Search

Patients with small node-negative HER2-positive breast cancer are commonly treated with paclitaxel and 1 year of adjuvant trastuzumab. We performed a sub-analysis of the ALTTO trial to explore the long-term outcomes of patients with small node-negative tumours.The ALTTO trial randomised 8381 patients with early HER2-positive BC treated with adjuvant chemotherapy (anthracycline/taxane- or taxane/carboplatin-based), to trastuzumab (T), lapatinib (L), their sequence (T → L) or their combination (L + T). Patients with tumours ≤3 cm and node-negative were included in this sub-analysis.A total of 2821 patients were analysed (median follow-up of 7 years). The median age was 52 years, and most patients had tumours ≤2 cm (64.3%). The 7-year disease-free survival (DFS) was 88.1% (95% CI: 86.7-89.3%). DFS was similar for arms T, T + L and T⟶L and significantly lower for arm L (stratified log-rank P = 0.031). The 7-year overall survival rate was 95.9% (95% CI: [95.0-96.6%) and the 7-year time-to-distant recurrence was 93.4% (95% CI: 92.3-94.4%).With most patients treated with anthracycline-based regimens, ALTTO shows that patients with small tumours treated with trastuzumab and concomitant chemotherapy have excellent long-term outcomes, similar to those of the APT trial.Clinicaltrials.gov identifier NCT00490139.

A growing number of young breast cancer survivors consider reproductive health issues, including subsequent fertility and pregnancy, of great importance, but many questions regarding safety remain unanswered. We conducted a comprehensive literature search and review of published articles, control-matched, population-based, and co-operative group reports that addressed various aspects of pregnancy after breast cancer (patients’ expectations, fertility damage, assessment and preservation, maternal and fetal outcome, breast feeding). Overall, available data support pregnancy and breast feeding after breast cancer as safe and feasible for women at low risk of recurrence. This retrospective and population-based evidence is, however, frequently incomplete; usually not representative of the entire population, it can be biased by patients’ related effects or underpowered and is often not controlled for biological factors and risk determinants in the statistical model used. Before making any definitive assumption on this delicate and fundamental aspect of a woman’s life after breast cancer, we should demonstrate without any reasonable doubt that the scattered information available today is scientifically sound. The Breast International Group and North American Breast Cancer Group are planning a global prospective study in young women with endocrine responsive, early breast cancer who desire pregnancy, to assess both patients’ and pregnancy outcomes. The trial will include an observational phase investigating the feasibility and impact of a temporary treatment interruption to allow conception and an experimental phase investigating the optimal duration of the subsequent endocrine treatment after delivery or the last failed attempt to get pregnant.

B126 Background Soy foods are a dietary staple in Asian countries and may play a role in this region’s historically low rates of breast cancer incidence. Isoflavones found in soy have structural similarities to estrogens and could exert protective effects by interacting with estrogen receptors, binding proteins, or metabolic enzymes. In a sample of Asian-American women we test whether soy is associated with urinary concentrations of estrogens and estrogen metabolites (EM). Methods This analysis was conducted among controls from a population-based case-control study of breast cancer among women of Chinese, Japanese and Filipino ancestry, aged 20-55 years, and living in San Francisco-Oakland (CA), Los Angeles (CA) and Oahu (HI). Of 966 controls, we included the 571 (59%) women who donated a 12-hour urine and had not been pregnant or lactating or used exogenous hormones in the last 6 months. At urine collection, 168 women were postmenopausal, 233 were pre-menopausal in mid-luteal phase, and 170 were in other categories. Fifteen EM were measured simultaneously with a highly sensitive and reproducible liquid chromatography-tandem mass spectrometry method. Participants had been queried about their usual adult frequency of intake of tofu and other selected soy foods. Robust regression was used to model the associations of soy intake (in tertiles) with EM measures. Models were adjusted for age, ethnicity, body mass index (BMI), and birthplace (Asia/West). Results No statistically significant associations were seen between soy intake and urinary concentrations of estrone, estradiol, estriol, or total EM in postmenopausal women or premenopausal women. In postmenopausal but not premenopausal women, we found significant trends across tertiles of soy intake for EM grouped by metabolic pathways. The 2- and 4-hydroxylated EM and the methylated catechols, each expressed as a percent of total EM, increased with soy intake, while relative levels of EM in the 16-hydroxylation pathway decreased. Models adjusted for age and ethnicity were similar. Factor analysis was used to confirm EM groupings. Among postmenopausal women, factor analysis identified four independent EM patterns, termed ‘catechols’, ‘methylated catechols’, ‘16-hydroxylation pathway EM’, and ‘parent estrogens’ based on the predominant EM. Factors for premenopausal women were similar. Discussion Our findings do not support the hypothesis that soy intake influences endogenous production of estrogens but they do suggest that soy intake can modify estrogen metabolism in postmenopausal women. Increased ratios of 2-hydroxyestrone to 16α-hydroxyestrone have been associated with lower breast cancer risk in some epidemiologic studies. Methylation of catechol estrogens results in deactivation of these metabolites and prevents conversion into genotoxic quinones. Thus, the trends by soy intake represent variations in EM metabolism that could reduce breast cancer risk. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B126.