ASCO 2010 Annual Meeting, 4—8 June 2010, Chicago

Interview with Dr Susanne Briest (University of Leipzig, Germany)

Welcome back to ecancer TV, this is your second showing and last time we were talking about the European meeting, the big conference in Europe, and this is ASCO. So you are a senologist, medical oncologist and you work in Leipzig.

Gynaecologist.

You have a different terminology and practice in Germany from the rest of the world.

I know!

So you come here to see whether you’re going to change your practice next week when you go back to Germany – are you?

That’s right.

What’s come up?

It’s difficult to summarise because until now I may be asked in the meeting, tomorrow we have another day, but to be honest I’m a little bit disappointed of this year’s ASCO. It’s always a great opportunity to meet people, to come together to exchange experiences and everything, but we didn’t have these real practice-changing phase 3 trials that we heard about or we saw in other meetings in other years. So this morning we had a very interesting hour’s session about breast cancer, early breast cancer and there were three trials reported about sentinel node biopsy and one trial reported about radiation in patients with lumpectomy where there is no radiation, in older patients. These were, to my mind, the most interesting part until now. Then we heard a little bit of the relation in between obesity and response to therapy which seems to be a real practice influencing factor.

Negatively?

Yes. And we heard a very nice update of some women’s health initiatives yesterday, which showed us , against our assumptions, that women who were on hormone replacement therapy and developed breast cancer, these women had not hormone-led positive breast cancer as you would assume, but they had more HER2 positive breast cancer, which was a completely new effect for everybody I suppose. And the death rate was doubled in this group as well. So this is something that we have to discuss really with our patients. I am a gynaecologist, as I said, so sometimes I have to discuss also hormone replacement therapy for women because they have these problems and want to have something. They ask you what can we do, and I think with this new data we have a lot more in our hands to give them good advice what to do.

And is that hormone replacement therapy combination or is that only oestrogen or oestrogen/progesterone? And is there a dose dependence or a duration dependence which came out of the million women study in Oxford?

The result was they used a combination between progesterone and oestrogen and we assumed that the progesterone is a bad player in this part so that’s why if you do a hormone replacement therapy you would try to avoid a high dose of progesterone of course. But until now we’ve thought if you give it in a very short time, only to cover the symptoms of the patients, it would be OK. But even with the short time duration of treatment you will have these negative effects on breast cancer probably.

Other things that have caught your eye?

Not really. As I told you, I found it really intriguing that one trial about radiation in elderly women, elderly means more than seventy years old, hormone receptor positive early breast cancer and there was a very nice comparison between radiation and Tamoxifen versus Tamoxifen. And finally it turned up that there is no difference in survival, and I think this is the main aim that we have in cancer therapy. So I think this is really something we have to discuss with our patients now. If you could spare them the radiation it would make a lot of benefit for these even a little bit older patients.

But then, of course, the local problems when you don’t irradiate can be quite nasty with ulceration.

This is after lumpectomy. So the tumour is removed with clear margins, this was a tumour less than a centimetre, and there were more inverse recurrences but even with these recurrences you didn’t have a relation to the overall survival, so that’s why it was interesting.

Susanne, thank you very much again for coming and telling us your views on the breast cancer research.

Thank you so much for inviting me.