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4 February/March 2004 Breast Cancer Action 3 Media Coverage of San Antonio continued from page 3 sound advice based on a study this small and this young, but you would have to read the whole story to get that point. Abraxane: Better taxane delivery? Abraxane is a new way of delivering a breast cancer standard—paclitaxel (Taxol ® ) [O’Shaughnessy 44]. The New York Times business section accurately reported this study with a story headlined “New Drug Said to Improve Delivery of Cancer Medication.” Getting the word out: BCA’s booth at the San Antonio Breast Cancer Symposium Abraxane consists of microscopic particles of paclitaxel bound to albumin, a blood protein. The albumin appears to help the drug reach the tumors. The use of albumin means that Abraxane does not require Cremophor ® , a toxic solvent now used to deliver paclitaxel. Cremophor causes some of the side effects associated with paclitaxel, such as severe allergic reactions. To avoid those reactions, doctors give patients steroids before giving them paclitaxel, but steroids can also have side effects. Cremophor also requires special intravenous tubes for delivery because it can leach the plastic from normal tubes. Patients receiving Abraxane in the trial received higher dosages of paclitaxel and in a considerably shorter time span. At this early phase of this Phase III clinical trial, involving 460 women with metastasized breast cancer, tumors shrank in 33 percent of those who received Abraxane, compared with 19 percent of those who received paclitaxel. It is too early to tell whether the drug will prolong women’s lives. In addition, Abraxane caused more neuropathy than paclitaxel did, though reducing the Abraxane dosages might reduce this impact. The drug has not yet been approved by the FDA, though the stock of American Pharmaceutical Partners, the manufacturer of Abraxane, has been on the rise on the strength of the trial news. The company expects FDA approval in 2004. ◆ Find Your Own Way of Giving We depend on you to be able to do what we do. Almost 60 percent of BCA’s income comes from individuals. Your gifts help keep our programs free of the restrictions that come with corporate and government funding. Unlike most other national breast cancer organizations, BCA is free to ask questions that corporations would rather we didn’t ask. Here are some ways you can help BCA: ◆ Make your annual gift in monthly or quarterly installments and become a member of the Susan Stone Circle, named in memory of an activist BCA Board member who believed strongly in this form of giving. A regular payment of $25, $50, or $100 gives us wonderful and predictable support with minimal shock to your budget. Contact Celeste Janssen at 415/243-9301, ext. 17, or via email at cjanssen@bcaction.org, to set up a monthly or quarterly payment schedule by check or credit card. ◆ If you sell items on eBay, you can designate BCA as the beneficiary of all or part of the proceeds from your sales, through eBay’s Giving Works program. For more information go to www.ebay.com/givingworks, or call Alex Momtchiloff at 415/243-9301, ext. 15. ◆ If you live in the Bay Area, donate used goods to San Francisco’s Community Thrift store and name BCA (account #236) as the beneficiary. Call the store at 415/861-4910 for more information. ◆ Designate BCA through your workplace giving program, including the Combined Federal Campaign (agency #0207). Many companies will match or even doublematch your donation. Check with your employer about their matching-gift program. ◆ Designate BCA when United Way comes calling. Simply fill in BCA’s name and address on your workplace campaign form: Breast Cancer Action, 55 New Montgomery St., Ste. 323, San Francisco, CA 94105. Consumers Urged to “Think Before You Pink” By Carrie Spector Last October, as corporations around the world cashed in on Breast Cancer Awareness Month with "philanthropic" pinkribbon product lines, Breast Cancer Action rolled out the second phase of Think Before You Pink, our campaign urging the public to think critically about marketing promotions like these. BCA’s campaign focuses this year on the cosmetics industry, which sponsors several high-profile cause-related marketing campaigns around breast cancer—yet whose products contain chemicals that may actually be associated with the development of the disease. With a revamped website and an ad on the op-ed page of the national edition of the New York Times (pictured), we drew attention to the troubling trend of corporate "pinkwashing" and encouraged consumers to pressure cosmetics companies to clean up their products. We provided contact information for companies that manufacture cosmetics with parabens and phthalates, two families of chemicals that are of particular concern when it comes to breast cancer—and we provided consumers with information on numerous lines of cosmetics that are free of these chemicals. Ultimately, the campaign urges the public to think about how funds raised for the “fight against breast cancer” are spent. As long as we believe we’re doing something meaningful about breast cancer by buying into these corporate marketing schemes, the real work that needs to be done around treatment, access to care, and true prevention will continue to be underfunded and ignored. ◆ After four years as BCA’s communications coordinator, Carrie Spector has moved into a position with a public health organization in Berkeley. BCA thanks Carrie for her stellar work. We look forward to introducing you to our new communications officer in a future issue of this newsletter. Visit www.thinkbeforeyoupink.org to confront the pinkwashing companies.
Breast Cancer Action February/March 2004 5 Clippings Pharma-funded Study Says Too Many Women Not Getting Enough Chemo In a study published in the December Journal of Clinical Oncology, a group called the Awareness of Neutropenia in Chemotherapy (ANC) Study Group reports on a retrospective study of 20,000 women with early-stage breast cancer that found that more than half did not receive the recommended schedule of chemotherapy. The study was reported as alarming on the assumption that women who didn’t get the full recommended dose or whose treatment was delayed for too long may have been put at risk for recurrences that could have been avoided. However, the study did not look at whether the women who received less than the recommended treatment actually did worse than women who got the recommended dose over the recommended period of time. So, it is not clear whether these women were in fact put at risk. In addition, the only “side effect” of chemotherapy that the study examined as explaining the delays or reductions in treatment was neutropenia (chemotherapyinduced decline in certain white blood cells, which increases the risk of infection). There are many other things that might cause a woman’s treatment to be deferred or discontinued, including nausea, fatigue, mouth sores, and neuropathy. The drug most commonly used to correct neutropenia is a colony-stimulating factor called Neupogen ® , which can add $20,000 to the cost of a chemotherapy regimen. Amgen, the funder of the study, produces Neupogen. An Amgen representative declined to state how much Amgen paid for the study. Lyman, G. et al., “Incidence and Predictors of Low Dose-Intensity in Adjuvant Breast Cancer Chemotherapy: A Nationwide Study of Community Practices,” Journal of Clinical Oncology, December 15, 2003. Update: Genetics and Risk for Ashkenazi Jewish Women Mary-Claire King, continuing her work on the genetic underpinnings of breast cancer risk, has coauthored an important article with the New York Breast Cancer Study Group on BRCA-related risk for Ashkenazi Jewish women (published in Science, October 24, 2003). In order to accurately calculate risk, the research group determined the BRCA1 and BRCA2 genotypes of more than 2,000 relatives of women with breast cancer. They report an 82 percent lifetime risk of developing breast cancer in women with the genetic mutations associated with Ashkenazi ancestry. Half the women in the study who carried BRCA mutations and developed cancer did not have a family history of breast cancer; in these cases, they were most likely to have inherited the genetic mutations from their father. Women who were born before 1940, those who exercised as young women, and those who had normal weight during adolescence developed breast cancer at a later age than those born after 1940. Research on Ashkenazi Jewish women’s genetic risks for breast cancer has shown inconsistent results. We are working on an article that summarizes the research for our next issue. Dr. King is a member of BCA’s Scientific Advisory Board. King, M.-C. et al., “Breast and Ovarian Cancer Risks Due to Inherited Mutations in BRCA1 and BRCA2,” Science, October 24, 2003. Adjuvant Letrozole Study Discontinued; Long-term Effects Still Unknown Astudy designed to test five years of letrozole (Femara ® ) treatment after tamoxifen therapy was discontinued in October 2003, after a median follow-up of only 2.4 years. Letrozole has previously been found to work better than tamoxifen for patients with metastatic disease who have HER2- positive tumors. This study was discontinued because the researchers observed fewer recurrences in the letrozole group compared with the placebo group. There were 5,187 women in the study. Local or metastatic recurrences of breast cancer or new cancers in the contralateral breast were noted in 75 women in the letrozole group, compared with 132 in the placebo group. The difference was statistically significant, meaning that it was 95 percent likely to be the result of a difference related to the drug, rather than chance. The discontinuation of the study leaves some important questions unanswered. We have no idea what the long-term effects of the drug might be, given that the median follow-up was only 2.4 years. In addition, the risk of osteoporosis in those in the trial was considerably higher for women on letrozole than for the placebo group. And even the study’s authors stated in the report that their results “leave the optimal duration of treatment undefined and the question of long-term toxicity unanswered.” The research community's tendency to shoot first and ask questions later when it comes to drug protocols is fraught with peril, as we recently learned with the controversy over the benefits of hormone replacement therapy. The long-term effects of cancer “prevention” drugs—whether intended to “prevent” recurrence or primary disease— can and do take decades to uncover. Goss, P. et al., "A Randomized Trial of Letrozole in Postmenopausal Women After Five Years of Tamoxifen Therapy for Early-Stage Breast Cancer,” New England Journal of Medicine, November 6, 2003.
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