Haematology+Oncology_News

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H aematology & Oncology News
is published by Elsevier Australia
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Medical Oncologist
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Ovarian suppression during breast cancer
chemotherapy helped preserve long-term function
BY AMY KARON
Frontline Medical News
From JAMA
Ovarian suppression with triptorelin during
chemotherapy for early-stage breast cancer
significantly increased the chances that
women would recover their long-term ovarian
function, according to a multicentre phase III
open-label study published online Dec. 22 in
JAMA.
The treatment and control groups had simi-
larly low pregnancy rates at 5 years, with no
significant overall difference in disease-free
survival, reported Dr Matteo Lambertini of
Istituto Nazionale per la Ricerca sul Cancro,
Genova, Italy, and his associates.
Cryopreserving embryos or oocytes remains
the main way to protect fertility in young
women with breast cancer. Clinicians have
debated whether to use luteinising hormone-
releasing hormone analogues because of
scarce data showing efficacy and concerns
about compromising disease-free survival, the
investigators noted. They randomised 281 pre-
menopausal women with stage I–III hormone
receptor-positive or hormone receptor-negative
breast cancer to receive chemotherapy alone
or with 3.75 mg triptorelin, given intramuscu-
larly at least 1 week before and every 4 weeks
during cancer treatment. The median age of
patients was 39 years, the range was 24–45
years (JAMA 2015;314:2632–40).
Nearly 73% of the triptorelin group and
64% of controls resumed menstruating within
5 years of completing chemotherapy, for an
age-adjusted hazard ratio of 1.48 (95% CI,
1.12 to 1.95; P = 0.006). Cumulative 5-year
pregnancy rates were 2.1% for the triptorelin
group and 1.6% for controls (aHR, 2.4; 95%
CI, 0.62 to 9.22; P = 0.2). About 81% of trip-
torelin patients and 84% of controls remained
disease free at 5 years (HR, 1.17; 95% CI, 0.72
to 1.92; P = 0.52). The increase in risk among
triptorelin patients was generally limited to
those with hormone receptor-negative disease
(5-year DFS, 62% and 76%), the investigators
said.
When combined with recent findings from
the POEMS study, the results show that tem-
porary ovarian suppression before and during
chemotherapy is an option for preserving ovar-
ian function in premenopausal women with
early-stage breast cancer, they concluded.
Istituto Nazionale per la Ricerca sul Cancro
and the Associazione Italiana per la Ricerca sul
Cancro funded the study. Dr Lambertini reported
no relevant disclosures. Two coauthors reported
receiving research funding and honoraria from
Amgen, GlaxoSmithKline, and Eisai. The sen-
ior author reported financial relationships with
Takeda and with Ipsen, which supplied the
triptorelin used in the study.
Nearly 73% of the triptorelin group
and 64% of controls resumed
menstruating within 5 years of
completing chemotherapy.
Cancer prevention field riding high into the new year
BY PATRICE WENDLING
Frontline Medical News
From Cancer Prevention Research
The new year has us all looking forward and
the cancer prevention community is no
exception.
In a special report entitled “Transforming
Cancer Prevention through PrecisionMedicine
and Immune-Oncology,” a team of experts offer
a brief look at what we can expect in the near
future for cancer prevention research, includ-
ing a Pre-Cancer Genome Atlas (PCGA), and
highlight some of the recent advances shaping
their optimism.
“Just as precision therapy and immunotherapy
are transforming cancer treatment, precision
medicine and immunoprevention approaches are
being translated to the clinic and showing great
promise. We stand at the edge of a new frontier
that will include comprehensively characteris-
ing the molecular and cellular events that drive
premalignant progression (eg, PCGA),” Dr Scott
M. Lippman, director of the University of Cali-
fornia SanDiegoMoores Cancer Centre, and his
coauthors wrote (Cancer Prev Res 2016;9:2–10).
The report details some of the clinical firsts in
2015 including genomic studies suggesting that
clonal haematopoiesis is a premalignant state
for blood cancer, the first precision medicine
trial in cancer prevention (EPOC) reporting
that loss of heterozygosity can predict which
patients with premalignant mouth lesions are
most likely to develop oral cancer, and the
United States Preventive Services Task Force
recommending low-dose aspirin for colorectal
cancer prevention based on age and risk.
Randomised trials have also suggested that
a single dose of human papillomavirus vaccine
can provide durable protection against HPV
infection. Tumour biology studies established
new chemoprevention for familial adenoma-
tous polyposis syndrome and universal tumour
screening guidelines based on DNA mismatch
repair mutations and microsatellite instability
for colorectal cancer in patients with Lynch
syndrome.
Further, remarkable advances have been
made in liquid biopsy technology, high-through-
put functional screening, and computational
biology methods and algorithms that “provide
unprecedented opportunities to interrogate the
biology of premalignancy...” they noted.
In an American Association for Cancer Re-
search blog post, Dr Lippman acknowledges
that not everyone is the same page when it
comes to the underlying principles of cancer
prevention.
A “contentious” paper published at the start
of 2015 suggested that variations in cancer risk
are due to random mutations or what might
otherwise be called bad luck. The new year was
heralded in by a second paper, however, that
came to roughly the opposite conclusion or that
most cancers are preventable.
In February, an AACR Cancer Prevention
Summit will bring together various stake-
holders to discuss the current state of cancer
prevention and to identify top priorities and
research directions for the field, he noted.
The authors acknowledged grant support from
the US National Institutes of Health/National
Cancer Institute.
Haematology & O ncology News • Vol. 9 • No. 1 • 2016
NEWS
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