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Total breast reconstruction with autologous fat grafting (May 2023)
Total breast reconstruction with autologous fat grafting (AFG) is a novel option following total mastectomy. Fat from remote sites is injected into the breast area, and a negative pressure skin expansion device facilitates breast creation. In the BREAST trial, which compared AFG with implant-based reconstruction, Breast-Q scores for satisfaction with breasts, physical well-being, and satisfaction with outcome were significantly higher at 12 months in the AFG group.1 The rate of serious adverse events, including oncologic events, was similar for both groups. AFG provides a reasonable alternative with good patient satisfaction; however, larger trials with complete and longer follow-up, comparison of AFG with other types of total breast reconstruction, and more widespread availability of the skin expansion device are needed.
Access to health care and survival in adolescent and young adult cancer survivors (May 2023)
Adolescent and young adult (AYA) cancer survivors often experience financial barriers, including issues with health insurance. However, there are limited data on the survival benefits of expanding access to health insurance in this population. In an observational study of over 345,000 AYA patients with cancer, two-year overall survival was higher in patients treated in states that expanded Medicaid access through the Affordable Care Act compared with those in states without expansion (net increase of 0.55 percentage points).2 These data support the importance of increased access to health insurance for AYA cancer survivors.
Panitumumab versus bevacizumab for metastatic colorectal cancer (May 2023)
For patients with RAS wildtype metastatic colorectal cancer (mCRC), studies are evaluating how primary tumor site influences the choice of biologic agent added to initial chemotherapy. In a randomized trial in over 800 patients with chemotherapy-naive RAS wildtype mCRC, the epidermal growth factor receptor inhibitor (EGFRi) panitumumab plus chemotherapy improved median overall survival compared with bevacizumab plus chemotherapy for those with left-sided tumors (38 versus 34 months) and the overall population (36 versus 31 months).3 For patients with chemotherapy-naive RAS wildtype mCRC and a left-sided tumor, we continue to suggest the addition of an EGFRi rather than bevacizumab to chemotherapy, and panitumumab is an acceptable option.
Interruption of endocrine therapy for an attempt at pregnancy after breast cancer (May 2023)
There are few data informing the risks of interrupting adjuvant endocrine therapy for breast cancer survivors desiring pregnancy. In a study in 516 patients with early breast cancer who had received adjuvant endocrine therapy for 18 to 30 months and desired pregnancy, endocrine therapy was interrupted upon enrollment, and pregnancy occurred in 74 percent.4 The three-year rate of breast cancer events was 8.9 percent, which was similar to the rate in an external control group who met study entry criteria aside from desire for pregnancy and treatment interruption (9.2 percent). These data suggest that endocrine therapy interruption for pregnancy does not increase short-term risks of breast cancer recurrence, but longer-term data are required. We typically advise women to wait for at least two years before attempting pregnancy to ensure that the patient does not have early cancer recurrence prior to a pregnancy attempt.
1. Piatkowski AA, Wederfoort JLM, Hommes JE, et al. Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer: A Randomized Clinical Trial. JAMA Surg. 2023;158(5):456.
2. Ji X, Shi KS, Mertens AC, et al. Survival in Young Adults With Cancer Is Associated With Medicaid Expansion Through the Affordable Care Act. J Clin Oncol. 2023;41(10):1909. Epub 2022 Dec 16.
3. Watanabe J, Muro K, Shitara K, et al. Panitumumab vs Bevacizumab Added to Standard First-line Chemotherapy and Overall Survival Among Patients With RAS Wild-type, Left-Sided Metastatic Colorectal Cancer: A Randomized Clinical Trial. JAMA. 2023;329(15):1271.
4. Partridge AH, Niman SM, Ruggeri M, et al. Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer. N Engl J Med. 2023;388(18):1645.
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