Breast Cancer

Axilla swelling, one of the side effects of the initial COVID-19 vaccine series in women, has also materialized with the boosters.

This inflammation is caused by the enlargement of lymph nodes and can show up as an abnormal finding on mammograms and other types of chest scans, causing concern and even the need for additional imaging and follow up, wrote Constance D. Lehman, MD, PhD, and colleagues in an article published in Journal of the American College of Radiology.

Lymph node swelling is a normal immune system reaction to vaccination, and “COVID-19 vaccinations in the arm are a well-documented cause of inflammatory unilateral axillary adenopathy,” noted Dr. Lehman, in an interview. The side effect will occur on the side of the body where the patient received a vaccine, and it is not always noticeable to the woman experiencing it, she said.

“We’re finding that the patients’ bodies are responding to the booster in many ways that are similar to the initial COVID vaccines, with lymph node swelling, muscle aches and pains, headaches, and so on,” said Dr. Lehman, who is chief of breast imaging at the Massachusetts General Hospital, Boston. There have been no real differences in reactions between the Moderna and Pfizer vaccines, she added.

Because axillary lymph node swelling can obscure mammogram results, staff of at least a few imaging centers, including Penn State Breast Center in Hershey, Pa., and Providence Women’s Imaging Center in Torrance, Calif., told this news organization that they are asking women to delay mammogram imaging either 6 weeks or 4-6 weeks after getting a COVID-19 booster.
 

Experts’ suggestions on mammograms, boosters timing

Other experts, including Jessica Leung, MD, acknowledged that vaccine-related reactive adenopathy is seen after the booster dose and provided recommendations for the timing of getting mammograms and the booster with this in mind.

“I would recommend getting the screening mammogram first, which can be followed immediately by vaccination, even on the same day,” said Jessica Leung, MD, a professor of diagnostic radiology at the University of Texas MD Anderson Cancer Center in Houston, Tex.

“If this is not possible from the scheduling perspective, then the patient should consult her health care provider regarding whether it is okay to wait a bit after receiving the vaccine before getting her screening mammogram.”

The answer to that question will likely depend on the time interval since the prior mammogram and the patient’s personal risk factors for developing breast cancer. Dr. Leung noted. “This is all predicated on the assumption that the patient is asymptomatic. If she has any symptoms, for example a palpable breast lump, then she should seek medical attention regardless of timing of vaccination.”

The same holds true for boosters, she said.

She emphasized that careful consideration should be given before delaying the mammogram. “The medical community has a great deal more knowledge at this time than in the early days of COVID-19 vaccination, so we are often able to identify reactive adenopathy related to vaccination. If patients were to delay the mammogram, any reactive adenopathy may persist, on average, for 4-6 weeks.”

Debra Patt, MD, PhD, MBA, executive vice president at Texas Oncology, professor at the University of Texas at Austin, provided a specific example of when a patient should not delay the diagnostic imaging, which is “in the event that there is an abnormal mass in the breast that requires evaluation.”

Providers are now prepared to address these issues, she added.
 

Dr. Lehman’s nuanced recommendations

“It’s easy to get both a mammogram and booster, and just a matter of timing them – so that the reaction doesn’t interfere with the mammography results,” Dr. Lehman said.

But she emphasized that women should not be choosing between their mammograms or a booster. “We are now saying the same thing that we did with the initial vaccine,” said Dr. Lehman. “We don’t want patients delaying their mammograms, and we don’t want them delaying their boosters – both are critical to staying healthy.”

In her center, a model was developed to navigate vaccine-associated adenopathy. While this approach was developed for the primary vaccine series, the same applies for the booster, which is essentially a third dose of the same vaccine, explained Dr. Lehman.

When patients present for mammography, ultrasound, or MRI, the technologist will document their COVID-19 vaccination status (first or second dose or booster), the date it was given, and the location. Adding vaccination documentation to intake forms helps to support appropriate management of patients who undergo imaging after COVID-19 vaccination. Six weeks is used as the cutoff point for defining “recent” vaccination.

For patients who are getting a screening mammography or MRI, and who have no symptoms beyond unilateral axillary adenopathy on the same side of the body where they received the COVID-19 vaccination (given in the arm) within a 6-week period, the following is included in the screening mammography or screening MRI report: “In the specific setting of a patient with documented recent (within the past 6 weeks) COVID-19 vaccination in the ipsilateral arm, axillary adenopathy is a benign imaging finding. No further imaging is indicated at this time. If there is clinical concern that persists more than 6 weeks after the patient received the final vaccine dose, axillary ultrasound is recommended.”

The experts interviewed reported no conflicts of interest.

Axilla swelling, one of the side effects of the initial COVID-19 vaccine series in women, has also materialized with the boosters.

This inflammation is caused by the enlargement of lymph nodes and can show up as an abnormal finding on mammograms and other types of chest scans, causing concern and even the need for additional imaging and follow up, wrote Constance D. Lehman, MD, PhD, and colleagues in an article published in Journal of the American College of Radiology.

Lymph node swelling is a normal immune system reaction to vaccination, and “COVID-19 vaccinations in the arm are a well-documented cause of inflammatory unilateral axillary adenopathy,” noted Dr. Lehman, in an interview. The side effect will occur on the side of the body where the patient received a vaccine, and it is not always noticeable to the woman experiencing it, she said.

“We’re finding that the patients’ bodies are responding to the booster in many ways that are similar to the initial COVID vaccines, with lymph node swelling, muscle aches and pains, headaches, and so on,” said Dr. Lehman, who is chief of breast imaging at the Massachusetts General Hospital, Boston. There have been no real differences in reactions between the Moderna and Pfizer vaccines, she added.

Because axillary lymph node swelling can obscure mammogram results, staff of at least a few imaging centers, including Penn State Breast Center in Hershey, Pa., and Providence Women’s Imaging Center in Torrance, Calif., told this news organization that they are asking women to delay mammogram imaging either 6 weeks or 4-6 weeks after getting a COVID-19 booster.
 

Experts’ suggestions on mammograms, boosters timing

Other experts, including Jessica Leung, MD, acknowledged that vaccine-related reactive adenopathy is seen after the booster dose and provided recommendations for the timing of getting mammograms and the booster with this in mind.

“I would recommend getting the screening mammogram first, which can be followed immediately by vaccination, even on the same day,” said Jessica Leung, MD, a professor of diagnostic radiology at the University of Texas MD Anderson Cancer Center in Houston, Tex.

“If this is not possible from the scheduling perspective, then the patient should consult her health care provider regarding whether it is okay to wait a bit after receiving the vaccine before getting her screening mammogram.”

The answer to that question will likely depend on the time interval since the prior mammogram and the patient’s personal risk factors for developing breast cancer. Dr. Leung noted. “This is all predicated on the assumption that the patient is asymptomatic. If she has any symptoms, for example a palpable breast lump, then she should seek medical attention regardless of timing of vaccination.”

The same holds true for boosters, she said.

She emphasized that careful consideration should be given before delaying the mammogram. “The medical community has a great deal more knowledge at this time than in the early days of COVID-19 vaccination, so we are often able to identify reactive adenopathy related to vaccination. If patients were to delay the mammogram, any reactive adenopathy may persist, on average, for 4-6 weeks.”

Debra Patt, MD, PhD, MBA, executive vice president at Texas Oncology, professor at the University of Texas at Austin, provided a specific example of when a patient should not delay the diagnostic imaging, which is “in the event that there is an abnormal mass in the breast that requires evaluation.”

Providers are now prepared to address these issues, she added.
 

Dr. Lehman’s nuanced recommendations

“It’s easy to get both a mammogram and booster, and just a matter of timing them – so that the reaction doesn’t interfere with the mammography results,” Dr. Lehman said.

But she emphasized that women should not be choosing between their mammograms or a booster. “We are now saying the same thing that we did with the initial vaccine,” said Dr. Lehman. “We don’t want patients delaying their mammograms, and we don’t want them delaying their boosters – both are critical to staying healthy.”

In her center, a model was developed to navigate vaccine-associated adenopathy. While this approach was developed for the primary vaccine series, the same applies for the booster, which is essentially a third dose of the same vaccine, explained Dr. Lehman.

When patients present for mammography, ultrasound, or MRI, the technologist will document their COVID-19 vaccination status (first or second dose or booster), the date it was given, and the location. Adding vaccination documentation to intake forms helps to support appropriate management of patients who undergo imaging after COVID-19 vaccination. Six weeks is used as the cutoff point for defining “recent” vaccination.

For patients who are getting a screening mammography or MRI, and who have no symptoms beyond unilateral axillary adenopathy on the same side of the body where they received the COVID-19 vaccination (given in the arm) within a 6-week period, the following is included in the screening mammography or screening MRI report: “In the specific setting of a patient with documented recent (within the past 6 weeks) COVID-19 vaccination in the ipsilateral arm, axillary adenopathy is a benign imaging finding. No further imaging is indicated at this time. If there is clinical concern that persists more than 6 weeks after the patient received the final vaccine dose, axillary ultrasound is recommended.”

The experts interviewed reported no conflicts of interest.

Axilla swelling, one of the side effects of the initial COVID-19 vaccine series in women, has also materialized with the boosters.

This inflammation is caused by the enlargement of lymph nodes and can show up as an abnormal finding on mammograms and other types of chest scans, causing concern and even the need for additional imaging and follow up, wrote Constance D. Lehman, MD, PhD, and colleagues in an article published in Journal of the American College of Radiology.

Lymph node swelling is a normal immune system reaction to vaccination, and “COVID-19 vaccinations in the arm are a well-documented cause of inflammatory unilateral axillary adenopathy,” noted Dr. Lehman, in an interview. The side effect will occur on the side of the body where the patient received a vaccine, and it is not always noticeable to the woman experiencing it, she said.

“We’re finding that the patients’ bodies are responding to the booster in many ways that are similar to the initial COVID vaccines, with lymph node swelling, muscle aches and pains, headaches, and so on,” said Dr. Lehman, who is chief of breast imaging at the Massachusetts General Hospital, Boston. There have been no real differences in reactions between the Moderna and Pfizer vaccines, she added.

Because axillary lymph node swelling can obscure mammogram results, staff of at least a few imaging centers, including Penn State Breast Center in Hershey, Pa., and Providence Women’s Imaging Center in Torrance, Calif., told this news organization that they are asking women to delay mammogram imaging either 6 weeks or 4-6 weeks after getting a COVID-19 booster.
 

Experts’ suggestions on mammograms, boosters timing

Other experts, including Jessica Leung, MD, acknowledged that vaccine-related reactive adenopathy is seen after the booster dose and provided recommendations for the timing of getting mammograms and the booster with this in mind.

“I would recommend getting the screening mammogram first, which can be followed immediately by vaccination, even on the same day,” said Jessica Leung, MD, a professor of diagnostic radiology at the University of Texas MD Anderson Cancer Center in Houston, Tex.

“If this is not possible from the scheduling perspective, then the patient should consult her health care provider regarding whether it is okay to wait a bit after receiving the vaccine before getting her screening mammogram.”

The answer to that question will likely depend on the time interval since the prior mammogram and the patient’s personal risk factors for developing breast cancer. Dr. Leung noted. “This is all predicated on the assumption that the patient is asymptomatic. If she has any symptoms, for example a palpable breast lump, then she should seek medical attention regardless of timing of vaccination.”

The same holds true for boosters, she said.

She emphasized that careful consideration should be given before delaying the mammogram. “The medical community has a great deal more knowledge at this time than in the early days of COVID-19 vaccination, so we are often able to identify reactive adenopathy related to vaccination. If patients were to delay the mammogram, any reactive adenopathy may persist, on average, for 4-6 weeks.”

Debra Patt, MD, PhD, MBA, executive vice president at Texas Oncology, professor at the University of Texas at Austin, provided a specific example of when a patient should not delay the diagnostic imaging, which is “in the event that there is an abnormal mass in the breast that requires evaluation.”

Providers are now prepared to address these issues, she added.
 

Dr. Lehman’s nuanced recommendations

“It’s easy to get both a mammogram and booster, and just a matter of timing them – so that the reaction doesn’t interfere with the mammography results,” Dr. Lehman said.

But she emphasized that women should not be choosing between their mammograms or a booster. “We are now saying the same thing that we did with the initial vaccine,” said Dr. Lehman. “We don’t want patients delaying their mammograms, and we don’t want them delaying their boosters – both are critical to staying healthy.”

In her center, a model was developed to navigate vaccine-associated adenopathy. While this approach was developed for the primary vaccine series, the same applies for the booster, which is essentially a third dose of the same vaccine, explained Dr. Lehman.

When patients present for mammography, ultrasound, or MRI, the technologist will document their COVID-19 vaccination status (first or second dose or booster), the date it was given, and the location. Adding vaccination documentation to intake forms helps to support appropriate management of patients who undergo imaging after COVID-19 vaccination. Six weeks is used as the cutoff point for defining “recent” vaccination.

For patients who are getting a screening mammography or MRI, and who have no symptoms beyond unilateral axillary adenopathy on the same side of the body where they received the COVID-19 vaccination (given in the arm) within a 6-week period, the following is included in the screening mammography or screening MRI report: “In the specific setting of a patient with documented recent (within the past 6 weeks) COVID-19 vaccination in the ipsilateral arm, axillary adenopathy is a benign imaging finding. No further imaging is indicated at this time. If there is clinical concern that persists more than 6 weeks after the patient received the final vaccine dose, axillary ultrasound is recommended.”

The experts interviewed reported no conflicts of interest.

Key clinical point: Palbociclib dose reduction occurs in real-world practice among patients with advanced breast cancer (BC) and has no negative clinical outcomes. It is more common in older patients, with no effect on survival.

Major finding: Overall, palbociclib dose reduction occurred in 33% of patients, with median time-to-next treatment (P < .001) and median overall survival (OS; P = .003) significantly longer in patients with vs without dose reduction. Dose reductions were more common in patients aged ≥70 years vs <70 years (P = .041), with no effect observed on median OS (P = .051).

Study details: This real-world analysis included 598 patients (median age, 64 years) with hormone receptor-positive, human epidermal growth factor receptor 2-negative, advanced BC who were treated with palbociclib combined with either fulvestrant or aromatase inhibitors.

Disclosures: This study was funded by Dutch health insurer VGZ. The authors declared no conflict of interests.

Source: Ismail RK et al. Breast. 2021 Nov 17. doi: 10.1016/j.breast.2021.11.013.

Key clinical point: Palbociclib dose reduction occurs in real-world practice among patients with advanced breast cancer (BC) and has no negative clinical outcomes. It is more common in older patients, with no effect on survival.

Major finding: Overall, palbociclib dose reduction occurred in 33% of patients, with median time-to-next treatment (P < .001) and median overall survival (OS; P = .003) significantly longer in patients with vs without dose reduction. Dose reductions were more common in patients aged ≥70 years vs <70 years (P = .041), with no effect observed on median OS (P = .051).

Study details: This real-world analysis included 598 patients (median age, 64 years) with hormone receptor-positive, human epidermal growth factor receptor 2-negative, advanced BC who were treated with palbociclib combined with either fulvestrant or aromatase inhibitors.

Disclosures: This study was funded by Dutch health insurer VGZ. The authors declared no conflict of interests.

Source: Ismail RK et al. Breast. 2021 Nov 17. doi: 10.1016/j.breast.2021.11.013.

Key clinical point: Palbociclib dose reduction occurs in real-world practice among patients with advanced breast cancer (BC) and has no negative clinical outcomes. It is more common in older patients, with no effect on survival.

Major finding: Overall, palbociclib dose reduction occurred in 33% of patients, with median time-to-next treatment (P < .001) and median overall survival (OS; P = .003) significantly longer in patients with vs without dose reduction. Dose reductions were more common in patients aged ≥70 years vs <70 years (P = .041), with no effect observed on median OS (P = .051).

Study details: This real-world analysis included 598 patients (median age, 64 years) with hormone receptor-positive, human epidermal growth factor receptor 2-negative, advanced BC who were treated with palbociclib combined with either fulvestrant or aromatase inhibitors.

Disclosures: This study was funded by Dutch health insurer VGZ. The authors declared no conflict of interests.

Source: Ismail RK et al. Breast. 2021 Nov 17. doi: 10.1016/j.breast.2021.11.013.

Key clinical point: The possibility of cancer-related or pathologic vertebral fracture should be considered in women with invasive breast cancer who received endocrine therapy, particularly those with, advanced stage cancer history where every 1 in 3 incident vetrtebral fractures was a pathologic fracture.

.Major finding: Overall, 21.2% of vertebral fractures were pathologic with the chances of vertebral fractures being pathologic higher in patients with stage 3-4 vs initial stage 1 and 2 breast cancer (41.2% vs 17.2%; P < .05).

Study details: Findings are from a cohort study including 5010 women with newly-diagnosed invasive breast cancer who received endocrine therapy and were followed up from invasive breast cancer diagnosis to 10 years or until September 30, 2015, for incident bone fracture.

Disclosures: This study was funded by the National Cancer Institute, National Institutes of Health, and the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California. The authors declared no conflicts of interest.

Source: Lo JC et al. JAMA Netw Open. 2021 Nov 17. doi: 10.1001/jamanetworkopen.2021.33861.

Key clinical point: The possibility of cancer-related or pathologic vertebral fracture should be considered in women with invasive breast cancer who received endocrine therapy, particularly those with, advanced stage cancer history where every 1 in 3 incident vetrtebral fractures was a pathologic fracture.

.Major finding: Overall, 21.2% of vertebral fractures were pathologic with the chances of vertebral fractures being pathologic higher in patients with stage 3-4 vs initial stage 1 and 2 breast cancer (41.2% vs 17.2%; P < .05).

Study details: Findings are from a cohort study including 5010 women with newly-diagnosed invasive breast cancer who received endocrine therapy and were followed up from invasive breast cancer diagnosis to 10 years or until September 30, 2015, for incident bone fracture.

Disclosures: This study was funded by the National Cancer Institute, National Institutes of Health, and the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California. The authors declared no conflicts of interest.

Source: Lo JC et al. JAMA Netw Open. 2021 Nov 17. doi: 10.1001/jamanetworkopen.2021.33861.

Key clinical point: The possibility of cancer-related or pathologic vertebral fracture should be considered in women with invasive breast cancer who received endocrine therapy, particularly those with, advanced stage cancer history where every 1 in 3 incident vetrtebral fractures was a pathologic fracture.

.Major finding: Overall, 21.2% of vertebral fractures were pathologic with the chances of vertebral fractures being pathologic higher in patients with stage 3-4 vs initial stage 1 and 2 breast cancer (41.2% vs 17.2%; P < .05).

Study details: Findings are from a cohort study including 5010 women with newly-diagnosed invasive breast cancer who received endocrine therapy and were followed up from invasive breast cancer diagnosis to 10 years or until September 30, 2015, for incident bone fracture.

Disclosures: This study was funded by the National Cancer Institute, National Institutes of Health, and the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California. The authors declared no conflicts of interest.

Source: Lo JC et al. JAMA Netw Open. 2021 Nov 17. doi: 10.1001/jamanetworkopen.2021.33861.

Key clinical point: Rupacarib did not show clinical benefits in the overall cohort of patients with metastatic breast cancer, but a small proportion of patients with high loss of heterozygosity (LOH) scores and no mutations in germline BReast CAncer genes 1 and 2 (BRCA1/2) seemed to benefit.

Major finding: Investigator-assessed clinical benefit rate was 13.5% (95% CI, 4.5%-28.8%) in the overall cohort, which was below the clinically relevant 20% mark. However, 5 patients achieved clinical benefits with rucaparib, with 2 of them with high LOH scores and no somatic BRCA1/2 mutation achieving a complete response of 12 months and 28.5 months, respectively.

Study details: Findings are from a phase 2 RUBY study including 40 adult patients with progressive human epidermal growth factor receptor 2-negative breast cancer with high LOH or nongermline BRCA1/2 mutation, who received at least 1 dose of rucaparib.

Disclosures: This study was funded by Clovis. The authors declared serving as speaker and advisor and/or receiving research grants, travel fees, consulting fees, and personal fees from various pharmaceutical companies.

Source: Patsouris A et al. Eur J Cancer. 2021 Nov 25. doi: 10.1016/j.ejca.2021.09.028.

Key clinical point: Rupacarib did not show clinical benefits in the overall cohort of patients with metastatic breast cancer, but a small proportion of patients with high loss of heterozygosity (LOH) scores and no mutations in germline BReast CAncer genes 1 and 2 (BRCA1/2) seemed to benefit.

Major finding: Investigator-assessed clinical benefit rate was 13.5% (95% CI, 4.5%-28.8%) in the overall cohort, which was below the clinically relevant 20% mark. However, 5 patients achieved clinical benefits with rucaparib, with 2 of them with high LOH scores and no somatic BRCA1/2 mutation achieving a complete response of 12 months and 28.5 months, respectively.

Study details: Findings are from a phase 2 RUBY study including 40 adult patients with progressive human epidermal growth factor receptor 2-negative breast cancer with high LOH or nongermline BRCA1/2 mutation, who received at least 1 dose of rucaparib.

Disclosures: This study was funded by Clovis. The authors declared serving as speaker and advisor and/or receiving research grants, travel fees, consulting fees, and personal fees from various pharmaceutical companies.

Source: Patsouris A et al. Eur J Cancer. 2021 Nov 25. doi: 10.1016/j.ejca.2021.09.028.

Key clinical point: Rupacarib did not show clinical benefits in the overall cohort of patients with metastatic breast cancer, but a small proportion of patients with high loss of heterozygosity (LOH) scores and no mutations in germline BReast CAncer genes 1 and 2 (BRCA1/2) seemed to benefit.

Major finding: Investigator-assessed clinical benefit rate was 13.5% (95% CI, 4.5%-28.8%) in the overall cohort, which was below the clinically relevant 20% mark. However, 5 patients achieved clinical benefits with rucaparib, with 2 of them with high LOH scores and no somatic BRCA1/2 mutation achieving a complete response of 12 months and 28.5 months, respectively.

Study details: Findings are from a phase 2 RUBY study including 40 adult patients with progressive human epidermal growth factor receptor 2-negative breast cancer with high LOH or nongermline BRCA1/2 mutation, who received at least 1 dose of rucaparib.

Disclosures: This study was funded by Clovis. The authors declared serving as speaker and advisor and/or receiving research grants, travel fees, consulting fees, and personal fees from various pharmaceutical companies.

Source: Patsouris A et al. Eur J Cancer. 2021 Nov 25. doi: 10.1016/j.ejca.2021.09.028.

Key clinical point: Including internal mammary node irradiation (IMNI) with regional node irradiation did not improve disease-free survival (DFS) significantly in the overall cohort of patients with node-positive breast cancer but benefited those with mediocentrally located tumors.

Major finding: The 7-year DFS rate was not significantly different between groups treated without vs with IMNI (81.9% vs 85.3%; hazard ratio [HR], 0.80; 95% CI, 0.57-1.14); however, it was significantly higher in patients with mediocentrally located tumor who were treated with vs without IMNI  (91.8% vs 81.6%; HR, 0.42; 95% CI, 0.22-0.82).

Study details: Findings are from phase 3 KROG 08-06 study including 735 patients with histologically confirmed, node-positive breast cancer who underwent breast-conservation surgery or mastectomy and axillary dissection and were randomly assigned to receive regional nodal irradiation with or without IMNI.

Disclosures: This work was supported by the Cancer Control of the Ministry of Health, Welfare, and Family Affairs, Korea. The authors declared no conflict of interests.

Source: Kim YB et al. JAMA Oncol. 2021 Oct 25. doi: 10.1001/jamaoncol.2021.6036.

Key clinical point: Including internal mammary node irradiation (IMNI) with regional node irradiation did not improve disease-free survival (DFS) significantly in the overall cohort of patients with node-positive breast cancer but benefited those with mediocentrally located tumors.

Major finding: The 7-year DFS rate was not significantly different between groups treated without vs with IMNI (81.9% vs 85.3%; hazard ratio [HR], 0.80; 95% CI, 0.57-1.14); however, it was significantly higher in patients with mediocentrally located tumor who were treated with vs without IMNI  (91.8% vs 81.6%; HR, 0.42; 95% CI, 0.22-0.82).

Study details: Findings are from phase 3 KROG 08-06 study including 735 patients with histologically confirmed, node-positive breast cancer who underwent breast-conservation surgery or mastectomy and axillary dissection and were randomly assigned to receive regional nodal irradiation with or without IMNI.

Disclosures: This work was supported by the Cancer Control of the Ministry of Health, Welfare, and Family Affairs, Korea. The authors declared no conflict of interests.

Source: Kim YB et al. JAMA Oncol. 2021 Oct 25. doi: 10.1001/jamaoncol.2021.6036.

Key clinical point: Including internal mammary node irradiation (IMNI) with regional node irradiation did not improve disease-free survival (DFS) significantly in the overall cohort of patients with node-positive breast cancer but benefited those with mediocentrally located tumors.

Major finding: The 7-year DFS rate was not significantly different between groups treated without vs with IMNI (81.9% vs 85.3%; hazard ratio [HR], 0.80; 95% CI, 0.57-1.14); however, it was significantly higher in patients with mediocentrally located tumor who were treated with vs without IMNI  (91.8% vs 81.6%; HR, 0.42; 95% CI, 0.22-0.82).

Study details: Findings are from phase 3 KROG 08-06 study including 735 patients with histologically confirmed, node-positive breast cancer who underwent breast-conservation surgery or mastectomy and axillary dissection and were randomly assigned to receive regional nodal irradiation with or without IMNI.

Disclosures: This work was supported by the Cancer Control of the Ministry of Health, Welfare, and Family Affairs, Korea. The authors declared no conflict of interests.

Source: Kim YB et al. JAMA Oncol. 2021 Oct 25. doi: 10.1001/jamaoncol.2021.6036.

Key clinical point: COVID-19 pandemic has changed breast cancer (BC) management strategies, with the use of neoadjuvant endocrine therapy (NET) increasing significantly during the pandemic; however, no effect was observed on BC stage at diagnosis.

Major finding: The use of NET increased significantly during COVID-19 pandemic period (P = .002), particularly in patients with stage I hormone receptor-positive, human epidermal growth factor receptor 2-negative BC where the use of NET increased from 10% pre-COVID-19 to 23% during COVID-19 pandemic (P = .001). The pandemic had no effect on clinical prognostic stage (P = 0.39) and proportion of patients with clinical nodal status+ BC (P = 0.38).

Study details: This was a retrospective chart review including patients with newly diagnosed BC who presented at Mayo Clinic, Rochester during (March-August 2020; n=197) or before (March-August 2019; n=376) the COVID-19 pandemic.

Disclosures: Dr. Boughey declared receiving research funding from Lilly and was on a data and safety monitoring board for Cairns Surgical.

Source: Tonneson JE et al. Ann Surg Oncol. 2021 Nov 23. doi: 10.1245/s10434-021-11088-6.

Key clinical point: COVID-19 pandemic has changed breast cancer (BC) management strategies, with the use of neoadjuvant endocrine therapy (NET) increasing significantly during the pandemic; however, no effect was observed on BC stage at diagnosis.

Major finding: The use of NET increased significantly during COVID-19 pandemic period (P = .002), particularly in patients with stage I hormone receptor-positive, human epidermal growth factor receptor 2-negative BC where the use of NET increased from 10% pre-COVID-19 to 23% during COVID-19 pandemic (P = .001). The pandemic had no effect on clinical prognostic stage (P = 0.39) and proportion of patients with clinical nodal status+ BC (P = 0.38).

Study details: This was a retrospective chart review including patients with newly diagnosed BC who presented at Mayo Clinic, Rochester during (March-August 2020; n=197) or before (March-August 2019; n=376) the COVID-19 pandemic.

Disclosures: Dr. Boughey declared receiving research funding from Lilly and was on a data and safety monitoring board for Cairns Surgical.

Source: Tonneson JE et al. Ann Surg Oncol. 2021 Nov 23. doi: 10.1245/s10434-021-11088-6.

Key clinical point: COVID-19 pandemic has changed breast cancer (BC) management strategies, with the use of neoadjuvant endocrine therapy (NET) increasing significantly during the pandemic; however, no effect was observed on BC stage at diagnosis.

Major finding: The use of NET increased significantly during COVID-19 pandemic period (P = .002), particularly in patients with stage I hormone receptor-positive, human epidermal growth factor receptor 2-negative BC where the use of NET increased from 10% pre-COVID-19 to 23% during COVID-19 pandemic (P = .001). The pandemic had no effect on clinical prognostic stage (P = 0.39) and proportion of patients with clinical nodal status+ BC (P = 0.38).

Study details: This was a retrospective chart review including patients with newly diagnosed BC who presented at Mayo Clinic, Rochester during (March-August 2020; n=197) or before (March-August 2019; n=376) the COVID-19 pandemic.

Disclosures: Dr. Boughey declared receiving research funding from Lilly and was on a data and safety monitoring board for Cairns Surgical.

Source: Tonneson JE et al. Ann Surg Oncol. 2021 Nov 23. doi: 10.1245/s10434-021-11088-6.

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer (BC) significantly benefitted from neoadjuvant chemotherapy with intense dose-dense epirubicin, paclitaxel and cyclophosphamide (iddPEC) vs paclitaxel plus non-pegylated liposomal doxorubicin (PM) plus carboplatin ([Cb], triple-negative BC only).

Major finding: Although the 4-year invasive disease-free survival (iDFS; P log-rank = .334) and overall survival (OS, P log-rank = .637) was not significantly different between iddEPC vs PM(Cb) arms in the entire cohort, the subgroup of patients with HR+/HER-2-, BC, showed significantly improved iDFS (hazard ratio [HR], 2.11; P log-rank = .025) and OS (HR,  3.26; P log-rank = .029).with iddEPC.

Study details: Findings are from phase 3 GeparOcto trial including 961 patients with high-risk early BC, who were randomly assigned 1:1 to receive iddEPC or PM(Cb), of which 706 patients completed treatment.

Disclosures: This study was funded by Roche, Amgen, TEVA, and Vifor. The authors reported receiving research grants, personal fees, consulting fees, honoraria and/ or travel support from the above companies and other sources.

Source: Schneeweiss A et al. Eur J Cancer. 2021 Nov 17. doi: 10.1016/j.ejca.2021.10.011.

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer (BC) significantly benefitted from neoadjuvant chemotherapy with intense dose-dense epirubicin, paclitaxel and cyclophosphamide (iddPEC) vs paclitaxel plus non-pegylated liposomal doxorubicin (PM) plus carboplatin ([Cb], triple-negative BC only).

Major finding: Although the 4-year invasive disease-free survival (iDFS; P log-rank = .334) and overall survival (OS, P log-rank = .637) was not significantly different between iddEPC vs PM(Cb) arms in the entire cohort, the subgroup of patients with HR+/HER-2-, BC, showed significantly improved iDFS (hazard ratio [HR], 2.11; P log-rank = .025) and OS (HR,  3.26; P log-rank = .029).with iddEPC.

Study details: Findings are from phase 3 GeparOcto trial including 961 patients with high-risk early BC, who were randomly assigned 1:1 to receive iddEPC or PM(Cb), of which 706 patients completed treatment.

Disclosures: This study was funded by Roche, Amgen, TEVA, and Vifor. The authors reported receiving research grants, personal fees, consulting fees, honoraria and/ or travel support from the above companies and other sources.

Source: Schneeweiss A et al. Eur J Cancer. 2021 Nov 17. doi: 10.1016/j.ejca.2021.10.011.

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer (BC) significantly benefitted from neoadjuvant chemotherapy with intense dose-dense epirubicin, paclitaxel and cyclophosphamide (iddPEC) vs paclitaxel plus non-pegylated liposomal doxorubicin (PM) plus carboplatin ([Cb], triple-negative BC only).

Major finding: Although the 4-year invasive disease-free survival (iDFS; P log-rank = .334) and overall survival (OS, P log-rank = .637) was not significantly different between iddEPC vs PM(Cb) arms in the entire cohort, the subgroup of patients with HR+/HER-2-, BC, showed significantly improved iDFS (hazard ratio [HR], 2.11; P log-rank = .025) and OS (HR,  3.26; P log-rank = .029).with iddEPC.

Study details: Findings are from phase 3 GeparOcto trial including 961 patients with high-risk early BC, who were randomly assigned 1:1 to receive iddEPC or PM(Cb), of which 706 patients completed treatment.

Disclosures: This study was funded by Roche, Amgen, TEVA, and Vifor. The authors reported receiving research grants, personal fees, consulting fees, honoraria and/ or travel support from the above companies and other sources.

Source: Schneeweiss A et al. Eur J Cancer. 2021 Nov 17. doi: 10.1016/j.ejca.2021.10.011.

Key clinical point: Preliminary evidence indicated feasibility of LY2780301, a dual inhibitor of p70 ribosomal protein S6 kinase and protein kinase B (AKT) and paclitaxel combination in patients with hormone-resistant2 (HER2)-negative advanced breast cancer (BC).

Major finding: The recommended phase 2 dose was LY2780301 500 mg once daily + weekly paclitaxel 80 mg/m². The 6-month objective response rate for phase 2 was 63.9% (90% CI, 48.8-76.8) in the overall population and 55% (90% CI, 35.0-73.7) in phosphatidylinositol-3-kinase/AKT positive patients. The common drug-related adverse events were neuropathy, asthenia, ungual toxicity and pneumonitis.

Study details: Findings are from a prospective, multi-centred, phase 1b/2 TAKTIC trial including 48 patients with HER2-negative advanced BC with (phase 1B; n=12) or without (phase 2; n=36) previous cytotoxic treatment for advanced disease who were administered oral LY2780301 + intravenous paclitaxel.

Disclosures: This study was funded by the French National Cancer Institute, the Caritative Foundation and the Ligue Nationale Contre le Cancer. Three authors declared serving as advisory board member and/or receiving research grants and non-financial support from various pharmaceutical companies.

Source: Vicier C et al. Eur J Cancer. 2021 Nov 12. doi: 10.1016/j.ejca.2021.09.040.

Key clinical point: Preliminary evidence indicated feasibility of LY2780301, a dual inhibitor of p70 ribosomal protein S6 kinase and protein kinase B (AKT) and paclitaxel combination in patients with hormone-resistant2 (HER2)-negative advanced breast cancer (BC).

Major finding: The recommended phase 2 dose was LY2780301 500 mg once daily + weekly paclitaxel 80 mg/m². The 6-month objective response rate for phase 2 was 63.9% (90% CI, 48.8-76.8) in the overall population and 55% (90% CI, 35.0-73.7) in phosphatidylinositol-3-kinase/AKT positive patients. The common drug-related adverse events were neuropathy, asthenia, ungual toxicity and pneumonitis.

Study details: Findings are from a prospective, multi-centred, phase 1b/2 TAKTIC trial including 48 patients with HER2-negative advanced BC with (phase 1B; n=12) or without (phase 2; n=36) previous cytotoxic treatment for advanced disease who were administered oral LY2780301 + intravenous paclitaxel.

Disclosures: This study was funded by the French National Cancer Institute, the Caritative Foundation and the Ligue Nationale Contre le Cancer. Three authors declared serving as advisory board member and/or receiving research grants and non-financial support from various pharmaceutical companies.

Source: Vicier C et al. Eur J Cancer. 2021 Nov 12. doi: 10.1016/j.ejca.2021.09.040.

Key clinical point: Preliminary evidence indicated feasibility of LY2780301, a dual inhibitor of p70 ribosomal protein S6 kinase and protein kinase B (AKT) and paclitaxel combination in patients with hormone-resistant2 (HER2)-negative advanced breast cancer (BC).

Major finding: The recommended phase 2 dose was LY2780301 500 mg once daily + weekly paclitaxel 80 mg/m². The 6-month objective response rate for phase 2 was 63.9% (90% CI, 48.8-76.8) in the overall population and 55% (90% CI, 35.0-73.7) in phosphatidylinositol-3-kinase/AKT positive patients. The common drug-related adverse events were neuropathy, asthenia, ungual toxicity and pneumonitis.

Study details: Findings are from a prospective, multi-centred, phase 1b/2 TAKTIC trial including 48 patients with HER2-negative advanced BC with (phase 1B; n=12) or without (phase 2; n=36) previous cytotoxic treatment for advanced disease who were administered oral LY2780301 + intravenous paclitaxel.

Disclosures: This study was funded by the French National Cancer Institute, the Caritative Foundation and the Ligue Nationale Contre le Cancer. Three authors declared serving as advisory board member and/or receiving research grants and non-financial support from various pharmaceutical companies.

Source: Vicier C et al. Eur J Cancer. 2021 Nov 12. doi: 10.1016/j.ejca.2021.09.040.

Key clinical point: Dalpiciclib plus fulvestrant prolonged progression-free survival (PFS) compared with placebo+fulvestrant in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer who progressed during or after endocrine therapy.

Major finding: Patients receiving dalpiciclib+fulvestrant showed significantly prolonged investigator-assessed progression-free survival than those who received placebo+fulvestrant (median, 15.7 months vs 7.2 months; hazard ratio, 0.42; P < .0001). Serious adverse events were reported by 5.8% vs 6.7% of patients recieving dalpiciclib+fulvestrant vs placebo+fulvestrant.

Study details: Findings are interim results from phase 3 DAWNA-1 trial, including 361 patients with HR-positive, HER2-negative locally advanced breast cancer who progressed on endocrine therapy and were randomly assigned to dalpiciclib+fulvestrant or placebo+fulvestrant.

Disclosures: This study was funded by Jiangsu Hengrui Pharmaceuticals. The authors reported receiving research grants, advisory fees from Hengrui and other sources. Four authors declared being employees of Hengrui.

Source: Xu B et al. Nat Med. 2021 Nov 4. doi: 10.1038/s41591-021-01562-9.

Key clinical point: Dalpiciclib plus fulvestrant prolonged progression-free survival (PFS) compared with placebo+fulvestrant in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer who progressed during or after endocrine therapy.

Major finding: Patients receiving dalpiciclib+fulvestrant showed significantly prolonged investigator-assessed progression-free survival than those who received placebo+fulvestrant (median, 15.7 months vs 7.2 months; hazard ratio, 0.42; P < .0001). Serious adverse events were reported by 5.8% vs 6.7% of patients recieving dalpiciclib+fulvestrant vs placebo+fulvestrant.

Study details: Findings are interim results from phase 3 DAWNA-1 trial, including 361 patients with HR-positive, HER2-negative locally advanced breast cancer who progressed on endocrine therapy and were randomly assigned to dalpiciclib+fulvestrant or placebo+fulvestrant.

Disclosures: This study was funded by Jiangsu Hengrui Pharmaceuticals. The authors reported receiving research grants, advisory fees from Hengrui and other sources. Four authors declared being employees of Hengrui.

Source: Xu B et al. Nat Med. 2021 Nov 4. doi: 10.1038/s41591-021-01562-9.

Key clinical point: Dalpiciclib plus fulvestrant prolonged progression-free survival (PFS) compared with placebo+fulvestrant in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer who progressed during or after endocrine therapy.

Major finding: Patients receiving dalpiciclib+fulvestrant showed significantly prolonged investigator-assessed progression-free survival than those who received placebo+fulvestrant (median, 15.7 months vs 7.2 months; hazard ratio, 0.42; P < .0001). Serious adverse events were reported by 5.8% vs 6.7% of patients recieving dalpiciclib+fulvestrant vs placebo+fulvestrant.

Study details: Findings are interim results from phase 3 DAWNA-1 trial, including 361 patients with HR-positive, HER2-negative locally advanced breast cancer who progressed on endocrine therapy and were randomly assigned to dalpiciclib+fulvestrant or placebo+fulvestrant.

Disclosures: This study was funded by Jiangsu Hengrui Pharmaceuticals. The authors reported receiving research grants, advisory fees from Hengrui and other sources. Four authors declared being employees of Hengrui.

Source: Xu B et al. Nat Med. 2021 Nov 4. doi: 10.1038/s41591-021-01562-9.

Key clinical point: Final 12-year results from the PROMISE-GIM6 study reassures safety of concurrent administration of gonadotropin-releasing hormone agonist (GnRHa), triptorelin during chemotherapy in premenopausal women with early breast cancer (BC).

Major finding: The 12-year disease-free survival (65.7 % vs 69.2%; hazard ratio [HR], 1.16; P = .50), overall survival (81.2 % vs 81.3%; HR, 1.17; P = .58), and posttreatment pregnancy (9 vs 4 patients; HR, 2.14; P = .20) were not significantly different in GnRHa+chemotherapy vs chemotherapy-only groups.

Study details: PROMISE-GIM6, a phase 3 superiority trial included 281 premenopausal women with hormone receptor-positive or -negative early BC who were randomly assigned to receive GnRHa+chemotherapy or chemotherapy alone.

Disclosures: This study was funded by IRCCS Ospedale Policlinico San Martino and Associazione Italiana per la Ricerca sul Cancro and the Italian Ministry of Health. Some of the authors declared serving as a consultant and/or receiving speaker honoraria and travel accommodation from various pharmaceutical companies.

Source: Lambertini M et al. J Natl Cancer Inst. 2021 Nov 25. doi: 10.1093/jnci/djab213.

Key clinical point: Final 12-year results from the PROMISE-GIM6 study reassures safety of concurrent administration of gonadotropin-releasing hormone agonist (GnRHa), triptorelin during chemotherapy in premenopausal women with early breast cancer (BC).

Major finding: The 12-year disease-free survival (65.7 % vs 69.2%; hazard ratio [HR], 1.16; P = .50), overall survival (81.2 % vs 81.3%; HR, 1.17; P = .58), and posttreatment pregnancy (9 vs 4 patients; HR, 2.14; P = .20) were not significantly different in GnRHa+chemotherapy vs chemotherapy-only groups.

Study details: PROMISE-GIM6, a phase 3 superiority trial included 281 premenopausal women with hormone receptor-positive or -negative early BC who were randomly assigned to receive GnRHa+chemotherapy or chemotherapy alone.

Disclosures: This study was funded by IRCCS Ospedale Policlinico San Martino and Associazione Italiana per la Ricerca sul Cancro and the Italian Ministry of Health. Some of the authors declared serving as a consultant and/or receiving speaker honoraria and travel accommodation from various pharmaceutical companies.

Source: Lambertini M et al. J Natl Cancer Inst. 2021 Nov 25. doi: 10.1093/jnci/djab213.

Key clinical point: Final 12-year results from the PROMISE-GIM6 study reassures safety of concurrent administration of gonadotropin-releasing hormone agonist (GnRHa), triptorelin during chemotherapy in premenopausal women with early breast cancer (BC).

Major finding: The 12-year disease-free survival (65.7 % vs 69.2%; hazard ratio [HR], 1.16; P = .50), overall survival (81.2 % vs 81.3%; HR, 1.17; P = .58), and posttreatment pregnancy (9 vs 4 patients; HR, 2.14; P = .20) were not significantly different in GnRHa+chemotherapy vs chemotherapy-only groups.

Study details: PROMISE-GIM6, a phase 3 superiority trial included 281 premenopausal women with hormone receptor-positive or -negative early BC who were randomly assigned to receive GnRHa+chemotherapy or chemotherapy alone.

Disclosures: This study was funded by IRCCS Ospedale Policlinico San Martino and Associazione Italiana per la Ricerca sul Cancro and the Italian Ministry of Health. Some of the authors declared serving as a consultant and/or receiving speaker honoraria and travel accommodation from various pharmaceutical companies.

Source: Lambertini M et al. J Natl Cancer Inst. 2021 Nov 25. doi: 10.1093/jnci/djab213.