Breast cancer medical updates
GRACE MAKARI-JUDSON, MD
Medical Director, D'Amour Center for Cancer Care
Chair, Baystate Health Breast Network
Co-Director, Rays of Hope Center for Breast Cancer Research
Prarthna Bhardwaj, MD
Hematology Oncology Fellow,
UMass Chan Medical School - Baystate
We are pleased to share with you some updates on breast cancer treatment and after-care from the 2022 San Antonio Breast Cancer Symposium, the premiere international breast cancer meeting that was held last December.
Early Breast Cancer Treatments Update
The results of the SWOG Cancer Research Network S1207 clinical trial, which enrolled 1,939 women (including nine from Baystate) between 2013 and 2019, were discussed at the conference. We learned that adding the medication everolimus to hormone therapy in patients with high-risk, early-stage, hormone-positive breast cancer who have already undergone surgery did not improve disease-free survival or overall survival above and beyond usual care. Increased side effects were noted with this medication, limiting the ability of individuals to complete the recommended treatment plan. Early trends of benefit were noted in pre-menopausal women, which may be explored further in the years to come.
Breast Cancer and Pregnancy
Young women diagnosed and treated for early-stage breast cancer may want to have children. Breast cancer treatment, including hormone therapy, is often recommended for five years, which reduces a woman’s egg reserves and chances of a successful pregnancy. Previously, we recommended waiting five years until completion of hormone therapy or discontinuation of treatment altogether. A temporary interruption of hormonal therapy to attempt and carry a pregnancy in a younger age group has never been studied in the past.
In the POSITIVE trial, young women between 27-43 years of age who had already received anywhere between 18- 30 months of hormonal therapy were allowed to interrupt treatment for about two years to achieve pregnancy. After the two-year break, they completed five to 10 years of hormonal therapy.
Of the 518 who enrolled into the study, 44 had experienced an event of local, regional, or distant cancer recurrence. At three years, there were no changes in the number of women who experienced these events off the hormonal therapy when compared with recurrence rates in historical studies with women on hormone therapy. A total of 74% of women had at least one pregnancy and 64% had at least one live baby born.
Bottom line: Temporary interruption of hormone therapy to attempt pregnancy does not mean a woman will have a higher than usual short-term risk of cancer recurrence. This is very promising news for young women desiring future pregnancies.
Managing Side Effects of Hormonal Therapy
Breast cancer survivors on hormonal therapy often report chronic muscle and joint pain. This can be so debilitating for some that they discontinue hormonal therapy, which is a key strategy for decreasing breast cancer recurrence. Complementary therapies including acupuncture and yoga have often reported to be beneficial. In one such study involving 850 patients, the impact of yoga as a complementary therapy on overall quality of life was studied.
Women with breast cancer during and after completion of treatment who performed yoga consistently for six months had an improvement in their physical and emotional function and fatigue and pain levels. This effect was sustained over a period of four years. More than 50% of the women had an improved overall quality of life from their baseline. This is a low-cost, low-risk therapy that improves day-to-day activity in women with breast cancer. These results are consistent with prior research among breast cancer survivors in the United States who found that yoga reduced musculoskeletal symptoms caused by hormonal therapy.
Similarly, acupuncture is a complementary therapy for treating musculoskeletal pain in women on hormonal therapy. In a study comparing true acupuncture with sham acupuncture or no acupuncture for women on hormonal therapy for early-stage breast cancer, pain scales improved significantly in women receiving true acupuncture at the end of one year.
Bottom line: Regular exercise including yoga and complementary therapies like acupuncture could be helpful in easing or decreasing muscle and joint pains from hormonal therapy. These strategies may be helpful in limiting the rates of discontinuation of life-saving treatment in women with breast cancer.
If you are interested in learning more about breast cancer clinical trials at Baystate Health, call the Baystate Regional Cancer Program at 413-794-9875.