Maintenance Treatment with REVLIMID® Improves Progression Free Survival in Diffuse Large B-Cell Lymphoma

July 28th, 2017

SUMMARY: The American Cancer Society estimates that in 2017, about 72,240 people will be diagnosed with Non Hodgkin Lymphoma (NHL) in the United States and about 20,140 individuals will die of this disease. Diffuse Large B-Cell Lymphoma (DLBCL) is the most common of the aggressive Non-Hodgkin lymphoma’s in the United States, and the incidence has steadily increased 3 to 4% each year. The etiology of Diffuse Large B-Cell Lymphoma is unknown. Contributing risk factors include immunosuppression (AIDS, transplantation setting, autoimmune diseases), ultraviolet radiation, pesticides, hair dyes, and diet. DLBCL is a neoplasm of large B cells and the most common chromosome abnormality involves alterations of the BCL-6 gene at the 3q27 locus, which is critical for germinal center formation. Two major molecular subtypes of DLBCL arising from different genetic mechanisms have been identified, using gene expression profiling: Germinal Center B-cell-like (GCB) and Activated B-Cell-like (ABC). Patients in the GCB subgroup have a higher five year survival rate, independent of clinical IPI risk score whereas patients in the ABC subgroup have a significantly worse outcome. Regardless, R-CHOP regimen (RITUXAN®-Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), given every 21 days, for 6 cycles, delivered with curative intent, is the current standard of care for patients of all ages, with newly diagnosed DLBCL, regardless of molecular subtype. Approximately 30-40% of patients experience disease progression or relapse, during the first 2 years and attempts to improve on R-CHOP regimen have not been successful. Maintenance treatment strategy following R-CHOP, to better control the disease, delay disease progression and improve long term survival, have included Autologous Stem Cell Transplantation, maintenance treatment with agents such as oral protein kinase inhibitor Enzastaurin and Everolimus. None of these interventions have been successful.

REVLIMID® (Lenalidomide) is an oral immunomodulatory agent (IMiD) with activity in lymphoid malignancies, primarily through immune modulation (repair T-cell immune synapse dysfunction and Natural Killer cell/T-cell effector augmentation). It additionally has antiproliferative effects. REVLIMID® was shown to have significant activity in relapsed DLBCL when given alone or along with RITUXAN®.

The REMARC study is an international, multicenter, double-blind, randomized, placebo-controlled phase III trial which compared REVLIMID® as maintenance therapy with placebo, in elderly patients with DLBCL, who achieved a Complete Response (CR) or Partial Response (PR) to R-CHOP induction treatment. A total of 650 patients who had CR or PR after 6-8 cycles of R-CHOP were randomly assigned in a 1:1 ratio to receive oral REVLIMID® maintenance 25 mg daily or placebo, for 21 days of every 28-day cycle, for 24 months. The median age was 68 years and approximately 90% of the patients had stage III-IV disease. The Primary end point was Progression Free Survival (PFS) and Secondary end points included safety, the percentage of patients who converted from PR to CR, Event Free Survival and Overall Survival (OS).

With a median follow up of 39 months, median PFS was not reached in the REVLIMID® group compared to 58.9 months in the placebo group (HR=0.70; P=0.013) favoring REVLIMID®. This PFS benefit with REVLIMID® maintenance was seen in all predefined subgroups (all age groups, all IPI scores, molecular subtypes, CR versus PR after R-CHOP, Positive versus Negative PET status at the time of randomization). The Overall Survival however was similar between the treatment groups after a longer median follow up of 52 months (P=0.26). The most common grade 3 or 4 toxcities associated with REVLIMID® maintenance were neutropenia and cutaneous reactions.

It was concluded that maintenance treatment with REVLIMID® for 24 months, after obtaining a CR or PR to R-CHOP, significantly prolonged Progression Free Survival in elderly patients with Diffuse Large B-Cell Lymphoma. This is the first randomized study showing a PFS benefit with an immunomodulatory agent as maintenance therapy, in this patient population. Lenalidomide Maintenance Compared With Placebo in Responding Elderly Patients With Diffuse Large B-Cell Lymphoma Treated With First-Line Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. Thieblemont C, Tilly H, Gomes da Silva M, et al. DOI: 10.1200/JCO.2017.72.6984 Journal of Clinical Oncology – published online before print April 20, 2017

FDA Approves NERLYNX® for Adjuvant Treatment of HER2 Positive Breast Cancer

July 28th, 2017

SUMMARY: The FDA on July 17, 2017 approved NERLYNX® (Neratinib) for the extended adjuvant treatment of adult patients with early stage HER2-overexpressed/amplified breast cancer, to follow adjuvant Trastuzumab (HERCEPTIN®)-based therapy. Breast cancer is the most common cancer among women in the US and about 1 in 8 women (12%) will develop invasive breast cancer during their lifetime. Approximately, 255,180 new cases of invasive breast cancer will be diagnosed in 2017 and over 41,070 women will die of the disease. The HER or erbB family of receptors consist of HER1, HER2, HER3 and HER4. Approximately 15%-20% of invasive breast cancers overexpress HER2/neu oncogene, which is a negative predictor of outcomes without systemic therapy. HERCEPTIN® (Trastuzumab) is a humanized monoclonal antibody targeting HER2 and adjuvant chemotherapy given along with HERCEPTIN® reduces the risk of disease recurrence and death, among patients with HER2-positive, early breast cancer. Nonetheless, approximately 25% of patients will develop recurrent disease within 10 years following this adjuvant intervention. Extending the duration of adjuvant HERCEPTIN® therapy or adding TYKERB® (Lapatinib), a Tyrosine Kinase Inhibitor that targets HER1 and HER2, has not improved outcomes.

NERLYNX® is a potent, irreversible, oral Tyrosine Kinase Inhibitor, of HER1, HER2 and HER4 (pan-HER inhibitor). NERLYNX® interacts with the catalytic domain of HER1, HER2, and HER4 and blocks their downstream signaling pathways, resulting in decreased cell proliferation and increased cell death. Clinical data has suggested that NERLYNX® has significant activity in suppressing HER-mediated tumor growth and is able to overcome tumor escape mechanisms experienced with current HER2-targeted and chemotherapeutic agents. It has been well known that hormone receptor positive breast cancer patients, who are also HER2-positive, have relative resistance to hormone therapy. Preclinical models had suggested that the addition of NERLYNX® could improve responses in ER positive, HER2-positive breast cancer patients. Further, NERLYNX® has clinical activity in patients with HER2-positive metastatic breast cancer.

The approval of NERLYNX® was based on ExteNET trial, which is a multicentre, randomized, double-blind, placebo-controlled, phase III study, in which the efficacy and safety of 12 months of NERLYNX® after HERCEPTIN®-based adjuvant therapy was evaluated, in patients with early stage HER2-positive breast cancer. Patients with early stage HER2-positive breast cancer (N=2,840), and within two years of completing adjuvant HERCEPTIN®, were randomized in a 1:1 ratio to receive either oral NERLYNX® 240 mg per day (N=1420) or placebo (N=1420), for one year. Patients were stratified by hormone receptor status, nodal status (0, 1-3, or 4 or more), and HERCEPTIN® adjuvant regimen (sequentially versus concurrently with chemotherapy). The Primary endpoint was invasive Disease Free Survival (iDFS), defined as the time between the randomization date to the first occurrence of invasive recurrence (local/regional, ipsilateral or contralateral breast cancer), distant recurrence, or death from any cause, within two years of follow up. The median follow up was 2 years.

In the updated analysis, the two year iDFS was 94.2% in patients treated with NERLYNX® compared with 91.9% in those receiving placebo (HR 0.66; P=0.008). Patients with ER positive breast cancer were noted to have greater benefit. The most common grade 3-4 adverse events associated with NERLYNX® were diarrhea, vomiting and nausea. Patients can experience diarrhea early, in the first 2 or 3 days and this can be alleviated using antidiarrheal prophylaxis with Loperamide, initiated with the first dose of NERLYNX® and continued for the first 2 months of treatment and as needed thereafter.

It was concluded that NERLYNX® when given for 12 months after chemotherapy and HERCEPTIN®-based adjuvant therapy, to women with HER2-positive breast cancer, significantly improved 2-year invasive Disease Free Survival. Longer follow up will hopefully address if there is an Overall Survival benefit with this treatment intervention. NERLYNX® is the first TKI approved by the FDA, shown to reduce the risk for disease recurrence, in patients with early stage HER2-positive breast cancer. Neratinib after trastuzumab-based adjuvant therapy in patients with HER2-positive breast cancer (ExteNET): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial Chan A, Delaloge S, Holmes FA, et al. The Lancet Oncology 2016; 17:367- 377

BLINCYTO® (Blinatumomab)

July 27th, 2017

The FDA on July 11, 2017 approved BLINCYTO® for the treatment of relapsed or refractory B-cell precursor Acute Lymphoblastic Leukemia (ALL) in adults and children. BLINCYTO® is a product of Amgen Inc.

NERLYNX ® (Neratinib)

July 27th, 2017

The FDA on July 17, 2017 approved NERLYNX ® for the extended adjuvant treatment of adult patients with early stage HER2-overexpressed/amplified breast cancer, to follow adjuvant Trastuzumab-based therapy. NERLYNX ® is a product of Puma Biotechnology, Inc.

FDA’s First Tissue/Site-Agnostic Approval

July 26th, 2017

The FDA for the first time approved a cancer treatment based on specific genetic biomarker, rather than location in the body where the tumor originated. KEYTRUDA®, an anti-PD1 monoclonal antibody was granted accelerated approval for treatment of adult and pediatric patients with unresectable or metastatic, MicroSatellite Instability-High (MSI-H) or MisMatch Repair deficient (dMMR) solid tumors that have progressed following prior treatment and who have no satisfactory alternative treatment options or with MSI-H or dMMR ColoRectal Cancer that has progressed following treatment with a Fluoropyrimidine, Oxaliplatin, and Irinotecan. MMR gene deficiency can be detected by ImmunoHistoChemistry and MSI testing is performed using a PCR based assay.

FDA Approves ENDARI® for Sickle Cell Disease

July 21st, 2017

The FDA on July 7, 2017 approved ENDARI® (L-Glutamine oral powder) for oral administration to reduce the acute complications of Sickle Cell disease, in adult and pediatric patients 5 years and older. There is a higher L-glutamine utilization in Sickle Cell Anemia resulting in its depletion and thereby contributing to oxidative stress. This oxidative stress is an important contributing factor to hemoglobin polymerization, with polymer formation occurring only in the deoxy state. ENDARI® is the first treatment approved for patients with Sickle Cell disease in almost 20 years.

Brachytherapy for Patients With Prostate Cancer American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update Summary

July 21st, 2017

SUMMARY: Prostate cancer is the most common cancer in American men with the exclusion of skin cancer and 1 in 7 men will be diagnosed with Prostate cancer during their lifetime. It is estimated that in the United States, about 161,360 new cases of Prostate cancer will be diagnosed in 2017 and 26,730 men will die of the disease. Brachytherapy for prostate cancer is a type of Internal radiation treatment in which radioactive material sealed inside a seed, pellet, wire, or capsule is implanted in the prostate gland using a needle or catheter. Brachytherapy allows the delivery of higher doses of radiation to the intended site, compared with the conventional form of radiation therapy (External Beam Radiation Therapy).

Types of Brachytherapy

1) Low-dose rate (LDR) implants that stay in the prostate gland for 1 to 7 days and then are taken out.

2) High-dose rate (HDR) implants that stay in the prostate gland for a few minutes at a time and are then taken out.

3) Permanent implants that stay in the prostate gland and are not removed.

Prostate Cancer Risk Categories

Very Low Risk: T1c, Gleason score 6 or less, PSA less than 10 ng/ml, Fewer than 3 prostate biopsy cores positive with 50% or less cancer in each core

Low Risk: T1-T2a, Gleason score 6 or less, PSA less than 10 ng/ml

Intermediate Risk: T2b-T2c and/or Gleason score =7 and/or PSA 10-20 ng/ml

High Risk: T3a or Gleason score 8-10 or PSA more than 20 ng/ml

Very High Risk: T3b-T4

With the gathering of new evidence from randomized trials since the original publication in 2013, a guidelines update became necessary. The scope of this guideline covers Brachytherapy boost and monotherapy. The relevant evidence was evaluated for inclusion in this updated clinical practice guideline after a systematic review of the literature and five randomized controlled trials provided the evidence for this update. 

Guideline Questions

1) In patients with newly diagnosed Prostate cancer, what is the efficacy of Brachytherapy alone for clinical outcomes compared with External Beam Radiation Therapy (EBRT) alone, or Radical Prostatectomy (RP) alone?

2) In patients with newly diagnosed Prostate cancer, what is the efficacy of Brachytherapy combined with EBRT for clinical outcomes compared with Brachytherapy alone, EBRT alone, or RP alone?

3) Among the isotopes used for low-dose-rate (LDR) Brachytherapy (eg, Iodine-125 [125I], Palladium-103 [103Pd], and Cesium-131 [131Cs]), which isotope maximizes clinical outcomes when used in patients with newly diagnosed Prostate cancer?

Updated recommendations

1) For patients with low-risk Prostate cancer who require or choose active treatment, LDR brachytherapy alone, EBRT alone, or RP should be offered to those who are eligible.

2) For patients with intermediate-risk Prostate cancer choosing EBRT with or without Androgen Deprivation Therapy (ADT), Brachytherapy boost (LDR or high–dose rate [HDR]) should be offered to eligible patients.

3) For low-intermediate risk Prostate cancer (Gleason 7, PSA 10 ng/mL or Gleason 6, PSA 10 to 20 ng/mL) LDR Brachytherapy alone may be offered as monotherapy.

4) For patients with high-risk Prostate cancer receiving EBRT and ADT, Brachytherapy boost (LDR or HDR) should be offered to eligible patients.

5)125I and 103Pd are each reasonable isotope options for patients receiving LDR Brachytherapy; no recommendation can be made for or against using 131Cs or HDR monotherapy.

6) Patients should be encouraged to participate in clinical trials

Qualifying Statements

1) Patients should be counseled about all of their management options (surgery, EBRT, Brachytherapy, or active surveillance, as applicable) in a balanced, objective manner, preferably by practitioners from multiple disciplines.

2) Recommendations for patients with low-risk disease are unchanged from the initial guideline because no new data from randomized studies informing this question have been presented or published since 2013.

3) Patients ineligible for Brachytherapy may include those with moderate to severe baseline urinary symptoms, large prostate volume, or prior transurethral resection of the prostate, those who are medically unfit, and those with contraindications to radiation treatment.

4) ADT may be given in neoadjuvant, concurrent, and/or adjuvant settings at the physician’s discretion. Note that neoadjuvant ADT may cytoreduce the prostate volume sufficiently to allow Brachytherapy.

5) There may be increased genitourinary toxicity with Brachytherapy compared with use of EBRT alone.

6) Brachytherapy should be performed at a center that has strict quality assurance standards.

7) It cannot be determined whether there is an overall or cause-specific survival advantage for Brachytherapy compared with EBRT alone because none of the trials were designed or powered to detect a meaningful difference in survival outcomes.

Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update. Chin J, Rumble RB, Kollmeier M, et al. Journal of Clinical Oncology 2017;35:1737-1743.

BAVENCIO® – First FDA Approved Agent for Merkel Cell Carcinoma

July 21st, 2017

SUMMARY: The FDA on March 23, 2017, granted accelerated approval to BAVENCIO® (Avelumab) for the treatment of patients 12 years and older with metastatic Merkel Cell Carcinoma (MCC). It is estimated that about 1500 cases of MCC are diagnosed in the United States each year and the life expectancy for metastatic Merkel Cell Carcinoma is less than 1 year and is associated mortality three times that of Malignant Melanoma (46% vs. 15% respectively). Merkel Cell Carcinoma, also described as Trabecular tumor of the skin, is rare but aggressive form neuroendocrine skin cancer and is much more common in elderly Caucasians. The rapid rise in the incidence of MCC over the past several years has been attributed to increased life expectancy, more sun exposure and weakened immune systems. Approximately 80% of Merkel Cell Carcinoma tumors have been found to be infected with Merkel Cell PolyomaVirus (MCPyV) and the natural history of the MCC has been linked to virus-specific humoral and cellular immune responses. MCC tumors are able to evade the immune system in spite of persistent expression of immunogenic viral proteins. It has been postulated that a high mutation burden associated with Merkel Cell Carcinomas leads to many new antigens being presented to the immune system. Tumor cells as well as tumor-infiltrating immune cells express PD-L1 (Programmed cell Death Ligands), which can contribute to inhibition of antitumor immune response in the tumor microenvironment. The immune system is harnessed and Cytotoxic T-cell activity is suppressed by the binding of PD-L1 to PD-1(Programmed cell Death 1) and B7.1 receptors found on T cells. Merkel Cell Carcinoma is associated with increased PD-L1 expression.

BAVENCIO® is a human, immunoglobulin G1 lambda, PD-L1 targeted monoclonal antibody that binds to PD-L1 and blocks the interaction between PD-L1 and its receptors PD-1. This in turn negates the inhibitory effects of PD-L1 on the immune response by unleashing the immune system and restoring antitumor immune responses. In addition, BAVENCIO® induces Antibody Dependent Cell-mediated Cytotoxicity (ADCC). The approval of BAVENCIO® for Merkel Cell Carcinoma was based on the phase II, prospective, open-label, international JAVELIN trial in which 88 patients with Stage IV Merkel Cell Carcinoma received BAVENCIO® 10 mg/kg IV infusion over 60 minutes, every 2 weeks, until disease progression or unacceptable toxicity. Enrolled patients had at least one prior chemotherapy regimen for metastatic disease. Over 50% of the patients had visceral metastases, two thirds of the patients had tumors with PD-L1 expression of 1% or more, by ImmunoHistoChemistry assay and 52% of the evaluable patients tested positive for Merkel cell Polyomavirus. However, patient selection in this study was not based on the level of PD-L1 expression or Polyomavirus status. The median age was 73 years. The Primary endpoint was Objective Response Rate (ORR). Secondary endpoints included Duration of Response and Progression Free Survival (PFS).

At a median follow up of 16 months, the Objective Response Rate at 1 year was 33% with a Complete Response Rate of 11%. The median time to response was 6 weeks. The 6-month durable response rate was 30.6% and the median Duration of Response had not yet been reached. These responses were noted irrespective of PD-L1 tumor cell expression or presence of Merkel cell Polyomavirus. The estimated one year PFS was 30% and one year Overall Survival was 52%. The most common adverse reactions were rash, fatigue, nausea, diarrhea, decreased appetite, musculoskeletal pain, infusion-related reaction and peripheral edema.

The authors concluded that BAVENCIO® showed durable antitumor activity with a manageable safety profile, in patients with metastatic Merkel Cell Carcinoma who had progressed on chemotherapy and is an important new treatment option for this patient population. BAVENCIO® is the very first drug approved by the FDA for Merkel Cell Carcinoma. Studies are also underway with KEYTRUDA® (Pembrolizumab), a PD-1 inhibitor, in this patient group, with promising outcomes thus far. Durable responses to avelumab (anti-PD-L1) in patients with Merkel cell carcinoma progressed after chemotherapy: 1-year efficacy update. Kaufman HL, Russell JS, Hamid O, et al. 2017 AACR Annual Meeting. Abstract CT079. Presented April 3, 2017.

FDA Approves ENDARI®, A New Treatment for Sickle Cell Disease

July 14th, 2017

SUMMARY: The FDA on July 7, 2017 approved ENDARI® (L-Glutamine oral powder) for patients age five years and older with Sickle Cell disease to reduce severe complications associated with the blood disorder. Sickle cell disease or Sickle Cell anemia is an Autosomal Recessive disorder and affects approximately 100,000 Americans. It is estimated that it affects 1 out of every 365 African-American births and 1 out of every 16,300 Hispanic-American births. The average life expectancy for patients with Sickle Cell disease in the United States is approximately 40 to 60 years.

HbSS disease or Sickle Cell anemia is the most common Sickle Cell disease genotype and is associated with the most severe manifestations. HbSS disease is caused by a mutation substituting thymine for adenine in the sixth codon of the beta-globin chain gene. This in turn affects the hemoglobin's ability to carry oxygen and causes it to polymerize. This results in decreased solubility thereby distorting the shape of the red blood cells, increasing their rigidity and resulting in red blood cells that are sickle shaped rather than biconcave. These sickle shaped red blood cells limit oxygen delivery to the tissues by restricting the flow in blood vessels, leading to severe pain and organ damage (vaso-occlusive crises). Oxidative stress is an important contributing factor to hemoglobin polymerization with polymer formation occurring only in the deoxy state. HbS/b-0 thalassemia (double heterozygote for HbS and b-0 thalassemia) is clinically indistinguishable from HbSS disease.

L-glutamine is a precursor for the synthesis of essential metabolic Oxidation-Reduction cofactors including Nicotinamide Adenine Dinucleotide (NAD). It has been shown in previous studies that there is higher L-glutamine utilization in Sickle Cell Anemia resulting in its depletion and thereby contributing to oxidative stress. Based on a phase II study showing favorable outcomes with ENDARI® compared with placebo, a phase III, randomized trial was conducted, in which the safety and efficacy of ENDARI® was studied in 230 Sickle Cell disease or beta-0 thalassemia patients, who had at least two episodes of painful crises during the 12 months before screening. Patients were randomized in a 2:1 ratio to receive ENDARI® (N=152) or placebo (N=78). Enrolled patients were 5-58 yrs old and ENDARI® was administered orally at 0.3 mg/kg/day for 48 weeks followed by a 3 week tapering period. Two thirds of the patients were on Hydroxyurea. The effect of treatment was evaluated over 48 weeks.

Patients who were treated with ENDARI® experienced fewer hospital visits for Sickle Cell crises pain management with parenteral narcotics or Ketorolac compared to those who received a placebo, fewer hospitalizations for Sickle Cell pain , and fewer days in the hospital (median 6.5 days versus median 11 days) compared to those on placebo. Further, patients who received ENDARI® also had fewer occurrences of acute chest syndrome (a life-threatening complication of sickle cell disease), compared with patients who received a placebo (8.6% versus 23.1%). The common side effects of ENDARI® included, nausea, constipation, headache, abdominal pain, cough, pain in the extremities, back pain and chest pain.

It was concluded that the benefit with ENDARI® for patients with Sickle Cell disease, was seen in all age groups and there was a consistent advantage with ENDARI® regardless of whether the patient was on Hydroxyurea or not. ENDARI® is the first treatment approved for patients with Sickle Cell disease in almost 20 years. Phase 3 Study of L-Glutamine Therapy in Sickle Cell Anemia and Sickle ß0-Thalassemia Subgroup Analyses Show Consistent Clinical Improvement. Niihara Y, Viswanathan K, Miller ST, et al. Abstarct#1318. Presented at ASH 58th Annual Meeting & Exposition, San Diego, CA. December 3-6, 2016

Weight Gain Increases the Risk for Postmenopausal Breast cancer

July 14th, 2017

SUMMARY: Breast cancer is the most common cancer among women in the US and about 1 in 8 women (12%) will develop invasive breast cancer during their lifetime. Approximately, 255,180 new cases of invasive breast cancer will be diagnosed in 2017 and over 41,070 women will die of the disease. Obesity is an important contributing factor to postmenopausal breast cancer incidence and mortality. Based on recently published meta-analysis, in women diagnosed with breast cancer, there is an approximately 30% increased risk of disease recurrence or death in those who are obese compared to those with ideal body weight. Increasing physical activity may lower the risk of breast cancer recurrence. According to the consensus from the St Gallen Consensus Conference in 2015, obesity has been associated with poor breast cancer outcomes. Obesity is associated with alterations in insulin/glucose homeostasis, adipokines, and sex hormones, which may play a role in breast cancer outcomes. Weight loss can lead to reductions in C-reactive protein, insulin, glucose, and leptin. These mediators have all been implicated to have prognostic significance in breast cancer.

The Nurses’ Health Studies (NHS) are the largest and longest running investigations focused on women’s health. This was established in 1976 and the information provided by its 238,000 dedicated nurse-participants has allowed NHS to produce key advances impacting women’s health. These studies are conducted by researchers at Harvard School of Public Health and Brigham and Women's Hospital in Boston, Massachusetts. The authors conducted a clinical trial in this NHS cohort and studied the effects of weight and weight changes in early adulthood and risk of breast cancer later in life. A prospective observational study was conducted among 74,177 women from the Nurses' Health Study from 1980-2012. These women provided information on breast cancer risk factors such as reproductive factors, hormone therapy, anthropometric variable, benign breast disease, and family history of breast cancer. This information was updated every 2 years up to the time of data analysis. Each individual’s weight at age 18 was collected in 1980.

During the observation period, 4965 cases of invasive breast cancer were reported for the 74,177 women followed from 1980 to 2012. Weight gain over a long period of time from age 18, both during premenopause and postmenopause, were positively associated with postmenopausal breast cancer risk. However, premenopausal weight gain was not related to premenopausal breast cancer risk. Further, weight gain from age 18 yrs onwards was positively associated with ER+/PR+ postmenopausal breast cancer and there was a 50% increased risk for breast cancer with a weight gain of 30 kg. This direct association was not seen for ER+/PR- or ER-/PR- breast cancer. The authors noted that overall, 17% of ER+/PR+ postmenopausal breast cancer and 14% of total postmenopausal breast cancer are attributable to weight gain of more than  5 kg after age 18.

It was concluded that 14% of postmenopausal breast cancer could be prevented if women avoided excessive weight gain of more than 5 kg after age 18. This study adds new insights on weight gain during premenopausal years and risk for postmenopausal breast cancer. Weight and weight changes in early adulthood and later breast cancer risk. Rosner B, Eliassen AH, Toriola AT, et al. Int J Cancer. 2017 Jan 30. doi: 10.1002/ijc.30627 [Epub ahead of print]