What'south New in Breast Cancer Research?

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Source:   —  April 18, 2016, at 11:24 PM

Oncologists (cancer doctors) used to see primarily at cancer size and lymph node status to define the likely course of a patient'south sickness and guide treatment.

Amy Tiersten, MD
Associate Prof of Medicine
Medical Oncology
Icahn School of Medicine at Mount Sinai

What'south New in Breast Cancer Research?

A new era in breast cancer is bringing hope to patients and physicians alike.

Oncologists (cancer doctors) used to see primarily at cancer size and lymph node status to define the likely course of a patient'south sickness and guide treatment. Over the past decade, we've understood more and more that it's the cancer'south molecular biology -- the molecules and processes regulating the growth, division, and survival of cancer cells -- that drive prognosis and treatment. This information is at the heart of an exciting revolution in cancer research and treatment: biologic, or targeted, therapies.

What's Biologic/Targeted Therapy?

Standard chemotherapy uses drugs to demolish cancer cells, but also kills many normal cells, causing side effects love fatigue, hair loss, pain, nausea, and vomiting. Biologic therapy (interchangeably called "targeted" therapy) works by targeting drugs to act against the specific molecular changes that create cancer cells "tick."

Because these newer therapies are aimed at cancer cells, they spare normal tissue and may produce milder side effects than chemotherapy. They also are curing more people of breast cancer and helping patients live longer.

The Role of Breast Cancer Subtypes

Biologic therapies are shaped by the three major molecular subtypes of breast cancer, classified according to the receptors present on (or absent from) the exterior of cancer cells. Receptors are protein molecules related to small baseball mitts that sit on the surface of the cells and "catch" certain substances, which, in turn, fuel the cancer.

• "Hormone receptor-positive" breast cancers have receptors for the hormones estrogen and/or progesterone.

• "HER2/neu-positive" breast cancers over-produce a protein called HER2/neu.

• "Triple negative" breast cancers lack estrogen, progesterone, and HER2/neu receptors.

Testing breast cancer tissue for the presence of hormone or HER2/neu receptors is a routine portion of diagnosis. The majority of patients have hormone-receptor positive cancer, but up to twenty % of cases are HER2/neu-positive, and about fifteen % are triple-negative.

Promising Research

In the United States, hundreds of clinical trials are testing the safety and efficacy of new biologic therapies for all three breast cancer subtypes. Below is just a sampling of such studies being conducted at several centers across the country, including the Dubin Breast Middle of the Tisch Cancer Institute at Mount Sinai, where my colleagues and I are very encouraged by the emerging data.

Hormone Receptor-Positive Breast Cancers

Several targeted, anti-estrogen therapies, such as tamoxifen, already exist for hormone receptor-positive breast cancers, but researchers are working to expand new therapies to better block, starve, or demolish the hormone receptors.

For patients with early-stage hormone receptor-positive cancer, a nationwide clinical trial is studying the utilize of anti-estrogen therapy instead of standard chemotherapy before surgery to shrink the cancer and create it more operable.

For patients with metastatic hormone receptor-positive cancer (cancer that's spread to another portion of the body), researchers are investigating a new anti-estrogen pill called GDC-0810. This pill destroys the estrogen receptor, starving cancer cells of the estrogen they necessity to survive. A bonus: It's easier to utilize than other anti-estrogen therapies that are administered via intramuscular injection.

HER2/neu-Positive Breast Cancers

One of the biggest advances in breast cancer treatment was the approval of trastuzumab for advanced cancer in one thousand nine hundred ninety-eighth and early-stage cancer in two thousand-sixth. Trastuzumab is a type of antibody that targets and attaches to HER2/neu receptors, thereby slowing or stopping the growth of cancer cells. Since then, prognoses have improved significantly for patients with HER2/neu-positive cancer.

Now, exciting research is underway in the area of immunotherapy, a type of biologic therapy that unleashes a person'south own immune system to assistance fight cancer cells. Two studies are looking at whether giving an anti-HER2/neu vaccine -- a form of immunotherapy -- along with trastuzumab is more effective than trastuzumab alone for certain patients with early-stage breast cancer.

One trial is studying this combination therapy in patients considered HER2/neu-positive. The other is investigating whether its benefits can be extended to patients whose cancer cells express low levels of the protein but not sufficient to be considered "positive." Early proof looks promising in both groups.

For metastatic HER2/neu-positive cancer, researchers are studying a new verbal biologic therapy called ruxolitinib, in combination with trastuzumab. Although trastuzumab can be effective alone, cancer cells eventually expand resistance to it, causing a relapse or progression of the cancer. Preliminary laboratory data propose this new drug may have the skill to restore cancer cells' sensitivity to trastuzumab, making it work again.

Triple-Negative Breast Cancers

Typical biologic therapies aren't available for triple-negative breast cancers, since the cells lack the normal targets (receptors). However, much research is underway to better realize the molecular processes involved in this cancer subtype, and expand corresponding targeted therapies.

For patients with metastatic triple-negative cancer, a study is looking at whether adding a different kind of targeted pill to traditional chemotherapy improves patients' responses to treatment. Called everolimus, this new pill targets molecular pathways necessary for cancer cell growth, division, and survival. Results thus distant are encouraging.

How to Discover a Clinical Trial

If you've breast cancer and are interested in joining a clinical trial for targeted therapy, ask your oncologist to assistance discover one you might be eligible for, or contact the American Cancer Society'south free clinical trials matching service. Participating in a trial just might give you the opportunity to benefit presently from a new, potentially more effective biologic therapy not yet available to the public.

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