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Evidence-Based Oncology September 2014
Patient-Contributed Tumor Genetics Data: A Pathway to Better Drug Development
Yair Benita, PhD; Barbara Marino, PhD; Aman Bhandari, PhD; Roni Zeiger, MD; and Sachin H. Jain, MD, MBA
Thyroid Cancer: Increased Incidence or Improved Diagnosis?
Sejal Saraiya, PharmD
Immunotherapy Trials Offering Promise in Hard-to-Treat Pancreatic Cancer
Mary Caffrey
Currently Reading
Recurrence of Breast Cancer Years After the Initial Tumor
Marj P. Zimmerman, MS, BSPharm; and Stanton R. Mehr
AACR Seeks FDA Oversight on LDTs
Surabhi Dangi-Garimella, PhD
First PD-1 Inhibitor Approved for Melanoma
Surabhi Dangi-Garimella, PhD
Avastin: First Molecule in Nearly a Decade for Metastatic Cervical Cancer
Surabhi Dangi-Garimella, PhD
Moving Beyond BRCA Mutations in Familial Breast Cancer
Surabhi Dangi-Garimella, PhD
Draft Statement: Evidence Connecting Diet to Colorectal, Breast Cancer Stronger Than Links to Lung, Prostate
Mary K. Caffrey
Oncology Medical Home: Improved Quality and Cost of Care
Surabhi Dangi-Garimella, PhD
FDA Oversight of Laboratory Developed Tests Essential for Patient Health and Safety
Rep. Louise M. Slaughter, MPH
Cancer Trials Face a Shortage of Teen, Young Adult Enrollees
Surabhi Dangi-Garimella, PhD

Recurrence of Breast Cancer Years After the Initial Tumor

Marj P. Zimmerman, MS, BSPharm; and Stanton R. Mehr
Tamoxifen was approved by the FDA in 1977 to treat advanced breast cancer. In 1998, the Early Breast Cancer Trialists’ Cooperative Group published results showing that tamoxifen was effective in preventing breast cancer recurrence in patients whose tumors were estrogen receptor (ER)-positive or of unknown ER status,1 which led to an expansion of the drug’s indication.2 As effective as tamoxifen and other therapies have been, some breast tumors do recur. Despite the considerable scientific data and many successes in treating breast cancer, not much is known about recurrent breast tumors, other than that they can appear in almost any location in the body and at any time after remission is attained—even decades later.

A Cure or a Disease-Free Period?

The incidence of breast cancer has remained relatively stable since 2004.3 Declining incidence during the 1990s was attributed in part to lower utilization for estrogen replacement therapy for the treatment of menopausal symptoms.4

Alongside a stable level of breast cancer incidence, breast cancer deaths have dropped 34% since 1990.5 Better therapies have led to improved 5-year survival rates, which vary by race (90% for Caucasians and 79% for African Americans) and by stage at the time of diagnosis (Table 1). The relative survival rates at 10 and 15 years are 83% and 78%, respectively, for diagnosis at any stage.3 As a result, the number of breast cancer survivors is accumulating; about 3.1 million Americans are breast cancer survivors, defined as those patients who have completed active treatment.6

Despite these encouraging statistics, mortality is still high among patients who are initially diagnosed with advanced-stage breast cancer. For patients who are initially diagnosed with earlystage disease, recurrent breast cancer remains a principal cause of death,7 which may occur years afterward: the old philosophy that patients who do not demonstrate tumor recurrence for 5 years are “cured” has been replaced by the more precise observation that they remain “cancer-free.”

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