Changes to This Summary (02/21/2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Updated statistics with estimated new cases and deaths for 2014 (cited American Cancer Society as reference 1).
Added text to state that in a large, prospective series from the National Surgical Adjuvant Breast and Bowel Project with a 12-year follow-up of 182 women with lobular carcinoma in situ that was managed with excisional biopsy alone, 26 women developed ipsilateral breast tumors (cited Fisher et al. as reference 1); 14 women developed contralateral breast tumors.
Added text to state that in a second, similarly designed trial, 929 women with breast tumors smaller than 5 cm and sentinel lymph node (SLN) involvement smaller than 2 mm were randomly assigned to receive or not receive axillary lymph node dissection. Patients without axillary dissection had fewer disease-free survival (DFS) events. No difference in overall survival (OS) was observed (cited Galimberti et al. as reference 52 and level of evidence 1iiA).
Added text to state that similar results were obtained in the ZO-FAST trial (NCT00171340) in which 1,065 postmenopausal women received letrozole and were randomly assigned to receive zoledronic acid immediately or only after the development of bone loss or fractures. Also added that immediate administration of zoledronic acid resulted in a 34% improvement in DFS but did not affect OS (cited Coleman et al. as reference 200 and level of evidence 1iiA).
Revised text to state that in the HERceptin Adjuvant trial, trastuzumab was given every 3 weeks within 7 weeks of the completion of primary therapy that included, for most patients, an anthracycline-containing chemotherapy regimen given preoperatively or postoperatively, plus or minus locoregional radiation therapy. Also added that 3,387 patients were enrolled in a comparison regimen of 1 year of trastuzumab versus observation.
Added text to state that after a median follow-up of 8 years, the results of the comparison of 1 year versus 2 years of trastuzumab were analyzed. No difference in DFS was found between the groups. Also added that the benefit of 1 year of trastuzumab over observation persisted, despite crossover of 52% of the patients on observation (cited Goldhirsch et al. as reference 204 and level of evidence 1iiA).
Added text to state that the results of two prospective studies indicate that SLN biopsy is associated with false-negative rates of 14.2% and 12.6%, respectively, when undertaken after neoadjuvant chemotherapy in patients who convert from a clinically positive to a clinically negative axillary status (cited Kuehn et al. and Boughey et al. as references 222 and 223, respectively, and level of evidence 3iiD). Also added that these rates are higher than those observed when SLN biopsy is done before adjuvant chemotherapy; the role of this procedure in the neoadjuvant setting is uncertain.
Added Pertuzumab as a new subsection.
Added text to state that a preplanned subgroup analysis subsequently revealed that the addition of bevacizumab to neoadjuvant chemotherapy significantly increased the pathologic complete response rate from 27.9% to 39.3% in patients with triple-negative breast cancer (cited Gerber et al. as reference 233 and level of evidence 1iiDii).
Added text to state that while there is a biologic rationale for combining fulvestrant with a third-generation aromatase inhibitor for patients with recurrent or metastatic disease, the benefits of such combination therapy have not been established (cited Buzdar as reference 47).
Added Lapatinib plus trastuzumab as a new subsection.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.