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In a recent publication in The Lancet Oncology, findings from a phase I clinical trial were reported. Dr Pernas and team reported on the use of a combination of the CXCR4 receptor antagonist, Balixafortide plus the anthracycline eribulin in patients previously treated Her2 negative metastatic breast cancer. The CXCR4 stromal derived factor I—L4 axis, SDF-1a, axis is implicated in regulating immune cells in the tumor microenvironment. 56 patients were enrolled in the study, over the span of almost 3 years. Both drugs were given intravenously. An objective response was seen in 30% of patients. Stable disease was observed and an additional 46% of patients, totaling 76% disease control rate was observed. The median duration of response was 97 days. Most common adverse events with fatigue, 79%, neutropenia 57%, infusion-related reactions 48%,. Investigators concluded that the safety and tolerability of this combination similar to that of monotherapy for both drugs respectively. This combination seems promising in patients with metastatic breast cancer, Her2 negative. Further clinical trials are in development.
Dr Henry Kuerer, a surgical oncologist who specialized in breast surgery, presented discussion at the 2018 Miami breast cancer conference. In highlight of recent development of numerous targeted therapies for breast cancer, physicians are seeing an increase in complete responses during surgery from various clinical trials. The neoadjuvant approach has traditionally been used in patients with stage III breast cancer. Depending on the biological characteristics of the tumor, certain patients can enter complete remission with no evidence of tumor present on pathologic assessment of the surgical specimen. This has raised the question of avoided surgery all together. While this idea seems appealing, at this time this remains completely experimental. Dr Kuerer discusses some of the data and the rationale behind this approach in this linked article. We currently do not have the technology that allows a resolution down to a single cell detection level. While it is true that a high number of patients will not have recurrence if they have enter a pathologic complete remission, the reality remains that, this reported figure is not 100%. We do not have a way to detect small residual cancer clones. Because the majority of recurrences are local, definitive surgery still remains the standard of care.
In a recent article published by Dr. Shaverdian, radiation oncologist at UCLA, light was shed on breast cancer patient perceptions of radiation therapy side effects. Patients were surveyed about anticipated side effects in perspective to their actual residual side effects. 6 months after completion of therapy. 85% of patients reported that their side effects were "not as bad" as they had feared. 92% of the 269 patients that were treated with breast conservation and 81% of the 50 patients treated with mastectomy with repeat staging “If the future patients knew the real truth about radiation therapy, they would be less scared about treatment."
On May 15, 2018, the FDA in the United States approved Retacrit , which is a biosimilar of epoeitin alpha. This is a biosimilar competitor to Epogen/Procrit. It is considered appropriate treatment of anemia related to chronic kidney disease, chemotherapy, or the use of Zidovudine in HIV. It can also be used perioperatively for patient who cannot accept ref blood cell transfusions. The Data included extensive structural and functional characterization, animal safety studies, human pharmacokinetics and pharmacodynamic data as well as human immunogenicity studies.
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