Abstract Targeting the human epidermal growth factor receptor 2 (HER2) has yielded major advances in breast cancer treatment. Accordingly, it has generated interest in targeting HER2 to treat ...gynecologic malignancies. Multiple studies have evaluated the rates of HER2 overexpression and/or amplification in ovarian and uterine cancers. HER2 has also been studied as a prognostic factor but resulting data has been contradictory. Moreover, clinical trials of HER2-directed therapies, including trastuzumab, pertuzumab, and lapatinib in ovarian and uterine cancers have been largely disappointing. Current research on HER2 in gynecologic malignancies has focused on identifying mechanisms of resistance and looking further into how HER2 signaling in gynecologic cancers differs from breast cancer. In this review, we highlight the existing data of targeting HER2 in ovarian and uterine carcinomas, many dating back more than a decade, and discuss future directions in pursuing HER2 as a potential target in these diseases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Targeted therapies in HER2-positive metastatic breast cancer significantly improve outcomes but efficacy is limited by therapeutic resistance. HER2 is an acutely sensitive Heat Shock Protein 90 ...(HSP90) client and HSP90 inhibition can overcome trastuzumab resistance. Preclinical data suggest that HSP90 inhibition is synergistic with taxanes with the potential for significant clinical activity. We therefore tested ganetespib, a HSP90 inhibitor, in combination with paclitaxel and trastuzumab in patients with trastuzumab-refractory HER2-positive metastatic breast cancer.
In this phase I dose-escalation study, patients with trastuzumab-resistant HER2-positive metastatic breast cancer received weekly trastuzumab (2 mg/kg) and paclitaxel (80 mg/m
) on days 1, 8, 15, and 22 of a 28-day cycle with escalating doses of ganetespib (100 mg/m
, 150 mg/m
, and a third cohort of 125 mg/m
if needed) on days 1, 8, and 15. Therapy was continued until disease progression or toxicity. The primary objective was to establish the safety and maximum tolerated dose and/or recommended phase II dose (RP2D) of this therapy. The secondary objectives included evaluation of the effects of ganetespib on the pharmacokinetics of paclitaxel, and to make a preliminary assessment of the efficacy of the combination therapy.
Dose escalation was completed for the two main cohorts without any observed dose-limiting toxicities. Nine patients received treatment. The median prior lines of anti-HER2 therapy numbered three (range 2-4), including prior pertuzumab in 9/9 patients and ado-trastuzumab emtansine (T-DM1) in 8/9 patients. The most common grade 1/2 adverse events (AEs) were diarrhea, fatigue, anemia, and rash. There were no grade 4 AEs related to ganetespib. The overall response rate was 22% (2/9 patients had partial response) and stable disease was seen in 56% (5/9 patients). The clinical benefit rate was 44% (4/9 patients). The median progression-free survival was 20 weeks (range 8-55).
The RP2D of ganetespib is 150 mg/m
in combination with weekly paclitaxel plus trastuzumab. The combination was safe and well tolerated. Despite prior taxanes, pertuzumab, and T-DM1, clinical activity of this triplet regimen in this heavily pretreated cohort is promising and warrants further study in HER2-positive metastatic breast cancer.
ClinicalTrials.gov NCT02060253 . Registered 30 January 2014.
e13646 Background: The integration of artificial intelligence (AI) technologies has opened new avenues for information dissemination. GPT-4 (GPT) is a large language model developed by open AI. ...Concerns about its accuracy exist, especially in health communications. We conducted a study to evaluate the accuracy of GPT responses to questions about anti-neoplastic agents for solid tumor malignancies. Methods: We evaluated GPT responses to four questions (Table 1) for each solid tumor drug newly approved or approved for a new indication between 2020 and 2022. The responses from GPT were saved and then compared to the information provided in the medication package insert. For discordant results, a second search was run using a new GPT session. The study was performed by two physicians who ensured that the comparison was both rigorous and unbiased. Results: 53 unique antineoplastic agents were included. GPT responses regarding FDA approval & mechanism of action were correct for each drug (100%). When asked about common adverse reactions, GPT provided incorrect responses for 47% (25/53) of the medications and correct responses for 53% (28/43). The inaccurate responses were either missing certain side effects (88%), provided inaccurate incidence rates (8%), and/or included side effects not listed on the package insert (20%). When a second search was conducted with the same question, GPT provided different responses in 76% (19/25), same responses in 16% (4/25) and now correct responses in 8% (2/25). When asked about drug warnings and precautions, GPT provided incorrect responses for 68% (36/53) of the medications and correct responses for 32% (17/53). The inaccurate responses were missing certain warnings and precautions (89%) and/or included warnings and precautions not listed on the package insert (25%). When a second search was conducted with the same question, GPT provided different responses in 53% (19/36), same responses in 39% (14/36) and now correct responses in 8% (3/36). Conclusions: Analysis of solid tumor drugs approved for use in 2020-2022 evaluated GPT's ability to provide drug information. GPT accurately identified FDA approved indications & mechanisms of action but had significant limitations in accurately reporting a comprehensive list of adverse reactions, drug warnings and precautions. GPT occasionally included drug side effects that are not listed in the package insert. Significant variability in output was demonstrated in repeated searches. Given the inconsistencies in the data identified, GPT should not be used as a primary source of medical information and may potentially cause harm. Table: see text
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•Academic or professional content on social media must be accurate and succinct.•Social media can be used to advance one’s academic or professional career.•Graphical abstracts ...increase reader engagement with articles and are easy to create.
On February 6th, 2024, Gynecologic Oncology Reports and the Society of Gynecologic Oncology Education Committee co-hosted a webinar about ways to use social media for career enhancement and for dissemination of research. During the discussion, we reviewed:i.how to identify one’s goals, target audience, and select a social media platform.ii.how to navigate the negatives of social media.iii.how to develop one’s online academic brand.iv.how to use social media for academic promotion and career advancement.v.how to use social media as a research tool.vi.how to use visual tools to bring attention to one’s research.The objective of this report is to review the literature on social media in oncology and review the webinar presentation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Micro-Abstract: Activation of the phosphatidylinositide-3-kinase/mammalian target of rapamycin and Janus kinase/signal transducer and activator of transcription pathways are described in inflammatory ...breast cancer (IBC) preclinical data. This retrospective analysis of IBC and invasive ductal carcinoma tumor tissues treated with neoadjuvant chemotherapy showed pathway activity compared with untreated invasive ductal carcinoma, which suggests a potential mechanism of resistance and supports a potential role for targeting these pathways in prospective studies.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
12132 Background: Sexual health is a prevalent and distressing toxicity in women after cancer treatment. Sexual health needs and treatment require multidisciplinary management and despite the ...existence of guidelines on the management of sexual health, are often overlooked in the clinical setting. Methods: An anonymous online survey regarding sexual health for people with a current or prior breast cancer diagnosis was distributed through a social media platform (Instagram) and e-mail. Questions included demographics, breast cancer history and treatment, sexual health symptoms, and experience with medical care for sexual health symptoms. Results: Out of 1775 respondents, 1462 answered the question of whether or not sexual health changed after breast cancer diagnosis or treatment & were included in this analysis. Mean age: 47.7 years. 87.3% of respondents identified as white and 1.6% as Black. Stage: 0 (8.5%), 1 (38.4%), 2 (34.2%), 3 (14.8%) & 4 (2.9%). Estrogen receptor positive (81.5%), HER2 positive (27%), triple negative (12.9%). Breast cancer diagnosis or treatments caused a moderate to great deal of change to sexual health in 89.5% of respondents and a moderate to great deal of distress in 85%. The sexual health concerns are summarized in the table. 73% of participants did not receive information about sexual health from their healthcare team. Among participants who reported a change to sexual health, only 12% were satisfied with how their sexual health concerns were addressed. Treatment was not offered for sexual health concerns to 39% of respondents and 63% had not been referred to any specialists for sexual health concerns. 46% of participants had not been offered non-hormonal treatments for genitourinary concerns, 55% were told vaginal hormones were not an option, and 83% were not offered treatment for low libido despite lower sexual desire. 80% of respondents received information about sexual health from social media. Of those, 62% stated that their primary source of information on social media were health care professional accounts. Conclusions: In this online survey, sexual health concerns were highly prevalent and distressing after breast cancer diagnosis. There was a very low level of discussion with medical professionals and treatments were infrequently offered to patients, despite the existence of medical guidelines on sexual health care for women after cancer. Patients are turning to social media, & specifically to medical professional accounts, for information. Future efforts to address sexual needs for breast cancer survivors and thrivers are warranted. Table: see text
Abstract
Background: Chemotherapy for breast cancer can have a detrimental effect on cardiorespiratory fitness. VO2max (maximal oxygen consumption measured during exercise) is a key predictor of ...cardiovascular risk and has been found to be lower in women with a history of breast cancer compared with healthy women. Chemotherapy is associated with a decrease in VO2max but these decreases may be attenuated with exercise training, such as resistance, aerobic and high-intensity interval training programs. Physical activity may reduce the risk of mortality for breast cancer patients, improve quality of life (QoL) and reduce weight. All gyms and fitness studios had to close due to the COVID-19 pandemic, and while some have re-opened, many patients are not comfortable returning to an exercise facility now and are incorporating virtual exercise into their routine. Prior studies have demonstrated the safety, feasibility and potential benefits of home-based exercise programs for breast cancer patients receiving chemotherapy. However, many of these programs are self-reported, which can create bias and to our knowledge, there is no existing data on the effect of home-based exercise programs for breast cancer patients receiving neoadjuvant chemotherapy. The goal of the STRENGTH Trial is to evaluate the effect of a 12-week virtual supervised exercise program in breast cancer patients receiving chemotherapy on cardiorespiratory fitness. Study Description: This is a single-center, prospective, single-arm study designed to evaluate the effect of a virtual supervised exercise training program in breast cancer patients receiving chemotherapy on cardiorespiratory fitness. All participants are assigned to a 12-week virtual supervised exercise program and asked to complete a total of 150 minutes of moderate intensity physical activity per week, as a combination of a weekly virtual personal training session and workout classes streamed from the Peloton®Digital platform (i.e. walking, running, cardio, yoga, strength training, and cycling classes). Due to the ongoing COVID-19 pandemic, cardiorespiratory fitness cannot be assessed using a cardiopulmonary exercise test. As such, the co-primary endpoints are resting blood pressure and heart rate and distance walked during a Six-Minute Walk Test (6MWT), which is measured at the start and completion of the 12-week supervised exercise program. Secondary endpoints are QoL as assessed by the Functional Assessment of Cancer Therapy - General (FACT-G) and symptom management assessment by the MD Anderson Symptom Inventory (MDASI). Several exploratory clinical endpoints will be collected including adherence to the program, type of fitness classes completed, and treatment toxicities. Eligibility Criteria: Patients aged ≥18 years with stage I to IV breast cancer who are planned to receive at least 12 weeks of chemotherapy of investigator’s choice are eligible for inclusion. Patients who have an ejection fraction on echocardiogram <40%, symptomatic heart failure, myocarditis, myocardial infarction, cerebrovascular accident, pulmonary embolism or COVID-19 infection within past 3 months, severe, uncorrected valvular disease, uncontrolled hypertension and/or uncontrolled arrhythmias are excluded. Statistical Methods: Continuous and categorical variables measured in this study will be summarized. The distributions of the data collected in the study participants from the 6MWT, FACT-G and MDASI will be evaluated. Based upon the findings, either paired t-tests or nonparametric Wilcoxon signed-rank tests will be performed to analyze the differences observed between the pre-exercise intervention data and the post-exercise intervention data. P values <= 0.05 will be considered statistically significant. . Accrual: At this time, 20 patients have enrolled out of a planned 30 participants.
Citation Format: Eleonora Teplinsky, Amanda Podolski, Benita Burke, Kasey Bessada, Laura Klein, Moira Christoudias, Kariann Abbate. Supervised training exercise program during chemotherapy for breast cancer (STRENGTH) trial abstract. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-13-01.
Purpose of Review
Male breast cancer is a relatively uncommon and rare disease that is often managed based on evidence adopted from trials pertaining to female breast cancer due to low accrual rates ...or exclusion of males. This is despite the known differences in the biology and epidemiology of this condition. This review provides an update regarding the management and surveillance of male breast cancer.
Recent Findings
Men with breast cancer tend to undergo more extensive surgery in the breast and axilla. The outcomes of male breast cancer compared to a similar subtype of female breast cancer appear worse when matched for stage. Systemic therapies remain predominantly based on recommendations for female breast cancer, although tamoxifen is the more optimal endocrine therapy for men than women. Surveillance with mammograms is recommended for patients harboring a breast cancer susceptibility gene but is otherwise not advised for men who have undergone a mastectomy. Notably, the role of other imaging modalities, including ultrasound and magnetic resonance imaging, is minimal. Although the focus on survivorship care among men is low, it is abundantly clear that this is a stigmatizing diagnosis for men, and they suffer from long-term physical and psychological sequelae following a diagnosis and treatment of breast cancer.
Summary
In summary, providing more gender-inclusive care and advocating for increased representation of men in prospective breast cancer studies and clinical trials may help improve outcomes and provide enhanced support for this population.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
e24032
Background: Nutrition and lifestyle interventions are instrumental in modifying cancer risk. These changes are often challenging for patients to make due to residual side effects from active ...treatment and/or ongoing toxicities from current treatment. The SHINE (Survivorship and Health Interventions in Nutrition and Exercise) Program is a wellness program for patients with breast cancer focusing on three pillars of nutrition, exercise and community in order to improve overall health outcomes and decrease the risk of cancer recurrence. Methods: Participants in SHINE have either been diagnosed with ductal carcinoma in situ (DCIS) and/or stage I-IV breast cancer. They are referred to the program at the three-month breast surgery post-operative follow-up appointment or any time after that. All patients are referred to meet with a registered dietitian (RD) and integrative health coach, who provides counseling and education on how to reduce risk through diet and lifestyle, using evidence-based recommendations. Patients are provided with support and accountability. A collaborative program, the Physician Referred Exercise Program (PREP), was established with our health system’s medical fitness center, Valley Health LifeStyles. Patients undergo a fitness assessment that focuses on aerobic fitness, muscle strength and endurance, flexibility, & functional activity. Each patient then receives an exercise prescription developed by a degreed exercise specialist, taking into account both the physician’s & patient’s recommendations & goals. Results: Each component of the SHINE Program has been developed in various stages due to the COVID-19 pandemic. 336 patients with either DCIS or stage I-IV breast cancer have been seen by the RD from December 2020 through January 2022. Mean number of visits/patient: 1.89 (range 1-8). N = 48 were participants in a 12-week study on the feasibility of nutrition counseling and impact on quality of life (QOL) which is still in progress. 76 patient referrals have been placed to the PREP program from August 2021-February 2022. Multiple community programs (Table) have been created for patients to help them develop shared experiences & camaraderie with each other so that they can better integrate new ideas and lifestyle modifications. Conclusions: The SHINE Program addresses care for the whole person, empowering individuals to live their healthiest lifestyle. Future work will focus on clinical trials to evaluate the benefits of these individual and collective interventions on overall QOL, QOL subscales (physical, psychological, social & spiritual well-being), & survivorship symptoms.Table: see text
11018
Background: Imposter syndrome (IS) is defined as an inability to believe that one’s success is deserved. It is commonly encountered by physicians, with cited statistics ranging from 22% to 98%, ...is associated with negative mental health impacts and can be harmful to one’s wellbeing. Given increasing SM use in hematology/oncology (H/O), we aimed to evaluate the effect of SM on IS among oncology trainees and oncologists. Methods: An anonymous online survey was distributed to oncology trainees and oncologists through SM platforms (Twitter, Facebook (FB), Instagram (IG)) and e-mail. Questions included demographics, current SM use, a novel scale for IS on SM (Table), Young Imposter Syndrome (YIS) Scale (a validated IS instrument) & assessment of mental health impacts of SM. Results: Out of 195 respondents, 103 answered all questions; median age 40y (27-65), 81% female. 21% were trainees and 36%, 30%, and 12% were early, mid and late-career faculty, respectively. Specialties included: adult H/O (72%), gynecologic oncology (11.3%), radiation oncology (10.5%), surgical oncology (4.1%), and pediatric H/O (1.5%). Twitter was the most commonly used SM platform (68%) followed by FB (36%) & IG (20%). 26% utilized professional SM 0-1 times/week while 28% did so daily. 97/157 (62%) noted positive mental health impacts from SM. 41% felt anxious, lonely or depressed due to SM. 19.7% have experienced SM harassment or cyberbullying. More than 50% of respondents met criteria on the YIS and IS scale; indeed, the YIS and IS on SM Scales were significantly correlated with each other (r = 0.57, p < 0.001, N = 103). The presence of IS on SM was associated with gender but not race/ethnicity or career stage. 59% of females versus 28% of males met criteria for IS (p = 0.02). The presence of IS on SM was significantly associated with self-perceived IS in professional settings (p < 0.001), but not in personal settings (p = 0.21). Conclusions: Many oncology professionals experienced IS while interacting on SM, but also note a positive mental health impact with SM use. The presence of IS on SM correlated with results on the YIS Scale, suggesting a novel assessment method, but further validation is needed. Future efforts to combat IS on SM while enhancing positive aspects of medical SM are warranted. Table: see text
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