What to expect in 2009 at SABCS

The 32nd San Antonio Breast Cancer Symposium has a slightly different flavor this year--more definitive trial data that will influence how we take care of breast cancer. Last year happened to be a time when few major trials with immediate implications were presented. But many preliminary findings from the laboratory and from early phase clinical trials were presented that set the stage for this year. Of course, we could not have more high-impact results without all the preliminary studies--they are all important in the grand scheme. This year, the timing was such that several trials now have complete data to report. Keep in mind that we cannot predict when the information from a clinical trial will be presented--that depends on the number of "events" as defined by the trial, such as the number of patients that recur. When this happens, all the data is gathered and the biostatistical team pours over the results. Then, along with the other investigators, the team presents their findings and their conclusions. This is not the end of the story, since the results are then critiqued by the scientific and clinical community, and again, when the final results are published in final form. Of course, for trials that lead to new drug approvals, the FDA and its advisers also have a say. Over the next few days, you will hear our first takes on key data from San Antonio and some of the early feedback from other attendees. New information about the use of Herceptin in early stage breast cancer exhibiting the HER2 protein will come from updated analyses of two major trials--one looking at giving Herceptin after chemo compared with the Taxol part of the chemotherapy regimen, and another that is looking at a regimen that omits the chemotherapy Adriamycin, which has been a staple drug for the last two decades. The risk of cardiac side effects is lower with these strategies, so if we can get the same benefit with lower risk of heart problems, that will be an important advance. For patient with bone metastases, a completely new drug is being tested in comparison to the current standard, Zometa. Denosumab works on a different pathway and may be superior to Zometa based on a trial recently reported initially in Berlin a few months ago. We will see the final results of this study and this is likely to be submitted to the FDA. The critical questions will be: Is it really better and how do the side effects compare? New trials on the anti-angiogenic drug Avastin, currently approved as first-line therapy for advanced breast cancer (HER2-negative), will be presented in the second-line setting, and this will have implications as to whether this drug might be used later in the course of treatment. We will also hear different approaches to breast cancer screening and whether ultrasound has a role in addition to mammography. There will be more on special tumor tests to individualize therapy and even preliminary information about using diabetes drugs in breast cancer as well as the reasons behind this.Despite the weather around the country, we expect about 10,000 to register for this meeting as it begins this afternoon. So stay with us for the next few days to keep up with the latest from San Antonio.