Research Think Tank Treatment

The Research Think Tank (RTT) Treatment Work Group focused on unanswered questions about the most optimal treatment of breast cancer in a young woman and how that treatment may differ from that given to an older woman.

The group was composed of advocates:

• Kimberly Hagerich (chair)
• Leslie Hammersmith
• Hannah Klein Connolly
• Tracy Leduc
• Debra Madden
• Elizabeth Wohl

As well as physicians/researchers:

• Dr. Ann Partridge
• Dr. Alexander Swistel

Research Priorities

Six of the 19 research priorities recommended by the RTT focused on treatment of breast cancer in young women. Below we list the priority, indicate any progress made since the RTT and list any open trials of which we are aware related to or focusing on these research priorities.

Are there specific factors in the tumor microenvironment of young women with breast cancer that contribute to worse prognosis, alter treatment response and increase risk for local recurrence, distant relapse and decreased overall survival?

Progress Made: In Progress

Recent research updates:

Young women’s microenvironment (stroma) may have a role in breast cancer growth, particularly in triple negative breast cancer. Read More

Current research initiatives/studies:

Development of a Quantitative Tissue Optical Index of Breast Density For Prediction of Hormone Therapy Response. Read More

In what context should younger women with breast cancer receive more aggressive treatments?

Progress Made: Thumbs Down

Recent research updates:

A recent study found a possible mechanism by which postpartum breast cancer is more aggressive and likely to metastasize. Read More

What are the optimal chemotherapy and targeted therapy regimens for each tumor type in young women? In what contexts should neoadjuvant chemotherapy be considered in young women?

Progress Made: Thumbs Up

Recent research updates:

A study examining neoadjuvant chemotherapy in young women found that young women, especially those with hormone receptor positive/HER2- and triple negative breast cancer, were more likely to achieve complete pathological response (pCR, breast cancer disappears), and young women with luminal-like breast cancer appeared to benefit more from neoadjuvant chemotherapy than older women. Read More

When is ovarian suppression (GnRH agonist or oophorectomy) appropriate in the treatment of young women with ER+ disease? Is inducing menopause in young women a valid treatment approach?

Progress Made: Thumbs Up

Recent research updates:

SOFT and TEXT trial data showed that ovarian suppression in combination with Tamoxifen or an Aromatase Inhibitor reduces breast cancer recurrence in young women, age 35 or younger, who were at high risk of recurrence (high enough risk that chemotherapy was ordered). Read More

In the long-term, which surgical option (mastectomy or lumpectomy with radiation) provides the best overall survival for young women? Does local recurrence impact survival in young women?

Progress Made: Work in Progress

Recent research updates:

There have been two recent, conflicting, studies on the long-term outcomes of mastectomy versus lumpectomy plus radiation. ESTRO reported that lumpectomy plus radiation therapy showed higher rates of recurrence in women under age 45 (compared to mastectomy), and that recurrence was more likely to lead to metastasis. It is important to recognize that this study’s observational data was collected in 1989-1998 and none of the women received systemic therapies, which is not representative of the current standard of care. Read More

A recent meta-analysis did not find a significant survival difference between lumpectomy plus radiation therapy and mastectomy in women age 40 and younger. Read More

How can we identify young women who may be candidates for endocrine therapy alone versus combined adjuvant or neoadjuvant chemotherapy with endocrine therapy? What is the optimal type/duration of endocrine therapy?

Progress Made: Thumbs Up

Recent research updates:

Oncotype DX is a test which shows which women can safely avoid chemotherapy and receive endocrine therapy only. A recent report of Oncotype DX data, which included data for women under 40, showed that a recurrence score less than 18 had no significant differences in outcomes compared to the 40-49 and 50-59 age groups. In the younger patients with node-negative disease and recurrence score <18, Breast Cancer Specific Mortality was <1.3% and those with node-positive was <1.7%. Read More

Recent studies have indicated that 10 years of tamoxifen is better than 5 at reducing the risk of recurrence in young premenopausal women with hormone receptor positive breast cancer. Read More

Please refer to the SOFT and TEXT trial results above for information on possible ovarian suppression as well.

Current research initiatives/studies:

The POSITIVE Trial is examining whether it is safe to take a “baby break” from Tamoxifen so that a woman can conceive a child and the length of time that Tamoxifen should be taken before the “baby break” occurs.

Read More

Read about our RTT work group on quality of life during and after breast cancer treatment.

If you believe we are missing a crucial piece of research or have not included a research study which should be here, please contact us!