Advances Made Lives Saved
Two breast cancer survivors share their stories.
Valerie Tabak of Albany, New York, didnt think her outlook was good when she was diagnosed with Stage IIIB inflammatory breast cancer in 2002. I left thinking that I was going to be dead, she says of her reaction to the diagnosis of aggressive disease. And with two children, ages 15 and 20 the time, Valerie was particularly concerned about the prognosis. Her own mother had died of ovarian cancer, so Valerie knew what it was like to lose a parent.
Twelve years later, however, Valerie is in good health. She credits much of her survival to receiving Herceptin for the HER2-positive disease. She says that, at the time, the targeted therapy was given to patients with more-advanced disease but not to Stage III patients like her. Dr. Chen, who treated Valerie at the Dana-Farber Cancer Institute, recommended that she enroll in a clinical trial using Herceptin in Stage III breast cancer. Now, in addition to seeing her children become young adults, Valerie is helping a friend who is undergoing treatment for inflammatory breast cancer. Its really amazing, she says. Ive been the luckiest person.
When Erin Oian of East Texas was diagnosed with breast cancer at age 29, she was determined to enter her next decade with a clean bill of health. My one wish for my thirtieth birthday was to be cancer-free, she says, a goal she met just before she turned 30. I actually finished my last treatment the day before my thirtieth birthday.
How Are Clinical Trials Helping To Improve Treatments
Scientists continue to conduct clinical trials to develop and test treatments for breast cancer.
These trials may help them develop new treatment options and learn which types of people are most likely to benefit from available treatments. Over time, this might lead to more effective and personalized treatment plans.
One 2018 trial found that chemotherapy doesnt benefit most women with early stage breast cancer that is hormone-positive and HER2-negative. These women may benefit from surgery and hormone therapy instead.
Researchers in many other trials are also trying to determine whether certain combinations of therapies work better in certain types of breast cancer, report the authors of a 2019 review .
Scientists are also studying ways to improve breast cancer screening and diagnosis to detect breast cancer in the earliest stage possible.
For example, the tomosynthesis mammographic imaging screening trial is evaluating the potential benefits of 3-D mammography.
This is a new technology that produces images from different angles around the breast to build a multidimensional picture.
There is no natural cure for breast cancer. Medical treatments are necessary to remove, shrink, or slow the growth of tumors.
That said, you may use certain complementary therapies and lifestyle changes alongside standard medical treatments to help:
- control symptoms of breast cancer
- ease side effects of treatment
- improve quality of life
For example:
More Accuracy Fewer Surgeries
Wire localization is often used to pinpoint the location of abnormal breast tissue that can be seen in a mammogram but not felt by your doctor. To ensure your surgeon removes the right breast tissue, a radiologist first inserts a wire into the breast and uses imaging technology to guide it to and mark the abnormal tissue. Later that day, youll undergo another procedure to remove the tissue.This method can be painful and uncomfortable. It also creates risk for less accuracy because the wire can be bumped or moved while the patient waits for surgery.
A newer technologymagnetic seed localization can locate the cancerous tissue days before its removed. Guided by imaging, a radiologist inserts a tiny magnet into the tissue. It does not move, and a surgeon can easily find it with a magnetic-detecting instrument.
Magseed eases many patients anxiety theyre not surprised by the location of their cancer the day its removed or upset by the sight of a wire protruding from their skin. And because the magnet stays in place, the surgeon is more likely to remove all of the abnormal tissue at once instead of performing another surgery to remove tissue that was missed the first time.
This technology can also be used to identify cancerous lymph nodes, reducing the amount of lymph nodes that are removed and the level of disruption to the lymphatic system.
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What Are Some Of The Primary Advances In Research And Treatment
Dr. Tarantino: Absolutely. This is key both to target the intensivity of the treatment upon the risk of disease, but also to be able to make the treatment as much like comfortable as possible. For instance, for the HER2-positive disease, we have these two bodies which work amazingly for HER2-positive breast cancer which are trastuzumab and pertuzumab , and now we have a trial that is testing the administration at home of the patient to avoid coming to the hospital and receiving it. This also is a great possibility, and I think this is the way for work for certain drugs.
Esther Schorr: That’s great news. So, I also know that several of the trials highlighted disparities that affect women of color, especially black women with breast cancer including that they have a higher risk for lymphedema and lower uptake of genetic testing by that community. What should patients make of those results? I mean how can black women ensure that they get the best care?
Esther Schorr: I think so and I think this discussion, it recognizes that we all want to solve the same problems. We want to solve them as quickly as possible but having the data to back up action is very important. So, are there any other trials or data that came out of the symposium that you found particularly exciting that our patient audience might want to know about?
Breakthrough Breast Cancer Treatments
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As an academic medical center and comprehensive cancer program, we lead innovative research and clinical trials that allow us to provide the most cutting-edge treatments available and truly make a difference in our patients lives. Three areas of care experiencing significant progress include:
Breast cancer survival rates continue to improve along with our understanding of the disease. Im excited to share how five recent innovations are helping our patients live longer and more comfortably.
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How Is Advanced Stage Breast Cancer Treated
Treatment for breast cancer depends on many factors, like your cancer stage, age, overall health, and testing results. If you have advanced stage breast cancer, your treatment may be different than someone who has early or moderate stage breast cancer. Your treatment may include some or all of the following:
How To Enrich The Tnbc Population: Pd
The positive results obtained in the PD-L1+ subgroup in the IMpassion130 trial suggest that there is a need to enrich the study population. However, PD-L1 is not the ideal biomarker to select patients for anti-PD1/PD-L1 therapies, as demonstrated in other cancers. Indeed, only a subset of patients with PD-L1+ tumors derives a real clinical benefit from immunotherapeutic treatment, while these therapies can determine clinical and radiological responses also in PD-L1 cancers. Considering multiple parameters which take into consideration both tumor- and patient-related characteristics, a comprehensive view of immunotherapy in cancer treatment has been proposed and included in the framework of the cancer immunogram . Given the potential toxicities of immunotherapy and the highly variable response across tumor types, as well as the significant economic burden of immunotherapeutic agents, the identification and implementation of novel biomarkers that can predict immunotherapeutic response are urgently required.
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Early Detection Of Breast Cancer
Breast cancer is one of a few cancers for which an effective screening test, mammography, is available. MRI and ultrasound are also used to detect breast cancer, but not as routine screening tools.
Ongoing studies are looking at ways to enhance current breast cancer screening options. Technological advances in imaging are creating new opportunities for improvements in both screening and early detection.
One technology advance is 3-D mammography, also called breast tomosynthesis. This procedure takes images from different angles around the breast and builds them into a 3-D-like image. Although this technology is increasingly available in the clinic, it isnt known whether it is better than standard 2-D mammography, for detecting cancer at a less advanced stage.
NCI is funding a large-scale randomized breast screening trial, the Tomosynthesis Mammographic Imaging Screening Trial , to compare the number of advanced cancers detected in women screened for 5 years with 3-D mammography with the number detected in women screened with 2-D mammography.
Two concerns in breast cancer screening, as in all cancer screening, are:
- the potential for diagnosing tumors that will not become life-threatening
- the possibility of receiving false-positive test results, and the anxiety that comes with follow-up tests or procedures
Parp Inhibitors Show Promise For Difficult
Researchers share the first encouraging findings on a new class of targeted drugs PARP inhibitors for difficult-to-treat “triple-negative” breast cancers and those that involve BRCA1 and BRCA2 gene mutations. PARP inhibitors are designed to disable key enzymes that cancer cells use to repair DNA damage, including damage inflicted by chemotherapy, and to promote cancer cell death. They may also make cancer cells more sensitive to other chemotherapy agents. Triple-negative breast cancers lack receptors for estrogen, progesterone and HER2, and therefore do not respond to targeted drugs that block these proteins.
Further long-term, randomized clinical trials are needed to determine whether PARP inhibitors truly benefit patients with breast cancer, and if so, which specific types of breast tumors are most likely to respond to the drugs.
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Second Parp Inhibitor Receives Fda Approval
Following surgery, chemotherapy, and radiation, patients with BRCA1 or BRCA2 genetic mutations may soon be offered an FDA-approved daily oral pill to reduce their risk of cancer recurrence. This drugolaparib is called a poly ADP-ribose polymerase inhibitor. Its one of two PARP inhibitors approved specifically for advanced breast cancer in patients with BRCA1 or BRCA2 mutations.
BRCA1 and BRCA2 genes produce proteins that assist cells with DNA repair. Mutations in these genes have been shown to increase cancer risk. When they cause cells to become cancerous, PARP inhibitors can further stop DNA repair proteins from helping the cancer cells repair and replicate.
Up to 5% of U.S. breast cancer patients have BRCA1 and BRCA2 mutations. However, many patients dont even know they have these mutations and could benefit from PARP inhibitors because they havent received genetic testing.
As testing becomes vitally important, our cancer genetics program at MedStar Health is growing. We already recommend genetic testing for high-risk patients such as women who received a breast cancer diagnosis at a young age or have a family history of breast cancer. But I dont think were too far from having so many treatments for gene mutations that many more women will benefit from genetic testing.
What Were Some Of The Most Exciting Research Reports From Sabcs
Dr. Tarantino: Well, there were many, this year’s meeting was full of interesting new findings and trials being presented. I think the three key features I would like to highlight for patients is like, there were several new drugs and new classes of drugs being presented. Second, for some of them data on quality of life was presented. So, we can see that not only they improve outcomes in terms of response rate, progression-free survival , but also quality of life. Lastly, we are conducting works in terms of de-escalation, and this is a controversial word, but basically it means that we want to adapt the size of the treatment, the intensity of the treatment upon the risk of the patient. When we can avoid using for instance chemotherapy, we are learning to do that. So, there was the RxPONDER trial, which was presented, and we have the first publishing of the data in New England Journal of Medicine.
Basically, it showed that even in patients with lymph node positive disease, many times we can avoid adjuvant chemotherapy because we understood how to select those for which chemotherapy is beneficial, and those for which chemotherapy can be safely avoided. So, I think this is an important point from this San Antonio.
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Advances In Breast Cancer Research
A polyploid giant cancer cell from triple-negative breast cancer.
NCI-funded researchers are working to advance our understanding of how to prevent, detect, and treat breast cancer. They are also looking at how to address disparities and improve quality of life for survivors of the disease.
This page highlights some of the latest research in breast cancer, including clinical advances that may soon translate into improved care, NCI-supported programs that are fueling progress, and research findings from recent studies.
Treatment Of Stage Iv Breast Cancer
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.
For women with stage IV breast cancer, systemic drug therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help some women live longer. These cancers are considered incurable.
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Targeted Therapy Ribociclib Added To Endocrine Therapy Improves Survival In Young Women With Certain Types Of Breast Cancer
The combination of the CDK4/6 inhibitor ribociclib with endocrine therapy provided an overall survival advantage for pre- and perimenopausal women with advanced HR+, HER2- breast cancer, compared to standard endocrine therapy plus placebo. Results from the MONALEESA-7 trial showed 42-month survival with ribociclib of 70.2%, compared with 46% for women who received placebo plus standard endocrine treatment. The treatment combination is an important step forward for the treatment of younger women with this disease, who tend to have more aggressive disease with worse survival than those who are postmenopausal.
Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
Before starting any integrative therapies, however, ask your care team for advice on which ones are most suited to you and fit into your overall treatment plan, as well as how to do them safely.
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Breast Care And Oncology Nurses
In addition to certifying oncology nurses, the Oncology Nursing Certification Corp. offers the Certified Breast Care Nurse credential to nurses actively caring for and experienced in working with patients with breast cancer.
They can address specific needs of breast cancer patients, Hammack said. Breast cancer nurses can handle many different aspects and have different roles from educator to helping with navigation and treatment.
Hammack finds working as an oncology nurse rewarding, including getting to know the patients, even when helping those patients at end of life.
You are able to help people navigate through their lives, Hammack said. Its rewarding to see them continue with their lives.
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Exercising And Maintaining A Healthy Weight
Over the past five to 10 years, there has been increasing understanding of the role of overweight and obesity and physical activity in terms of breast cancer risk, says Dr. Chen. The benefits of these healthy lifestyle measures, she explains, apply to survivors, as they can reduce the risk of recurrence, and also to people who have not been diagnosed, as maintaining a healthy weight and exercising appear to help prevent a primary diagnosis.
Theres no magic diet, Dr. Litton explains, but across the board weight loss and exercise have been shown to improve outcomes, and obesity has been shown to worsen outcomes. These findings are significant because they give survivors and those looking to prevent breast cancer a way to control risk with everyday choices.
Todays Outlook
With the past 10 years of progress in breast cancer treatment and research, women facing the disease today have many promising options as therapies become more tailored to particular disease types and are designed to minimize side effects. And with greater understanding of risk factors and preventive lifestyle choices, women are gaining more ways to reduce the risk of diagnosis and recurrence on a daily basis. All in all, its progress worth celebrating.
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Advances In Breast Cancer Diagnosis And Treatment
Breast cancer remains one of the two most-common types of cancer in the world, according to the World Health Organization. Its the fifth-leading cause of cancer-related deaths annually. And more than 265,000 people will be diagnosed with it in the United States alone, during any given year.
But there is reason for hope. Research has yielded a number of exciting developments in breast cancer diagnosis and treatment that will improve the lives of breast cancer patients for years to come. We spoke with our Senthil Damodaran, M.D., Ph.D.,Jennifer Litton, M.D., and Anthony Lucci, M.D., to learn more.
1. Node preservationreduces lymphedema cases
Axillary lymph nodes used to be removed from the armpit routinely during breast cancer surgery to test for metastasis. This caused chronic pain, numbness and lymphedema in about 1 in 5 patients. But studies have shown that many of those nodes can be preserved without compromising long-term survival rates.
Sentinel node mapping lets surgeons identify which lymph nodes are most likely to be affected by a tumor. Targeted axillary dissection allows surgeons to potentially preserve nodes that once tested positive for cancer, but reverted to negative status after chemotherapy or another treatment. In both cases, if tests come back negative for cancer on the first few nodes taken out, the remaining nodes can be left alone. That means fewer complications, and fewer side effects for our breast cancer patients.