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January 2021 Notable News

What do cancer cells and bears have in common? How is artificial intelligence changing cancer? How do ovarian cancer cells survive in hostile environments? Can CML patients stop taking their medication? Why are cancer death rates continuing to decline? What should cancer patients know about the Covid-19 vaccines? There are a lot of questions to answer this month. Fortunately, we have the answers.

COVID-19 Vaccine

Some of the most pressing questions cancer patients have are about the Covid-19 vaccines. Some of the answers can be found at curetoday.com, which has put together a list of some things you should know. There are currently two Covid-19 vaccines available in the United States. They were authorized by the Food and Drug Administration (FDA) in late 2020. The two vaccines made by Pfizer-BioNTech and Moderna both require two doses, and both have an over 90 percent efficacy rate after both doses are administered. Both vaccines trigger the immune system to react defensively to the SARS-CoV-2 virus without causing the virus. There are common side effects seen as a result of the vaccines that include tiredness, pain at the injection site, headache, muscle ache, and fever. The side effects can last for several days or a week. While cancer patients should discuss the vaccine options with their doctors, it’s important to note that getting the vaccine should not affect most cancer treatments. Find the complete comparison of the two vaccines, which includes an explanation of how each vaccine works and the common side effects specific to each vaccine, here. There is also a helpful and easy-to-read infographic.

Declining Cancer Death Rates

There’s no question that declining death rates are good news. As of 2018, cancer death rates are continuing to decline in the United States, reports abcnews.go.com. The rate has been falling since 1991, and from 2017 to 2018, it fell 2.4 percent. In the past five years, almost half of the decline in cancer deaths was attributed to lung cancer. With fewer people smoking, the rates of lung cancer illness and death have declined, and due to better treatments and diagnostics, people with lung cancer are living longer. While cancer remains the second leading cause of death, it’s encouraging that the death rates are continuing to decline. Learn more here.

CML News

A question CML patients could be asking their doctors is whether or not they can stop taking their medication. Some chronic myelogenous leukemia (CML) patients may not have to, reports cancer.gov. The tyrosine kinase inhibitors (TKIs) CML patients take to make the disease manageable are taken every day and they come with some disruptive side effects, which affect the quality of life for patients. However, a new clinical study shows that patients who were in remission for at least two years, and stopped using nilotinib, imatinib, and two other TKIs, had an improved quality of life, and about two thirds of the patients remained in remission three years after stopping treatment. Find more information about the study results and which patients could be eligible to stop taking their CML medications here.

Ovarian Cancer

Researchers have long been questioning how ovarian cancer cells survive in hostile environments, but now have an understanding of how ovarian cancer cells survive and grow in the fluid of the abdomen, which should be a hostile environment of low nutrients and oxygen, reports eurekalert.org. The study looked at the structures inside the cells during different stages of ovarian cancer and found that one of the structures, the mitochondria, changed shape and function in the peritoneal cavity, the space in the abdomen that contains the intestines, liver, and stomach, which made it possible for aggressive cancer cells to flourish. Knowing how the cells are able to survive and thrive in the abdomen could help develop better treatments for the disease that may prevent the spread of cells from the original tumor to the peritoneal cavity. When ovarian cancer cells spread through the peritoneal cavity, a patient’s survival rate is just 30 percent. Learn more about the findings here.

AI Being Used in Cancer Care

Some researchers are answering the question of how artificial intelligence will play a role in the future of treating cancer. A new telescope developed at Rice University could be a game changer for cancer surgeries, says texasmonthly.com. Using artificial intelligence, it can take a lot of the guess work out of analyzing tissue and could save valuable time during surgeries. Find out how here.

Artificial intelligence is also being used to develop a technique to diagnose prostate cancer, reports phys.org. The technique is almost 100 percent accurate and can diagnose prostate cancer from urine within 20 minutes. This new technique is less invasive and much more accurate than current prostate cancer testing. Learn more about the development of the new technique here.

Cell Hibernation

Finally, who isn’t asking what bears and cancer cells have in common? It’s hibernation, of course! Cancer cells can go into a type of hibernation as a means of surviving chemotherapy, reports scitechdaily.com. Research shows that cancer cells have the ability to become sluggish and enter a slow-dividing state of rest to protect themselves when threatened by chemotherapy or other targeted therapies. They hibernate, just like bears, until the threat is gone, and they can resume their normal state of growth. The information helps look at chemotherapy-resistant cancers and how to better treat them. The study also showed that cancer regrowth can be prevented when therapies target cancer cells in their slow-dividing state of rest. Learn more about hibernating cancer cells here.

Cancer Awareness Calendar 2021

January

Cervical Cancer Awareness Month

Blood Donor Month


February

National Cancer Prevention Month

Gallbladder and Bile Duct Cancer Awareness Month

World Cancer Day (February 4, 2021)

National Donor Day (February 14, 2021)

Rare Disease Day (February 28, 2021)


March

Colorectal Cancer Awareness Month

International Women’s Day (March 8, 2021)

Triple-Negative Breast Cancer Day (March 3, 2021)

Kidney Cancer Awareness Month

Multiple Myeloma Awareness Month

Anal Cancer Awareness Day (March 21, 2021)


April

National Cancer Control Month

Esophageal Cancer Awareness Month

Minority Cancer Awareness Month

Minority Health Month

National Oral, Head, and Neck Cancer Awareness Week (April 11-17, 2021)

Testicular Cancer Awareness Month

World Health Day (April 7, 2021)


May

Bladder Cancer Awareness Month

Brain Tumor Awareness Month

Cancer Research Month

Clinical Trial Awareness Week

Melanoma and Skin Cancer Awareness Month

Melanoma Monday (May 3, 2021)

Women’s Check-up Day (May 10, 2021)

Women’s Health Week (May 9−15, 2021)

Skin Cancer Detection and Prevention Month


June

Cancer Survivors Month

Cancer Survivors Day (June 6, 2021)

Men’s Health Week (June 14−20, 2021)


July

UV Safety Awareness Month

Sarcoma and Bone Cancer Awareness Month


 August

Summer Sun Safety Month

World Lung Cancer Day (August 1, 2021)


September

Childhood Cancer Awareness Month

Uterine Cancer Awareness Month

Gynecologic Cancer Awareness Month

Blood Cancer Awareness Month

MPN Awareness Day (September 9, 2021)

Ovarian Cancer Awareness Month

Prostate Cancer Awareness Month

Take a Loved One to the Doctor Day (September 21, 2021)

Thyroid Cancer Awareness Month


October

Breast Cancer Awareness Month

National Mammography Day (October 15, 2021)

Liver Cancer Awareness Month


November

Lung Cancer Awareness Month

National Family Caregiver Month

Carcinoid Cancer Awareness Month

Neuroendocrine Tumor (NET) Awareness Day (November 10, 2021)

Pancreatic Cancer Awareness Month

Stomach Cancer Awareness Month

The Best of 2020

As 2021 begins, we would like to take a moment to highlight a few of our most popular posts from 2020 and to thank the people who contributed to the popularity of these posts. We cannot thank the authors and organizations enough that have contributed to make 2020 one for the books, even during a trying year. Your efforts to Patient Empowerment Network are greatly appreciated!

January

Patient Profile: Perseverance and Positive Thinking Helped This Young Mother

Stage IIB Hodgkin Lymphoma patient, Lindsay, shares her cancer journey from searching for a diagnosis to adjusting to her new mantle of ‘cancer survivor’.

10 Body Signals Warning Health Problems

We should always be aware of what our body is trying to tell us. Here are ten ways our body is signaling that we should be more concerned with our health.


February

How Can You Best Support A Friend With Cancer?

What happens when someone close to you has been diagnosed with cancer? Here are some tips and advice to be the most helpful to cancer patients.

Confused About Immunotherapy and Its Side Effects? You Aren’t Alone

Patients need to be aware of the side effects of immunotherapy and vigilant in addressing them with their doctor as they can signal complications.


March

Practicing Self Care In The Time of Coronavirus – How To Mind Your Mental Health And Well-Being During Covid-19

While this is naturally a worrying time, there are many things we can do to mind our mental health and boost our immunity and well-being at this time. In this blog, you will find tips to help you navigate your way through this time of global crisis.

Health Fraud Scam – Be Aware and Careful

This blog explains what healthcare fraud is and provides tips to help you avoid falling victim to these scams.


April

Cutting Through the Panic in a Pandemic

A list of trusted sources to help you cut through all the information that is being share online about the coronavirus pandemic.

Fact or Fiction: Finding Scientific Publications Infographic

This infographic from our PEN Powered Activity Guide shares her tips for finding and understanding scientific publications.


May

Cancer, COVID, and Change

Cissy White gets used to her new normal dealing with having ovarian cancer during a pandemic, and the challenges and benefits that presents.

Diversity in Clinical Trials Benefits Everyone

It is critical that minority groups are included in clinical trials because, as the broader population, their data will affect the outcome of precision medicine for everyone.


June

Social Determinants of Hope

Casey Quinlan explains that everyone’s social determinants of health have been impacted by COVID19, but she is seeing strong signals of hope.

Music as Medicine: The Healing Power of Music

For cancer patients, music can be a powerful therapeutic tool in coping with a cancer diagnosis and treatment. Here is a list of some crowd favorites.


July

Dealing with a Cancer Diagnosis During COVID-19

There’s never a good time for a cancer diagnosis, especially during a global pandemic. Here are some recommendations from cancer treatment experts.

Quotation Inspiration: 10 Quotes to Inspire, Motivate and Uplift Cancer Patients

A list of 10 quotes and messages of hope and inspiration from patients that can bring you that much needed boost in your day.


August

Turning Your Home Into a Sanctuary

These days we are spending more time at home, so you need to feel like your happy place. Turn your home in a sanctuary in 5 simple steps.

Oncology Social Worker Checklist

Oncology Social Worker, Sara Goldberger, MSSW, LCSW-R, shares her checklist for resiliency during the time of a global pandemic.


September

The Nitty Gritty on Care Partnering

Casey Quinlan provides a short checklist that can be used in any patient-with-a-bedside-care-partner situation.

Are Cancer Survivors More Susceptible To Respiratory Illnesses When Air Quality Is Poor?

A recent study published examines the connection between air pollution and respiratory health among cancer survivors.


October

Patient Empowerment Revisited

In this Part 2, we’ll look at the role of peer to empowerment and explore whether the term “empowerment” is even the right term to use.

The Power of Journaling During Cancer Treatment

This article is meant to help cancer patients understand just how much journaling can help them emotionally and physically during their treatments.


November

The Caregiver Impact: A Vital Part of Healthcare

Network Managers, Carly Flumer and Sherea Cary, team up to discuss the importance caregivers and some quick tips for caregivers.

5 Ways a Patient Portal Can Improve Your Health Care Experience

This blog shares 5 helpful tips for utilizing your patient portal to the fullest.


December

“Wait, There’s a Good Cancer?”

Carly Flumer shares her thyroid cancer diagnosis story and what it’s like being told you have the “good” cancer.

Chronic Myeloid Leukemia (CML) Patient Profile

A patient story from a chronic myeloid or myelogenous leukemia (CML), an uncommon cancer of the bone marrow, patient.

December 2020 Notable News

This month there is a lot of promising news giving hope to the possibility of a brighter, better new year. A better understanding of why humans are prone to advanced cancers and more knowledge about obesity as a risk factor, coupled with advances in targeted therapies and combinations of medications to better treat myeloid leukemias, breast cancer, and get the immune cells involved are all helping to bring about better treatments and outcomes for cancer patients. However, the technology used to create the vaccine for the novel coronavirus Covid-19, that dominated the year and changed the world for us all, just may be the biggest game changer of all. It could revolutionize the way we treat cancers and many other diseases.

The Covid-19 vaccines use a technology that could lead to managing other diseases, like cancer and heart disease, reports bloomberg.com. The technology, called mRNA therapeutics, uses messenger RNA in the vaccines to turn the body’s immune system into a factory with the healthy cells producing viral proteins that create a strong immune response. The approach has never-before been used outside of clinical experiments, and many researchers are stunned by how well it works. Cancer researchers have been studying the technology for 20 years, and the vaccine was able to be created so quickly due to what they knew from working on developing cancer vaccines. These vaccines could lead to a whole new field of medicine, with mRNA drugs for treating cancer expected to be approved in two or three years. It’s possible all infectious disease vaccines will use the technology in the next ten to 20 years, as the method is faster and cheaper than current options. The hope is to use mRNA to create flu vaccines, heart failure treatments, an HIV vaccine, and much more. Learn more about the exciting mRNA possibilities here.

When compared to our closest cousin, the chimpanzee, humans have a high risk of developing advanced cancers, and researchers now think they know why, says sciencedaily.com. New research shows that there is an evolutionary genetic mutation that is unique to humans. The SIGLEC12 gene was eliminated by the body because it lost its ability to distinguish between self and invading microbes. However, it’s not completely gone from the population, and it can be a problem for the 30 percent of people who still produce SIGLEC12 proteins. Those people, when compared to people who don’t produce the proteins, are at more than twice the risk of developing an advanced cancer during their lifetimes. Researchers are hoping to use the information to help determine who is most likely to get advanced cancers, and have developed a simple urine test to detect the proteins. Learn more about this evolutionary snafu here.

In another story about cancer risk from sciencedaily.com, researchers better understand the relationship between obesity and cancer. Obesity is linked to increased risk for more than a dozen types of cancer, as well as a worse prognosis and chance of survival. Researchers at Harvard Medical School have discovered that obesity provides the right environment for cancer cells to take fuel away from cancer-fighting T cells. Cancer cells respond to increased fat availability by reprograming themselves to eat fat molecules and thus deprive T cells of fuel. Get more information here.

When it comes to treating cancer, better therapies are discovered all the time, and now researchers have found a new class of targeted cancer drugs that may effectively treat some common types of leukemia, reports medicalxpress.com. The drugs target and eliminate leukemia cells with TET2 mutations, which are one of the most common mutations found in myeloid leukemias. The findings show that a synthetic molecule called TETi76 can target and kill cancer cells in both early and fully developed phases of leukemia and may be more effective than current targeted therapies. Find out more here.

Speaking of more effective treatments, it turns out that some women with breast cancer might not have to undergo chemotherapy for treatment, reports nih.gov. Initial results from a clinical trial show that postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER 2)-negative breast cancer that has spread to one to three lymph nodes and has a low risk of recurrence won’t benefit from adding chemotherapy to hormone therapy. The trial also showed that premenopausal women with the same HR-positive, HER2-negative breast cancer characteristics did benefit from chemotherapy. The trial was made up of more than 9,000 women who were monitored for an average of five years and will continue to be followed, so more insights about breast cancer are expected to come out of the trial. Get more information about the trial here.

Another advancement in breast cancer treatment was reported by cancernetwork.com. The U.S. Food and Drug Administration (FDA) approved margetuximab-cmkb (Margenza) in combination with chemotherapy to treat patients with metastatic HER2-positive breast cancer who have received 2 or more prior anti-HER2 regimens. A study showed a 24 percent reduction in the risk of disease progression or death. More information is available here.

Immunotherapies have helped change the way many cancers are treated, and the process is still evolving. Researchers at Purdue University have created a new immunotherapy treatment, reports purdue.edu. The new treatment focuses on the immune system and has been shown to work in six different tumor types by reprograming the immune cells within the tumor to kill the tumor rather than giving it the chance to grow. The technique could be used to treat many types of cancers because the nonmalignant immune cells that are in the different types of tumors tend to be similar. Folate, a type of vitamin B, is used to deliver the anti-cancer drugs to the cells. The new therapy could be available within ten years. Learn more about the new therapy here.

Immunotherapies used to treat advanced cancers don’t always work for everyone, but now researchers have found that two cholesterol lowering drugs might improve the effectiveness of these therapies, reports cancer.gov. Studies show that when evolocumb (Repatha) and alirocumab (Praluent) are used on their own and in combination with immune checkpoint inhibitors, they slowed the growth of tumors. The drugs, approved by the FDA since 2015 are considered safe, can be taken at home, and are less expensive than many cancer therapies. Learn more here.

Metastatic BC Research: How Can You Advocate for the Latest Treatment?

Metastatic BC Research: How Can You Advocate for the Latest Treatment? from Patient Empowerment Network on Vimeo.

What do metastatic breast cancer patients need to know about the latest research news? Dr. Megan Kruse shares highlights from the 2020 San Antonio Breast Cancer Symposium (SABCS), along with her advice for advocating for the right testing to help guide treatment options.

Dr. Megan Kruse is a Breast Medical Oncologist at the Cleveland Clinic. More about this expert here.

See More From INSIST! Metastatic Breast Cancer

Related Resources:

 

What Could Advances in Breast Cancer Research Mean for You?

How Can You Advocate for the Best Breast Cancer Care?

Factors That Guide a Metastatic Breast Cancer Treatment Decision

 


Transcript:

Dr. Kruse:                   

At this year’s San Antonio Breast Cancer Symposium, there were a few interesting presentations about the treatment of first-line metastatic triple-negative breast cancer that I think patients should be aware of.

Two of the presentations centered around trials that were presented in the past. Those reporting, patients reported outcomes from the IMpassion 130 study, which looked at chemotherapy for metastatic triple-negative disease plus the immunotherapy atezolizumab. And then, there was also an update on the results from the KEYNOTE-355 study, which was a study again of chemotherapy for metastatic triple-negative patients in combination with pembrolizumab, a different immunotherapy. And both of these studies showed that there was benefit for women in certain sub-groups of triple-negative breast cancer when looking at addition of immunotherapy.

And so, what I’d like to draw patients’ attention to with these presentations is that you have to be aware of if you fall into one of these categories so you know if you’re a candidate for the particular type of immunotherapy that can be added to chemotherapy. There are two different ways to test for if a patient is a candidate for immunotherapy and they are both tests that can be done on biopsies of metastatic or cancer recurrent sites in the body.

They can also be sent off of original breast cancer tumors. And what we now know is that for patients who do not have markers that suggest immune activation or where the immune system would be responsive to immunotherapy the addition of that extra therapy really does not help to improve cancer control over chemotherapy alone. And I think that’s a really important topic because everyone is very interested in immunotherapy, but it does have side effects of its own and it can actually be lasting side effects in terms of inflammation in organs like the liver, the colon, and the lungs.

And then, the third presentation that I’d like to bring up is the IPATunity study, which looked at the addition of a targeted therapy called ipatasertib to, again, chemotherapy for the first treatment of metastatic triple-negative disease.

And so, this is getting into an area of targeted therapy for metastatic triple-negative disease. And again, only looks at patients that have a particular marker that suggests sensitivity to this drug. And those are certain genetic markers, predominately changes in a DNA marker called PIK3CA. In this study, we actually found that there was no benefit for the targeted therapy added to chemotherapy for patients that had that genetic mutation, which was different than what was seen in earlier studies of the same combination. So, I think there’s more work to be done and it’s probably too early to say that this targeted therapy will not be used in treatment of metastatic breast cancer.

But what all of these research studies show together is that metastatic triple-negative cancer is not really just one disease. It’s very clear that within that one name, there are multiple different patient types and tumor types that need to be cared for differently.

And so, again, I think the theme from these abstracts and these research presentations is that we have to look into the right therapy for the right patient at the right time, which largely involved DNA-based testing.

So, when patients are thinking about their treatment options and how to best help with their providers about what treatment options exist for them, I think it’s important to recognize the type of testing that may be advantageous in your cancer type.

And so, for all metastatic breast cancer patients, we really recommend that they’ve had genetic testing to look for DNA changes like BRCA mutations that will lead to treatment options. For metastatic triple-negative disease, it’s important to make sure that you’re providers are testing for PDL1, which would make you a candidate for immunotherapy. And then, the more we learn about clinical trials, the more we have options for patients that have had drug-based DNA or genome-based testing. So, that’s an important term for patients to become familiar with is genomic testing.

And I think when you bring that up with your providers, they’ll know what you’re talking about and they’ll know that what you’re potentially interested in is new targeted therapy for the cancer that may either come in combination with chemotherapy or as a standalone treatment option. If you don’t have those options that are available, and FDA approved basis for regular routine patient care, there is always the option of clinical trials.

And so, if that is something that you’re interested in, genomic testing will often open the way. So, I think as you’re writing notes when you’re talking to your providers, you might wanna jot down whether or not you’ve had genetic testing and whether or not you’ve had genomic testing in the past, as both of those things will help potentially address all of your treatment options.

I’ve very hopeful about the research that is going to lead to new developments for breast cancer treatment in the next few years.

I think what we’ve seen both at this San Antonio Breast Cancer Symposium as well as other conferences in the recent past has been a lot of focus on finding the right treatment for the right patient at the right time. And so, patients seem to be very interested in finding out this information. They often come to clinic armed with the most recent data, which allows their providers to have really informed discussions about what the best treatment might be. And to talk about if the new treatments are not great right now, what treatments might look like in the future.

I think the other thing that’s encouraging about the research that we’ve seen presented at this conference is that some of these trials are very, very large. For example, the RxPONDER trial was a trial of over 9,000 patients. And I really think that’s amazing to get that many patients interested in research that may not directly impact their patient care but will impact the care of others moving forward.

It’s just a sign that our breast cancer patients are empowered, and they want to make a difference in the scientific community as a whole.

 

Breast Cancer Research News: SABCS Conference Highlights

Breast Cancer Research News: SABCS Conference Highlights from Patient Empowerment Network on Vimeo

Expert Dr. Megan Kruse shares highlights from the 2020 San Antonio Breast Cancer Symposium (SABCS). Dr. Kruse provides an overview of what this news means for early stage breast cancer patients, along with her optimism about the future of breast cancer research and treatment.

Dr. Megan Kruse is a Breast Medical Oncologist at the Cleveland Clinic. More about this expert here.

See More From The Pro-Active Breast Cancer Patient Toolkit

Related Resources:

 

Transcript:

Dr. Kruse:                   

The San Antonio Breast Cancer Symposium is a national meeting with international presence that combines all of the latest data from research on breast cancer topics. It involves clinical research, basic science research, a lot of patient, and patient advocate support.

And the idea here is to bring together all the different disciplines that are involved in breast cancer patient care and do the best information and knowledge sharing that we can each year.

This year’s San Antonio Breast Cancer Symposium brought us a lot of interesting research focusing on early-stage breast cancer patients. I think the most important presentations that were given had to do with the treatment of high-risk lymph node-positive hormone receptor-positive breast cancer patients. And these were really across three abstracts. The first abstract of interest was the Monarch E study, which looked at high-risk women with hormone receptor-positive HER2-negative breast cancer and optimizing their medical therapy.

So, these patients are typically treated with anti-estrogen therapy and the idea of the research that was presented was if the addition of a targeted medication called abemaciclib or Verzenio could help to improve outcomes for women in this population. And what the trial found was that for women who took their anti-estrogen therapy for the usual length of time but added the abemaciclib for the first two years of that anti-estrogen therapy that there is actually an improvement in cancer-free survival time or an improvement in cure rates. And this was important because these women may not benefit from chemotherapy, as we’ll talk about in another abstract.

An addition research presentation that was given that goes alongside of the monarch E study was that of the Penelope B study. And the Penelope B took a similar population to what was studied in Monarch E. So, again high-risk women with lymph node-positive, hormone receptor-positive, HER2-negative breast cancer; however, in Penelope B, all of these patients had received pre-surgery chemotherapy.

And in order to qualify for the trial, the patients had to have some cancer that remained in the breast or the lymph nodes that was taken out at the time of their surgery. So, these are patients clearly in which chemotherapy did not do the whole job in terms of getting rid of the cancer. And again, the idea here was to add a second targeted therapy to the endocrine therapy to see if that would improve cancer-free time for patients in this population. The difference in this study was that the partner targeted therapy that was used was a drug called palbociclib or Ibrance.

And the drug was actually only used for one year in combination with endocrine therapy rather than two years as was used in the Monarch E study with abemaciclib. Interestingly enough, the Penelope B study was a negative study, meaning that it did not improve the cancer-free survival time for women who took the endocrine therapy plus targeted therapy compared to women who took the endocrine therapy alone.

So, I think that these are two interesting studies that one should look at together. And clearly, may impact what we do for the treatment of high-risk hormone receptor-positive women moving forward. The third abstract that I’d like to touch on that I think was important for women with early-stage breast cancer is the RxPONDER study, also known as SWOG 1007. And this study again was looking at lymph node-positive, hormone receptor-positive HER2-negative breast cancer patients and seeing if the addition of chemotherapy helped to improve their cancer-free survival compared to anti-estrogen therapy alone.

And so, in this study, while the study population was all women with early-stage breast cancer, meeting the one to three lymph node-positive criteria, you really have to break the results down into the results for pre-menopausal women and the results for post-menopausal women.

Because overall the study really showed no significant benefit to chemotherapy on top of endocrine therapy for women in this population; however, we did see that there was a clear benefit for women who were pre-menopausal. So, the women who had no benefit from chemotherapy were largely those who were post-menopausal, while those who were pre-menopausal derived extra benefit from chemo on top of anti-estrogen therapy. And that benefit depended on what the Oncotype recurrent score was.

With women that had the lowest of the recurrent scores having a chemo benefit of about three percent going up to over five percent for women who had Oncotype recurrent scores in the mid-teens to 25 range. In both of these groups, women who had Oncotype scores of 26 or above would have chemotherapy as per our standard of care.

So, I think that this abstract is important because in the past women who had lymph node-positive breast cancer generally received chemotherapy no matter what. More recently we’ve understood that not all of these cancers are created equal and that some cancers may not actually have benefit from chemotherapy in terms of improving cure rate. So, this study is a big step forward to help individualize and specify the treatment for women with lymph node-positive, hormone receptor-positive, HER2-negative early breast cancer.

I’ve very hopeful about the research that is going to lead to new developments for breast cancer treatment in the next few years.

I think what we’ve seen both at this San Antonio Breast Cancer Symposium as well as other conferences in the recent past has been a lot of focus on finding the right treatment for the right patient at the right time. And so, patients seem to be very interested in finding out this information. They often come to clinic armed with the most recent data, which allows their providers to have really informed discussions about what the best treatment might be. And to talk about if the new treatments are not great right now, what treatments might look like in the future.

I think the other thing that’s encouraging about the research that we’ve seen presented at this conference is that some of these trials are very, very large. For example, the RxPONDER trial was a trial of over 9,000 patients. And I really think that’s amazing to get that many patients interested in research that may not directly impact their patient care but will impact the care of others moving forward.                                   

It’s just a sign that our breast cancer patients are empowered, and they want to make a difference in the scientific community as a whole.

 

November 2020 Notable News

If you or someone in your life has been affected by cancer, you probably know that cancer isn’t fair, but the evidence is mounting that, when it comes to cancer diagnosis and treatment, cancer may be particularly unfair to those who are of lower income or who are minorities. This month there is also evidence that vitamin D could help lower cancer risk if you have the right BMI, a popular gameshow host made us all very aware of pancreatic cancer during Pancreatic Cancer Awareness month, and WHO has launched big plans to eliminate cervical cancer.

Poverty and Cancer

Poverty is known to put people at a higher risk of dying from cancer, and in a new study, the National Cancer Institute took a closer look at the relationship between poverty and cancer deaths, reports cancer.gov. The study revealed that people in the United States, who live in counties with persistent poverty, have a higher risk of dying from cancer. Counties with persistent poverty are identified by the US census as having had 20 percent or more of the population living below the federal poverty level from 1980 to the present day. Twelve percent of the counties in the US are considered persistent poverty counties, and many of them are in the southeastern part of the country. The counties are mainly rural and have a high percentage of Black and Hispanic residents. Between 2007 and 2011, cancer deaths were higher in counties with persistent poverty. The study specifically showed an increased risk of dying from lung, colorectal, stomach, and liver cancers. The findings reveal the widespread need to address the disparities among those living in poverty who are diagnosed with, and are at risk of, developing cancer. More information can be found here.

Inequities in Lung Cancer

Another report reveals further inequities when it comes to lung cancer treatment and survival rates. Black Americans, and in particular Black males, are more likely to get lung cancer and less likely to survive it, reports healthline.com. When Black Americans are diagnosed, the cancer is more likely to be in a later stage and to have spread to other parts of the body, making it harder to treat. No matter when they are diagnosed, Black Americans tend to have worse outcomes. Past studies have shown that Black patients are 66 percent less likely than white patients to get quality treatment for lung cancer. Many factors are involved, but there is research that shows that bias and racism in the healthcare system affects the quality of care given to racial and ethnic minorities. Learn more about the healthcare disparity affecting Black Americans and what can be done about it here.

Vitamin D

Vitamin D may reduce your risk of cancer, but only if you are at a healthy weight, reports medicalxpress.com. People who live near the equator, where they have a high exposure to vitamin D-producing sunlight, have lower incidence of and lower death rates from some cancers. However, clinical trial results have not shown vitamin D to have much effect on cancer, despite the fact that vitamin D deficiency is present in 72 percent of cancer patients. A study known as the Vitamin D and Omega-3 Trial (VITAL), which ended in 2018, found that vitamin D did not reduce cancer. However, researchers are analyzing the VITAL data again and think they have found the link between vitamin D and a reduction in cancer risk. The connection seems to be body mass. Researchers found, that when vitamin D supplements were used, the overall risk reduction for advanced cancer was 17 percent. However, the risk reduction increased to 38 percent in study participants with a normal body mass index. Find out more about vitamin D and cancer here.

Pancreatic Cancer Awareness

November is the month dedicated to pancreatic cancer awareness, and despite losing popular “Jeopardy!” host, Alex Trebek, to the disease early in the month, the outlook on pancreatic cancer is improving, reports medicalxpress.com. The improved outlook is a result of advances in screening, early detection for high-risk people, and treatment. Advances in MRI technology are used for screening and detection, and improvements in chemotherapy have increased the chance of removing tumors. A diabetes diagnosis can also help find the cancer early, while it is still curable. In this small number of cases, the diabetes diagnosis is unexpected and is actually being caused by the cancer. Researchers continue to focus on early diagnosis, and there have been promising advances in that as well, including a potential stool test like the Cologuard test that is used to screen for colon cancer. Trebek, who succumbed to pancreatic cancer on November 8, was able to posthumously address his audience on World Pancreatic Cancer Day, November 19. He described the disease as terrible and urged people to see their doctors if they experienced symptoms. Per mayoclinic.org, pancreatic cancer symptoms include abdominal pain that radiates to your back, loss of appetite or unintended weight loss, yellowing of skin and whites of your eyes (jaundice), light-colored stools, dark-colored urine, itchy skin, new diagnosis of diabetes or existing diabetes that’s becoming more difficult to control, blood clots, and fatigue. Learn more about the positive developments for pancreatic cancer here. See Alex Trebek’s posthumous message on World Pancreatic Cancer Day here. See the Mayo Clinic’s list of pancreatic cancer symptoms here.

Cervical Cancer

The World Health Organization (WHO) launched its strategy to eliminate cervical cancer, reports who.int. WHO hopes with vaccination, screening, and treatment, more than 40 percent of new cases and 5 million deaths will be reduced by 2050. This is the first time that 194 countries will come together with a commitment to eliminate cancer. Cervical cancer is preventable, and it is curable if detected early and treated properly. However, for women, it is the fourth most common cancer in the world. If no changes are made to address cervical cancer, the number of new cases is expected to increase from 570,000 to 700,000 each year, and the number of deaths may increase from 311,000 to 400,000 each year. Find more information about the WHO strategy to eliminate cervical cancer here.

How Can You Advocate for the Best Breast Cancer Care?

How Can You Advocate for the Best Breast Cancer Care? from Patient Empowerment Network on Vimeo.

Breast cancer expert Dr. Julie Gralow explains how you can advocate for the best metastatic breast cancer care, through speaking up, utilizing care team members and taking key steps to achieving better care.

Dr. Julie Gralow is the Jill Bennett Endowed Professor of Breast Medical Oncology at the University of Washington, Fred Hutchinson Cancer Research Center, and the Seattle Cancer Care Alliance. More about this expert here.

See More From INSIST! Metastatic Breast Cancer


Related Resources:

How Genetic Mutations Affect Metastatic Breast Cancer Disease Progression and Prognosis

Factors That Guide a Metastatic Breast Cancer Treatment Decision

What Could Metastatic Breast Cancer Genetic Testing Advances Mean for You?


Transcript:

Katherine:                  

For patients who may be hesitant to speak out for themselves and advocate for their own care and treatment, what advice do you have?

Dr. Gralow:                

You have a whole team who’s behind you, and I’m the MD on the team, but I’ve got a nurse practitioner, and a nurse, and a scheduler, and a social worker, and a nutritionist, and a physical therapy team, and financial counselors. I’ve got a whole team who works with me. And so, a patient might be hesitant to speak up during the actual appointment with their physician. It’s a short amount of time. I would recommend come into it with written-down questions because things go fast. You don’t get a lot of time with your doctor.

Things go fast, but don’t come in with 25 questions, either. Pick your top few that you want to get taken care of this visit because if you come in with 25 or 30, you’re going to lose the answers to most of them. Maybe bring somebody with you who’s an advocate and a listener for you who could be taking notes, so you can process and you don’t have to write it down, or ask if you can record it. It’s really important if you’re newly diagnosed or maybe there’s a progression and you’re going on a new treatment. That’s okay too.

But, I would also say you have a whole team behind you, so sometimes, if you don’t have time or if you’re hesitant to speak up in your doctor’s visit, you can ask the nurse, or maybe you can ask the social worker for help, even. See if there’s support groups around.

Interestingly, we’ve got a peer-to-peer network where patients can request to talk to somebody else who’s matched to them by some tumor features, and their stage, and things like that. Maybe finding somebody else who’s gone through something similar, and somebody independent to talk to instead of relying on your family.

It can also be really helpful to talk to a therapist or a psychologist about your fears, and sometimes, you want to be strong for your family, strong for your children and all, but you need a safe space with somebody that you can just express your fears and your anger if that’s what’s going on, or your depression or anxiety to while you’re trying to hold a strong face for others in your family. So, I would encourage patients to look at who is the whole team and talk to the other members of the team as well, and sometimes, they can help advocate.

Also, find somebody who might be able to come to your appointments with you, somebody who will help you advocate or remind you – “Didn’t you want to ask this question?” – or be another set of ears that you can process it with afterwards.

Katherine:                  

Dr. Gralow, we’ve covered a lot of useful information today for patients. Thank you so much for joining us.

Dr. Gralow:                 

Thank you, Katherine.

Katherine:                  

And, thank you to all of our partners. To learn more about breast cancer and to access tools to help you become a proactive patient, visit powerfulpatients.org. I’m Katherine Banwell.

Empowering Ourselves Forward: Applying Skills to Our Cancer Journey

During the pandemic, all of us have had to do some adjusting, some more than others. As cancer patients, we recognize the “new normal” everyone else is experiencing. While this can be detrimental, it can also be seen as somewhat gratifying. The non-cancer world finally understands what we’ve gone through and/or are going through on a daily basis and for the rest of our lives. Yet we’ve all learned new skills and coping mechanisms to make the best of our situation:

Virtual Appointments (Telehealth)

By now, the majority of patients have experienced at least one telehealth appointment where we see a doctor, NP, PA, etc. virtually. Whether this a completely new experience or not, there are many ways in which we can benefit from these appointments, which, hopefully, continue into the future.

What can be applied in the future:

  • Writing down a list of questions before your appointment so that nothing is missed
  • The feeling of comfort with your health care professional, especially if they weren’t in a white coat. They’re humans just like us
  • Asking questions when you don’t understand something – there is time!
  • The importance of having a caregiver as a second set of eyes and ears

Being Active

Gyms were closed (and some still are) for a long period of time, which forced us to be creative in being active.

What can be applied in the future:

  • If you watched YouTube videos or downloaded fitness apps, continue to use them to apply those movements to your routine
  • If you tried free classes offered by a local studio or gym, see what these places offer in-person
  • For motivation, grab a family member of friend to keep you accountable

Mindfulness

Perhaps the hardest part of going through the pandemic is the mental aspect, especially for cancer patients who are considered more vulnerable.

What can be applied in the future:

  • Continue using apps and YouTube videos to guide you through meditations
  • Keep a journal to write down your feelings
  • Set intentions at the start of each day
  • Remember how far you’ve come and what you can be grateful for

Family and Friends

Social distancing and wearing masks were suggestions (and in some states mandatory) to help stop the spread of the virus. This led to family and friends not being able to see one another, often for months. What’s more is the masks often concealed our expressions, making communication a little bit harder.

What can be applied in the future:

  • Spend more time with people who care about you, knowing it is possible for it to be taken away from you
  • Practice being in the moment, really focusing on what the person is saying and watching their facial expressions
  • Remember your own needs: people may now want to get together more often, but that may not be possible due to a number of factors, including your place in treatment, symptoms, and mental/physical/emotional states. Take the time you need for yourself

How Can Breast Cancer Genetic Testing Empower Women?

How Can Breast Cancer Genetic Testing Empower Women? from Patient Empowerment Network on Vimeo.

Dr. Stephanie Valente explains how breast cancer genetic testing results can help women learn about their breast cancer risk and guide prognosis and treatment choices.

Dr. Stephanie Valente is the Director of the Breast Surgery Fellowship Program at Cleveland Clinic. More about this expert here.

See More From INSIST! Metastatic Breast Cancer

Related Resources:

 

Transcript:

Dr. Valente:                

So, genetic testing in this day and age is really empowering to a lot of women. So, it allows women to take control of their health from the beginning. So, if somebody has a strong family history of breast cancer, and that woman doesn’t have breast cancer but wants to know if she’s at an increased genetic risk for developing breast cancer in her lifetime – Knowing that risk and if a gene is identified, that woman could undergo high-risk screening.

So, saying if she develops breast cancer, it would be caught early, and she can go into a high-risk program. Or she can elect to prophylactically – meaning before cancer – remove her breasts. That would be both of the breasts with a mastectomy – Again, with or without reconstruction. And so, that decreases the risk.

Nothing in life is 100%. But it essentially decreases the risk of getting breast cancer. Some of the genes, like the BRCA gene – that’s a very common gene – is a 60% to 80% lifetime risk of developing breast cancer. And so, that would take that lifetime risk down to about 5% risk of developing breast cancer. And so, that’s empowering for a lot of women. And so, some women do elect to have that procedure.

The other thing for genetic testing is that for women who are diagnosed with breast cancer, sometimes the triple-negative breast cancer – finding out whether or not they carry a BRCA gene. We know that certain genes in triple-negative breast cancer allow patients to have better treatment outcomes with certain chemotherapy. So, the medical oncologist may opt to add a specific chemotherapy based on whether or not that patient actually carries a genetic mutation.

What Should You Know About the Role of Surgery in Breast Cancer Treatment?

What Should You Know About the Role of Surgery in Breast Cancer Treatment? from Patient Empowerment Network on Vimeo.

Dr. Stephanie Valente explains how surgery approaches, including mastectomy and lumpectomy, are used in treating breast cancer, and addresses common misconceptions about mastectomy.

Dr. Stephanie Valente is the Director of the Breast Surgery Fellowship Program at Cleveland Clinic. More about this expert here.

See More From The Pro-Active Breast Cancer Patient Toolkit

Related Resources:

 
 

Transcript:

Dr. Valente:            

So, breast cancer patients have the option to remove their whole breast, which is called a mastectomy. And if they pick that option, they could choose to have reconstruction or to essentially go flat. Yes, we have even done reconstruction in metastatic breast cancer patients. Metastatic breast cancer patients live for a really long time, so giving them reconstruction to make them feel whole and kind of put them back together after a mastectomy is definitely a good option.        

The other option is to just remove the cancer. So, if the patient has a small breast cancer, and it’s metastatic, we can just say – Hey, you don’t have to have the whole breast removed. So, we can do a lumpectomy, as well.

So, a lumpectomy is essentially a surgery that removes the cancer with a normal rim of tissue around it. We also call it a partial mastectomy, meaning you’re removing just part of the breast. Or it’s also called breast-conserving surgery. So, it’s any method that removes that cancer with a normal rim of healthy tissue around it but allows the woman to keep her breasts.

So, when it comes to surgical choices and a cancer coming back, some women think that if they pick the most advanced surgery, such as a mastectomy, it helps prevent cancer from going somewhere else in the body. And that’s actually not true. Removing both breasts, doesn’t make you live one day longer. At that point, a mastectomy or a lumpectomy is a choice.

And prognosis – meaning whether or not the cancer’s gonna show up somewhere in the body – is based really on two things – the stage at which the breast cancer presents itself and what type of breast cancer it is – meaning is the cancer outside of the lymph nodes? How large is it? And if it’s a triple negative or some other type of breast cancer? Those determine the higher likelihood that somebody could develop metastatic breast cancer later in their life, even though small, early-stage breast cancers, unfortunately, can also develop metastasis later on in life.

But women sometimes think that if they pick the most aggressive surgery, it’s helping prevent metastatic spread later on in life. And that’s actually not the choice.  Breast cancer surgery is the option that women choose to surgically remove their breast cancer. But again, choosing a mastectomy or a lumpectomy for an early-stage breast cancer is a choice of how they wanna remove the breast cancer. But it doesn’t improve the chances that they won’t have metastatic spread later on.

So, the role of surgery for metastatic breast cancer is mainly for what we call to remove the cancer or sometimes for local control. So, the number one treatment if somebody is diagnosed with metastatic breast cancer is systemic therapy. That might be chemotherapy or endocrine therapy. But it’s really to get the metastatic disease under control.

So, where does breast cancer usually go? Bones, liver, lungs, brain. So, surgery to remove the breast or the breast cancer in the breast doesn’t really take care of those problems. But a lot of times for metastatic cancer, the one reason would be for local control. So, if the cancer is causing issues in the breast – swelling, coming out of the skin – where it’s a wound issue, then we’ll remove that to get better control of the area in the breast.

The other reason is if somebody has metastatic cancer, and their cancer in the other area of their body is controlled with the therapy, then we say – Hey, chemo’s working, or the systemic therapy’s working. The only thing that seems to be left is the area in your breast. Then for a conversation with medical oncology, we say you don’t have to come off your medications. This is a good time to remove the breast cancer to control that problem.

Notable News: October 2020

Researchers have been studying cancer for a long time, and now there is a timeline listing some of the most important milestones over the past 250 years. It’s exciting to think that some of the latest discoveries, involving a plant virus, extra DNA in cancer cells, the best time of day to exercise, and who isn’t getting enough breast cancer screenings, could one day be added to the timeline.

Timeline of Cancer Research

The National Cancer Institute, cancer.gov, has put together the timeline of cancer research to highlight some of the most critical milestones during the past 250 years. The timeline begins in 1775, when the first clear link between environmental exposure and cancer was documented. Percival Pott connected the exposure to chimney soot and the occurrence of squamous cell carcinoma in the scrotum of chimney sweeps. Also of note, the first mastectomy to treat breast cancer was done in 1882, and the link between cancer and inflammation was first observed in 1863. In 1903, radiation was used to cure cancer for the first time. It was used to successfully treat two patients with the skin cancer basal cell carcinoma. The Pap Smear test was invented in 1928, and in 1937, the National Cancer Institute was established through legislation signed by President Franklin D. Roosevelt. In 1941, hormonal therapies to treat prostate cancer were discovered and are still used to this day. The timeline includes critical discoveries and advances in treatment through 2020 and can be found here.

Plant Virus

A plant virus could be a new source for cancer treatment, reports wired.com. The treatment is based on the cowpea mosaic virus (CPMV) that infects cowpea plants, a variety of which are the source for black-eyed peas. The virus doesn’t reproduce in mammals like it does in plants, but it does prompt the immune system to respond, which makes researchers hopeful that it could treat a lot of cancers. The body doesn’t always recognize cancerous cells when they appear, but the virus will hopefully help the body’s immune systems recognize the cancer cells and attack them. The study is now being done in dogs that have a common type of oral cancer. When the virus is injected into the cancerous cells in the dogs, their immune systems recognize it as foreign and attack the virus while also attacking the cancerous cells. So far CPMV has proven more effective than other viruses at triggering the immune system response. Learn more about CPMV and how it could one day be used to treat cancer in humans here.

ecDNA Linked to Tumor Growth

Some extra DNA floating around in cancer cells could teach us a lot about tumor growth and drug resistance, reports cen.acs.org. Decades ago, scientists noticed round circle pieces of DNA floating around in cancer cells, and even though that’s not normal, the pieces were mostly ignored. That changed over the past ten years as scientists have been taking a closer look at the extra DNA, now called extrachromosomal DNA (ecDNA). In addition to learning that ecDNA are linked to tumor growth and drug resistance, scientists have found evidence that they exist in at least 15 percent of tumors. They appear to be more common in breast, cervical, and esophageal cancers, and a hard-to-treat brain tumor called glioblastoma. Researchers also found that people with ecDNA in their tumors have lower five-year survival rates. Researchers are now hoping to learn more about ecDNA and hope it is the key to effectively treating some hard to treat cancers like glioblastoma. Read more here.

Exercise Early to Prevent Cancer

By now we have probably all heard that exercise helps reduce cancer risk, but the time of day you exercise may be important as well, reports medicalnewstoday.com. New research indicates that people who exercise between 8 a.m. and 10 a.m. are less likely to get cancer than people who exercise later in the day. The effect exercise has on circadian rhythm and production of melatonin may be part of the reason the timing matters because both have been shown to have links to a person’s risk of developing cancer. Researchers found that exercising between 8 a.m. and 10 a.m. had the best effect on reducing breast and prostate cancers. While the study results couldn’t be confirmed with certainty, it might be worth adjusting your workout time. Learn more about the study here.

Breast Cancer Screenings

Screenings have proven to be important in treating cancer, but not everyone is getting the screenings they need. Women in the United States who speak only Spanish are 27 percent less likely to get breast cancer screenings, reports medicalnewstoday.com. A new study, based on data from the 2015 National Health Survey, led researchers to estimate that 450,000 women aged 40-75 had never gotten a mammogram. The consequences of not being screened can be life threatening, as breast cancer often has no symptoms, and the chances of surviving are greater when the cancer is detected early. One of the reasons researchers found that the Spanish only speakers weren’t getting screened is because they may consider themselves at low risk. Breast cancer does affect fewer Hispanic women than non-Hispanic white women, but it is still the leading cause of cancer death among Hispanic women. Find more information about the study and recommended screening guidelines here.

While much of October is spent raising awareness about breast cancer screenings, sometimes it’s important to look at some of the other aspects of a cancer diagnosis, such as the financial implications. After a breast cancer diagnosis and subsequent MRSA infections, a finance and credit card expert learned a lot about medical debt, and she shares her story and tips for how to manage medical bills here. It’s an interesting and informative must read for those with medical debt.

Whether or not any of these studies will end up on future versions of the NCI milestone timeline remains to be seen. In the meantime, if they help any one person survive cancer, that feels monumental enough.

Metastatic Breast Cancer Treatment and Research News

Metastatic Breast Cancer Treatment and Research News from Patient Empowerment Network on Vimeo.

As metastatic breast cancer testing approaches continue to expand, new and promising treatments have emerged. Dr. Lisa Flaum shares information on recently approved treatment options and the role of genetic markers in accessing targeted therapy. 

Dr. Lisa Flaum is a Medical Oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Learn more here.

See More From The Pro-Active Breast Cancer Patient Toolkit

Related Resources:

 

Transcript:

Dr. Flaum:                  

There are a lot of new and promising treatments for metastatic breast cancer. So, the treatments in general and the novel treatments and studies really vary based on the subset of metastatic breast cancer. So, when we’re making our treatment decisions, a lot of it is defined by those markers. So, if someone has a tumor that is hormone receptor, estrogen and progesterone receptor positive, and HER2-negative, the mainstay of treatment is typically drugs that target estrogen and often partnering drugs that target estrogen with other more novel or newer treatments.

So, just in the last five plus years, there have been a number of new drugs and even new drug categories that we didn’t have previously. So, for that population of the estrogen receptor positive tumors, the biggest breakthrough over the last number of years has been a class of drugs called CDK4/6 inhibitors. So, that includes drugs like Ibrance, Kisqali, Verzenio. And they’ve emerged as a very important and effective and often a recommendation for our first-line treatment for these patients combined with anti-estrogen therapies that have vastly improved outcomes for patients. So, a much higher percentage of patients respond to these drugs, the duration of the responses has extended quite a bit. And importantly, patients tend to tolerate this drug class really, really well.

 So, for many patients starting out with that diagnosis, this type of drug class is going to be part of the discussion. Even in the last year, another drug category has emerged with approval of a new drug called alpelisib, which is something called at PI3 kinase inhibitor. So, again, back to defining the options based on the molecular profile of the tumor. So, this newer oral drug also partnered with anti-estrogen therapy, has been an important breakthrough for the treatment of patients who harbor this specific molecular abnormality. So, important to define whether that’s an option by some of these molecular testing.

There’s also newer drugs and studies of newer drugs that affect the estrogen receptor in different ways than some of our traditional medications.

And this is an ongoing area of significant research. So, that’s the estrogen receptor positive tumors.

For patients who have HER2-positive tumors, these are tumors that tend to be more aggressive, that tend to require more aggressive upfront treatment, which usually involves drugs that specifically target HER2. So, again, defining what’s driving the tumor and hopefully having drugs available that can target that specific abnormality. So, HER2 targeted drugs have evolved quite a bit over the last couple of decades.

Initially, we just had a drug called Herceptin and then a drug called Perjeta or pertuzumab was developed. Then more recently a drug called Kadcyla. And then even in just the last six to 10 months, two new drugs that target that HER2 protein. One of them is called tucatinib, the other one is called Enhertu. They’re not necessarily appropriate for the first line of treatment, but really sort of expands our toolbox in terms of how we treat these types of tumors. And these are developments that have occurred, for one of the drugs, just in the last six months, and the other within the last year. So, a lot of progress.

And then for the third subset of tumors, which are the triple-negative tumors, those are the ones that do not over-express estrogen, do not have estrogen or progesterone receptors, and don’t overexpressed HER2. This has been historically an area of unmet need. So, tumors where we can’t use anti-estrogen therapies, we can’t use HER2 targeted drugs. And so, the main stay has always been chemotherapy. And even for this subset, we’ve had progress.

So, one of the drug classes that’s been approved in the last couple years for triple-negative breast cancers is immunotherapy. So, immunotherapy has gotten a lot of press. It’s been really breakthrough treatment for a lot of different cancers, has lagged behind to some degree in breast cancer, but has become now one of the early treatment options for people with metastatic disease, specifically those that harbor a molecular marker, an immune marker, something called PD-L1. So, another example of the tumor’s biology dictating potentially one of the treatment options.

There have been other drugs that have been approved for triple-negative breast cancers in women who have BRCA mutation, so who have germline genetic predisposition to breast cancer. And that opens another array of treatment tools that have been approved in the last few years. And then more recently, just over the last six months, another drug that’s been approved for triple-negative breast cancer, which is a drug called sacituzumab, again, not first treatment, but something that defines potentially future lines of treatment. So, big picture, there has been a lot of progress that increasingly alters our treatment tools for patients and allows us to have sequential treatments that can be effective if their given treatment is no longer effective.

Metastatic Breast Cancer Treatment Decisions: Which Path is Best for You?

Metastatic Breast Cancer Treatment Decisions: Which Path is Best for You? from Patient Empowerment Network on Vimeo.

 For each metastatic breast cancer patient, there are several variables to consider to access the best treatment path. Dr. Lisa Flaum explains key factors to consider, and discusses how the risks and benefits are weighed when making treatment decisions for an individual patient.

Dr. Lisa Flaum is a Medical Oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Learn more here.

See More From The Pro-Active Breast Cancer Patient Toolkit

Related Resources:

 

Transcript:

Dr. Flaum:                  

So, when we’re determining a treatment approach, there are a number of variables. So, to some degree, based on a patient’s individual characteristics, their age, their other health issues, may guide what treatments are available or indicated or even desirable from a patient’s standpoint. To some degree, the locations and extent of disease are important. So, if someone has cancer and that’s causing a particular symptom, with bony sites being a particular example, there may be a role for something targeted; Something like radiation, and in rare cases, surgery to target a specific symptomatic or worrisome spot of metastatic cancer.

In general, the mainstay of treatment for metastatic breast cancer is what we call systemic treatment or medical treatment, treatment that’s going to go everywhere and treat the cancer wherever it is. In some situations, we may be deciding between more or less aggressive treatment, and the locations and sites of disease may be important in determining that. If someone has extensive disease, for instance in a vital organ like the lung, the liver, the brain, we may start with something more versus less aggressive to try to get it better under control quickly. Whereas people with more limited metastatic disease may be able to start with something less aggressive.

And then beyond that, a lot of the decision-making is based on those molecular markers that I alluded to, which are defined by the hormone receptor status. So, whether the tumor expresses those estrogen and progesterone receptors, and whether the tumor over-expresses HER2. And then to a lesser degree, based on other markers that may be defined by additional tests.

So, every treatment discussion we have is a two-way street. So, our job is to present the data, present options, present recommendations. And often, we have an opinion on where we would fall and if there are a number of different options. But to me, it’s a collaborative discussion. And if there are options, it’s weighing what potential benefit do we get from a single option or from adding something to that particular option versus what are the downsides? And some of it is discussion about logistics. Do we do something IV versus oral? Is there a particular side effect that we’re hoping to avoid, such as hair loss? Which of course, we’re trying to avoid. Some treatments may have a higher likelihood of working, but a higher likelihood of causing hair loss. That may factor into our decision.

So, whether it’s the first decision point when we’re deciding on preliminary therapy or future decision points as we go through this journey, there is always a discussion about this is where we are, these are what our options are. Here’s how we’re going to weigh the pros and cons. And then it comes back to a collaborative decision about how we weigh the risks and rewards and where we’re going with an individual patient.

So, clinical trials are always part of at least the conversation, so they’re always a consideration at each step of our discussion. So, from a preliminary treatment standpoint, we’re always going to go through here are our standard options. Here’s, again, what we think is most appropriate. And if there’s a clinical trial that’s appropriate in that scenario, we’ll lay that out there as an option. So, a clinical trial is always worth discussing. It’s always worth asking that your doctor, “Is a clinical trial appropriate for me at this point?” But it’s not always the right recommendation.

So, there are a lot of scenarios, especially at the beginning of treatment for metastatic disease where we have so many options, and so many new and novel treatment options and drugs that have been approved fairly recently that have defined the standard of care, that the standard is going to be often what we recommend. And a clinical trial may be something that we would use if that treatment fails to work or at some future point down the line. And at other points in time, we have very good, appropriate clinical trials that could be indicated at any step along the way. So, it’s worth the discussion. Whether it’s the recommendation or not depends on the circumstances, it depends on the time. What we have today was very different than what we might’ve had available six months ago and six months from now. But clinical trials are out there, and if the location that a patient is going doesn’t have access to clinical trials, it’s always reasonable to ask too, “Should I be going somewhere else to see if a clinical trial is appropriate?”

Essential Testing Following A Metastatic Breast Cancer Diagnosis

Essential Testing Following a Metastatic Breast Cancer Diagnosis from Patient Empowerment Network on Vimeo.

Following a metastatic breast cancer diagnosis, what tests are essential? Dr. Lisa Flaum reviews the role of key tests, and the impact of molecular (genetic) test results on treatment decisions.

Dr. Lisa Flaum is a Medical Oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Learn more here.

See More From INSIST! Metastatic Breast Cancer

Related Resources:

 

Should You See a Breast Cancer Specialist?

Are You Prepared for Your Breast Cancer Appointment?

What Do Breast Cancer Patients Need to Know About COVID?

 

Transcript:

Dr. Flaum:                  

When someone has either a diagnosis or a suspected diagnosis of metastatic cancer, meaning a diagnosis of cancer that has spread somewhere outside of the breast. And the most important initial step is establishing a tissue diagnosis. So, we could have our suspicions based on imaging, based on symptoms, but the most important thing is to confirm it. And usually that confirmation involves some type of tissue biopsy. So, collecting cells, examining them under the microscope, making sure that the diagnosis in fact, is cancer. Making sure that the cancer has spread from the breast, which is something that is definable under the microscope for the most part. And then evaluating various molecular markers within the tumor itself that are critical to guiding treatment.

So, in addition to the tissue diagnosis, the other important first step is what we call cancer staging. So, establishing the extent of the tumor within the body, which typically involves some type of scans, which may be variable depending on the situation or depending on the physician often could be a CT scan and a bone scan, maybe a PET scan. There may be an MRI.

So, a number of different tests that help us establish where the tumor is at baseline, so we can better understand the anatomy, but also to follow down the road to establish whether any given treatment is working. There are also maybe discussions of other types of molecular testing beyond what we determined in terms of the traditional biologic markers. You might hear the terms next generation sequencing tests like Foundation, Guardant, Tempus, which better define the cancer’s biology, which increasingly is becoming useful in terms of targeting treatment to someone’s specific cancer.

So, the molecular tests are looking at a few different things. So, first and foremost from a breast cancer standpoint, the most important basic molecular markers are what we consider to be the four main receptors, which is the estrogen and progesterone receptor, which dictates whether a given tumor is driven by estrogen and importantly dictates whether anti-estrogen therapy is going to be an appropriate component of the treatment. The other basic marker is called HER2, which is a protein that’s over-expressed.

In about 20% of breast cancer patient cells, and it’s also very critical in terms of guiding treatment. For specific types of breast cancer, once we know those preliminary molecular markers, then there’s an array of other types of anomalies within the tumor itself that could help to guide specific treatment. So, a couple of examples, and I can talk about that when you talk about treatment. If someone has a genetic predisposition to breast cancer with a BRCA mutation, there’s a specific treatment that might be appropriate. More recently, there’s another abnormality that can be detected by these tests called a PI3-Kinase mutation that identifies a population of patients who could be appropriate for another type of targeted therapy. So, for an individual, knowing what their particular profile is, whether or not those treatments are going to be indicated right at the beginning of treatment or maybe something that we use down the road. Inevitably, they’re going to help us understand what our tools are when we’re helping to make those decisions.