

Unlike ER or PR measurement, the HER2 gene copy test (called the HER2 FISH test) is quite expensive, so a cheaper test was found where they just measured the amount of HER2 protein found on the cancer cells instead (the HER2 IHC test). If a large amount (3+) of it was found, trastuzumab treatment was in order. If only a small amount (0 to 1+) was found, it wasn’t prescribed. The gene test was only done when there was a middling amount of HER2 (2+) by IHC.

This introduced a level a discrepancy since a small number of IHC negative tests end up being FISH positive (about 4%).

The next difficulty lies in that fact that doing the FISH test accurately is like rocket science – it’s hard to do well. So, when researchers want to make absolutely sure of precise testing, they will send their samples only to a few highly regarded “central labs” as opposed to letting the local pathology staff perform the test.

But even if you use a perfectly accurate FISH testing laboratory, there still are some hurdles to be crossed. First, there is about 20% disagreement between expert FISH testers[1]. How can this be? It turns out that a single breast cancer specimen contains a heterogeneous population of cells – some cells have a much higher FISH copy number than others. So the test result, even when very accurate, can vary depending on which population of cancer cells is tested. (I was very interested to see a couple of biotech companies at the SABCS conference developing rigorous specimen analysis algorithms to compensate for this FISH test weakness. I will be following their development with much interest.)

And if that were not enough of a challenge, there is debate as how to best quantify HER2 FISH. Some labs use the standard technique where the CEP17 gene is the reference. But, because anomalies in the CEP17 gene number can result in misclassifying cancers as HER2 negative, many of the more advanced labs are using additional reference genes such as the RARA gene or p53.

The next problem is that, when presented with the same FISH test result, some experts will call it HER2 positive while others say the opposite. Why don’t the experts agree? It turns out that two groups have developed different definitions of what constitutes HER2 positivity. The ASCO/CAP criteria are more strict than that used by the FDA. So a small number of ASCO HER-negative cases become HER2-positive when the FDA criteria is applied[2].

Now here is where the story takes a real left turn. We may not need to do the test in the first place! It turns out that there are not one but two large, gold-standard clinical trials (NSABP-B31and N9831) showing that HER2-negative patients erroneously labeled as HER2-positive by local labs, derived almost as much benefit from Herceptin as HER2-positive patients! Even some NSABP researchers theorize that trastuzumab effectiveness may not be limited to only those with extra HER2 gene copies[3]. It really makes one think…

After hearing Di Leo’s talk and learning about all the pitfalls in HER2 measurement, one could logically ask, why spend the time and the money doing this test in the first place? Amazingly, the HER2 FISH test works a lot of time despite its inherent inaccuracies. And, until more research comes along that points to a better way to predict trastuzumab effectiveness, it’s all we have.

With that in mind, here are a few tips to minimize your risk of HER2 error.

1) If you are told you are HER2-negative, ALWAYS get a 2^nd pathology opinion from a lab that is recognized for their expertise in HER-2 testing. Phenopath an example of such a lab. There are others.

2) Make sure the lab uses an additional reference gene rather than just relying on CEP17.

3) If you are just below the cut-off point for being designated HER2-equivocal, ask the lab to analyze an additional 20 – 40 cells in your specimen.

4) If you’re told you are HER2 equivocal (a.k.a. HER2-borderline or HER2-indeterminant), ask your oncologist if there is a good reason to NOT take trastuzumab in your case. In general, a FISH HER2 copy number between 1.8 and 2.2 is considered equivocal.

So, get a close look at your full HER2 test report. For those who were told they were HER2-negative and they want to retest their cancer specimen at a central lab (the most recent biopsy specimen is the one that is usually best to use), the process will be as simple asking your oncologist to order it for you. But make sure the test is not ordered from the same lab as tested it originally.

Please see references below.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

References

[1] Standardization of HER2 testing: results of an international proficiency-testing ring study

[2] Predictability of Adjuvant Trastuzumab Benefit in N9831 Patients Using the ASCO/CAP HER2-Positivity Criteria

[3] HER2 Status and Benefit from Adjuvant Trastuzumab in Breast Cancer

Gwen’s best of SABCS 2011: Diligently taking hormone therapy increases survival in metastatic breast cancer

Gwen — Wed, 25 Jan 2012 03:25:55 +0000

You can find an overview of the most important presentations of the 2011 San Antonio Breast Cancer Symposium here.

#P1-08-12 by T I Barron and others

First comes the diagnosis of breast cancer. Then comes the cancer surgery. This is often followed by grueling chemotherapy or radiation protocols. Just when you’re about to declare victory and go home, you are now told you have to take an anti-estrogen pill for 5 years.

Fortunately, for many women, the side effects of this hormone therapy are quite tolerable. However, about 20% of those on hormone therapy are unable to take the potentially life-saving medication. Side effects such as joint and muscle pain, insomnia, fatigue and mood disturbance can be quite debilitating.

Here is a report that looks at hormone therapy compliance in the metastatic breast cancer setting. This research, coming out of Ireland, showed that women who took their hormone therapy less than 80% of the time almost doubled their risk of dying over the next 3 years.

So, what to do if you are one of those whose quality of life is significantly worsened by taking anti-estrogens? Fortunately, there are some excellent preventive actions you can take, thus making it easier to adhere to your treatment. First and foremost, a beautifully designed and implemented 2010 study from Columbia University proved that acupuncture is very effective for controlling joint symptoms caused by aromatase inhibitors (i.e. Arimidex, Femara, Aromasin)[1].

Additionally, a quick internet search will yield many other clinical trials showing acupuncture can reduce other symptoms such as fatigue, insomnia, hot flashes.

In smaller studies, Vitamin D supplementation has also been shown to be beneficial. My initial interest in high-dose supplementation in this group has been damped quite a bit by a report from ASCO this past June showing Vitamin D increases estrogen levels in some women taking aromatase inhibitors (AIs)[2]. We will need larger clinical trials to be sure, but until then women taking AIs should think twice about having Vitamin D blood levels greater than the 30 – 40 ng/ml range. Such women should also consider following high-sensitivity estrogen blood levels (note: it must be a high-sensitivity test).

Yoga is another complementary approach that has clinical evidence of effectiveness. A small study of 12 women showed that those doing Iyengar yoga twice a week for 8 weeks reduced their pain on average by 30% and reduced their activity interference by 50%[3]. Several other small but randomized studies show other types of yoga reduced fatigue and improved psychological well-being. Together, these studies suggest a benefit. Since yoga has virtually no adverse effects, it makes sense to try it.

So, with a little effort, you can minimize anti-estrogen side effects and greatly increase your chance of taking AIs and Tamoxifen as directed, doubling your survival in the process.

Please see references below.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

References

[1] Randomized, Blinded, Sham-Controlled Trial of Acupuncture for the Management of Aromatase Inhibitor-Associated Joint Symptoms in Women With Early-Stage Breast Cancer

[2] An analysis of vitamin D (Vit D) and serum estrogens in postmenopausal (PM) breast cancer (BC) patients receiving aromatase inhibitors (AIs)

[3] Impact of Yoga on Functional Outcomes in Breast Cancer Survivors With Aromatase Inhibitor-Associated Arthralgias.

Gwen’s best of SABCS 2011: Circulating Tumor Cells Can Predict Relapse in Non-metastatic Breast Cancer Patients

Gwen — Sun, 08 Jan 2012 08:29:10 +0000

You can find an overview of the most important presentations of the 2011 San Antonio Breast Cancer Symposium here.

Poster #4-07-07 by A. Lucci and others.

For a while now, we have seen how a simple blood test that measures circulating tumor cells (CTCs) can predict response to treatments for metastatic breast cancer. Now we have evidence that they can predict which women would be more likely to relapse after their lumpectomy or mastectomy.

The folks at MD Anderson prospectively evaluated 290 women at the time of their breast surgery. 56% had small T1 tumors. Those with 2 or more CTCs had much greater odds of relapse (OR = 4.5; p = 0.002) and of death (OR = 4.5; p = 0.011) regardless of how small the tumor was at diagnosis.

I think many women newly diagnosed with breast cancer will want to see their CTC count – it will be yet one other piece of data to help them decide how aggressive to be with adjuvant and lifestyle therapies.

Of note, the authors of this study reported no financial conflicts and they did not report receiving funding from Veridex, the company that makes the circulating tumor testing platform used in the study.

Caveat: this is a relatively small study and many oncologists will want to wait for larger studies to confirm its findings before ordering this test on newly diagnosed breast cancer patients. In my experience, surgeons often adopt such tests earlier than oncologists.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

Gwen’s best of SABCS 2011: Blood test predicts risk of heart problems after trastuzumab (Herceptin)

Gwen — Sun, 08 Jan 2012 08:26:02 +0000

You can find an overview of the most important presentations of the 2011 San Antonio Breast Cancer Symposium here.

Poster #5-20-02 by I. Blancas and others

Significant heart problems develop in about 25% of those taking trastuzumab. Early identification is important to minimize the risk of overt heart failure.

In this study, measuring a blood protein called NT-proBNP (aka N-terminal pro-brain b-type natriuretic peptide) helped identify who was at most risk for this side effect.

40 patients had their blood checked for the protein before and during trastuzumab therapy. NT-proBNP was higher in those who had heart problems. If the test result was < 600 pg/ml, there was a 98% chance of having normal heart function. On the other hand, those who had results > 600 pg/ml had a 99% chance of having impaired cardiac function.

This bolsters the results of a study done in 2006 where the same test predicted trastuzumab-related cardiac toxicity.[1]

Importantly, this is a simple blood test that can be done at many medical centers. It costs around $200.

Caveat: this is a small study. Because of the cost of the test, many insurance companies may not cover it until larger clinical trials are done

Please see references below.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

[1]Indium-111-labeled trastuzumab scintigraphy in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer by P. J. Perik and others. You can find this research paper here

Gwen’s best of SABCS 2011: Oncotype DX test underestimates HER2

Gwen — Sun, 08 Jan 2012 08:17:12 +0000

You can find an overview of the most important presentations of the 2011 San Antonio Breast Cancer Symposium here.

Poster #01-07-20 by D. J. Dabbs and others

The Oncotype DX test is amazing. The folks at Genomic Health who developed it are my personal heroes. But recently a problem has cropped up. Genomic Health may not have fallen off their pedestal but they certainly have been teetering on the edge quite a bit lately.

The Oncotype DX test has been a godsend to those who want objective evidence of chemotherapy effectiveness before undergoing such a toxic regimen. Its scope has been recently expanded to quantifying ER (estrogen receptor) and PR (progesterone receptor) expression. This is served as a great “2^nd opinion” on the pathology report since Oncotype ER and PR scores have been shown to predict response to anti-estrogen therapy.

Not so for the HER2 score. When a patient of mine had an Oncotype HER2 score much lower than FISH testing done at 2 other labs, I called Genomic Health. To my amazement, they admitted that they had not yet done the research to verify that their HER2 score accurately predicted who would and who would not benefit from trastuzumab (Herceptin). I asked them why they had no disclaimer on the HER2 score report – no answer was forthcoming.

One might theorize that the discrepancy lies not in the test, but in the tissue, where HER2 gene expression may differ from cell to cell. But if that were the case, one would expect Oncotype to sometimes overestimate and sometimes underestimate. But it turns out that it only underestimates. So I have ignored the HER2 score on the Oncotype DX report ever since.

This research report validates my approach. The authors found that Oncotype DX classified 71% of the HER2 FISH-positive and HER2 FISH-equivocal cases as HER2-negative. This is important since FISH-equivocal HER2 cancers respond just as well to trastuzumab treatment. A previous study by the same author looking at samples from 3 labs, including the Cleveland Clinic, found similar results.

Caveat: We need other independent researchers to validate this report by publishing their experience with the Oncotype DX HER2 score.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

Gwen’s best of SABCS 2011: Isolated tumor cells (ITCs) and micrometases in lymph nodes do NOT worsen overall survival

Gwen — Sun, 08 Jan 2012 08:12:56 +0000

You can find an overview of the most important presentations of the 2011 San Antonio Breast Cancer Symposium here.

Poster #3-07-34 by A. Valachis and others

There has been a lot of debate as to whether very tiny deposits of cancer cells found in lymph nodes removed at the time of breast surgery mean increased risk of relapse or death. Some studies find no association and others do.

Swedish researchers had the bright idea to pool all the studies that had been done on the subject and analyze the data as a whole. This technique is called a meta-analysis. Using this method, their report would be more accurate as it analyzes data from over 2,200 patients instead of only 100 – 150 as found in the average report.

While they found some increased risk of breast cancer relapse, there was no increase in deaths. This makes sense since breast cancer relapse can often be cured.

Since this meta-analysis was performed, the updated results of the ACOSOG Z0010 trial[1], a very large research study involving over 5,000 breast cancer specimens, also showed no increased risk of death with isolated tumor cells.

So those of you whose lymph nodes turned up a tiny bit of cancer can rest a bit easier.

Please see references below.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

Reference:

[1] The ACOSOG Z0010 abstract can be found here.

Gwen’s best of SABCS 2011: One dose of pre-operative ketorolac (Toradol) prevents early breast cancer relapse

Gwen — Sun, 08 Jan 2012 08:05:40 +0000

You can find an overview of the most important presentations of the 2011 San Antonio Breast Cancer Symposium here.

Poster #2-01-06 by M. Retsky and others

This fascinating report comes from an international study headed by the Harvard School of Public Health[1].

First, a little background. One mystery yet unsolved is why some patients recur early (within 24 months) of breast surgery. The leading theory is that some folks are susceptible to immune system dysfunction in this period. So researchers have been testing ways to minimize this problem by using NSAIDs after surgery instead of opiates such as Vicodin, Oxycodone, Percocet, etc. that may worsen the immune system impairment sometimes seen after surgery. NSAIDs, or non-steroidal anti-inflammatory drugs are used to treat pain and reduce fever. This class of drugs includes ibuprofen (Motrin, Advil) and naproxen (Aleve) but not acetaminophen (Tylenol).

Dr. Retsky and his colleagues reviewed the cases of 327 women who had mastectomy followed by conventional adjuvant therapy (anti-estrogen therapy or chemotherapy). Those who had a single dose of the IV NSAID ketorolac had 1/4 of the relapses occurring in the first 24 months! Another way to look at the data: at the 2 year mark, 92% of the Toradol group were relapse-free whereas only 78% of the non-Toradol group were.

I was so amazed that one dose of IV NSAID could achieve this result that I immediately checked out the 2010 report by Dr. Forget et al[2] from which Dr. Retsky derived his raw data. Interestingly, I found that the patients were also allowed to get a 2^nd NSAID called diclofenac (available as a pill) for the first 3 days after surgery. When I queried Dr. Retsky about this potentially confounding factor, he assured me that Dr. Forget had looked at this and found no effect of giving diclofenac post-operatively.

So, if I were having a biopsy or cancer surgery, I would ask the physician whether it is safe to take ibuprofen or naproxen, both before surgery and in lieu of opiates after surgery. In my opinion, taking NSAIDs in this manner has small risk of causing complications and potentially huge benefits: reduced cancer relapse and increased survival.

Caveat: This is a very small retrospective study. Its findings must be validated in a large, prospective randomized study before oncologists and surgeons will start routinely offering this to their patients.

Please see references below.

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!

References:

[1] A PDF of Dr. Retsky’s report, NSAID analgesic ketorolac used perioperatively may suppress early breast cancer relapse: something for nothing in breast cancer? (posted with Dr. Retsky’s permission), can be downloaded here

[2] Dr. Forget’s report can be found here

Gwen’s Best of SABCS 2011: Overview

Gwen — Sun, 08 Jan 2012 07:59:37 +0000

In early December, San Antonio is a very colorful town. At night, the lights on the trees, horse-drawn carriages and the Riverwalk provide a calm and picturesque view of the city.

Not so during the day. Along with several thousand other oncologists, researchers and patient advocates, I descended upon the convention center at 7 AM every morning. The main lecture hall is the about length of 3 football fields. There were numerous huge monitors dangling from the ceiling throughout. Moving into and out of this room felt like a cattle call as the tide of people rushed to and fro.

Despite the maddening crowd, it was an amazing symposium this year. As usual, the most publicized research presentations were those involving pharmaceuticals that are patented and therefore have access to large marketing budgets.

However, I spent much of my time in the poster sessions where the unsung researchers were available to directly answer my questions about their work. I found several gems that will be immediately valuable to those affected by breast cancer.

But first, you need to know how I whittle down roughly 1,000+ research abstracts down to a few.

First of all, while I find much preclinical research interesting, my heart has been broken too many times by approaches that worked extremely well in the test tube or in mice, only to be found toxic or to lack effectiveness in human beings. It turns out that preclinical research is like throwing the dice – once in a while, just often enough to keep you addicted – you hit the jackpot and something like trastuzumab (Herceptin) works just as effectively in people.

Translational or biomarker research was going to change all that. It seemed very straightforward: if you could find the molecule driving cancer growth and block it, you would destroy the cancer. But with the exception of trastuzumab, the overwhelming majority of biomarker-developed drugs had low effectiveness, high toxicity or both (witness the Avastin debacle). For more on the the pitfalls of preclinical research, please see my blog post here.

So, that is why I love to check out preclinical and translational research but do not report on it – it’s only occasionally applicable to human beings.

About 70% of the work presented at the SABCS is preclinical.

You might ask: if preclinical research is so lousy at predicting what will work in people, why is so much time and money spent on it? First of all, it costs only a fraction of what clinical research costs. But more importantly, there is not a better system for researchers to use – until someone comes up with a better idea, it is all we have.

So, I immediately crossed hundreds of abstracts off my review list by just limiting myself to clinical research.

My next criterion is that the science be useful and its implementation accessible to patients now, not 5 years from now when the randomized clinical trial result is reported. Accessible means that the treatment is available usually via off-label prescribing or over-the-counter purchase.

Once the research passes through this sieve, there are only a few abstracts left. Over the next several weeks, I will be posting a short discussion of some of these gems. Here are the ones I’ve selected as the best of SABCS 2011:

One Dose of Pre-operative Ketorolac (Toradol) Prevents Early Breast Cancer Relapse

Circulating Tumor Cells Can Predict Relapse in Non-metastatic Breast Cancer Patients

Oncotype DX test underestimates HER2 expression

Blood test predicts risk of heart problems after trastuzumab (Herceptin)

Isolated tumor cells (ITCs) and micrometastases in lymph nodes do NOT worsen overall survival

Diligently taking hormone therapy increases survival in metastatic breast cancer

Don’t be a victim of HER2 errors!

Was this information useful? If so, please help Gwen continue to bring unbiased breast information to the people. Donate now!