Breaking Research News from sources other than Breastcancer.org
Comments
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Updated Guidelines on Biomarkers for Early-Stage Breast Cancer
According to the April 25 press release from Hologic (the parent medical technology company that developed BCI), ASCO "now recognizes BCI as the only genomic test to help guide extended endocrine therapy decisions in early-stage, HR+ (hormone receptor-positive) breast cancer patients with node-negative or node-positive (one-three positive nodes) disease when treated with five years of primary endocrine therapy without evidence of recurrence."
BCI is a microarray-based test that analyzes the expression of 11 genes associated with breast cancer recurrence.
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Dear all, has anyone had any news from Lumpie? She's the "founder" of this thread and used to post constantly but does not anymore after the site was renewed:/ Hmm...
Saulius
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It is so depressing the number of good friends who have given up and no longer post. It was bad enough losing friends to cancer - but many members just will no longer deal with the inane revisions & issues & problems on BCO. I too hope Lumpie is OK - along with a ton of other people who have (understandably) disappeared.
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Hi all! Lumpie here. Thank you so much for your concern. Sorry I have not been present as much as in the past. You know how life just catches up with you some times and is demanding? That's kind of where I am. The side effects of my current treatment are chronic and annoying which slows me down. I have had some personal business and family matters that have consumed a great deal of my available time and energy lately. Some fun stuff, too: I saw a couple of college friends last week that I had not seen in a very long time. And then there is the less fun stuff (semi-flooded basement). You know.... life is messy and it comes at you non-stop. So it has taken away from my time to read and research. Maybe I have missed it due to inattention, but I have not seen the volume of new research with eye-catching results coming out lately. (Sidebar: I confess that, while I think that the new BC.com format is "prettier," I find it more challenging for posting to-be-read research-type material. A minor issue, but a thought.) I hope that in a few more months I will still be doing well and will be on a more even keel. Maybe more promising research will be published then, too. I do watch the discussion and if I see anything really good, I will try to pop over and post. The mutual support and concern in this forum - and others - is so wonderful. It's keeps me believing in humanity. More asap... take care and be well!
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Lumpie, so glad that all is [essentially
] well!0 -
Lumpie- so glad to see you as well.
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Lumpie - thanks for posting. HOpe all life's hassles settle down soon.
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Thanks for checking in, Lumpie! Hope you are in a good place to start posting again soon!
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Dear Lumpie, this is what we wanted to hear - that you are alright:) And living life... is a wonderful thing, glad that you are doing it
Saulius
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Promising compound kills range of hard-to-treat cancers by targeting a previously undiscovered vulnerability
The researchers soon noticed that a compound called ERX-41 not only killed ER-positive cancers in petri dishes, but also readily killed TNBCs, including more than 20 distinct TNBC cell lines. Further experiments showed that ERX-41 also effectively shrunk human cancers and several of these cancer cell lines when grown as tumors in mice without affecting normal cells or causing any discernible toxicity in these animals.\
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Lumpie 👏🏻👏🏻
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Symptom trackers may improve QOL in metastatic cancer
People with metastatic cancer who reported symptoms, lifestyle habits and daily challenges electronically every week had greater improvement in physical function, symptom control and health-related quality of life than those receiving usual care, researchers reported in the Journal of the American Medical Association. Care teams were alerted when patients reported severe or worsening symptoms, potentially enabling interventions that prevented complications, but the researchers also noted that alerts could be difficult for care team members to address in the absence of dedicated time.
Reported here: https://www.mobihealthnews.com/news/study-electron...
Study here: doi:10.1001/jama.2022.9265
Relevant clinical trial: NCT03249090
{Of course, they will charge for access to the full study. Reporting and abstract are free. I have been encouraging my computer science guru nephew to develop a symptom tracking app that is not evil (=sells your private info). We'll see.}
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Trastuzumab Deruxtecan in Patients With CNS Involvement From HER2+ Breast Cancer
- This primary analysis of the phase II DEBBRAH trial evaluated the efficacy and safety of trastuzumab deruxtecan (T-DXd) in patients with HER2-positive breast cancer with CNS involvement, including those with active brain metastases and even leptomeningeal disease. An impressive objective response rate was noted with T-DXd in all three cohorts. Toxicity was manageable, with 9.5% of the patients having grade 1 pneumonitis.
- These data suggest that T-DXd is a promising treatment option for patients with HER2-positive metastatic breast cancer with stable, untreated, or progressing brain metastases. Larger trials are warranted to validate the findings. {Cohort was 21 patieints.}
The manuscript has been accepted but not yet published. It is currently available in its entirety without charge. That may change once it goes to press.0 -
Not really news, but interesting...
Getting closer to a vaccine for cancer
https://www.washingtonpost.com/health/2022/06/14/cancer-vaccine-future/
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Study Compares DBT With Digital Mammography Screening
Digital breast tomosynthesis linked to lower risk of advanced breast cancer for women with extremely dense breasts, high risk for breast cancer
- HealthDay WEDNESDAY, June 15, 2022 (HealthDay News) -- Compared with digital mammography, digital breast tomosynthesis (DBT) is not associated with a significant difference in the risk of interval invasive cancer or advanced cancer among women who are not at high risk, according to a study published in the June 14 issue of the Journal of the American Medical Association.Karla Kerlikowske, M.D., from the University of California in San Francisco, and colleagues conducted a cohort study involving 504,427 women aged 40 to 79 years who underwent 1,003,900 screening digital mammography and 375,189 screening DBT examinations from 2011 through 2018.The researchers observed no significant difference for interval invasive cancer rates per 1,000 examinations for DBT versus digital mammography, or among all 836,250 examinations with Breast Cancer Surveillance Consortium (BCSC) five-year risk <1.67 percent, or among all the 413,061 examinations with BCSC five-year risk of 1.67 percent or higher across breast density categories. Among women at low-to-average risk or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts, advanced cancer rates were not significantly different for DBT versus digital mammography. For the 3.6 percent of women with extremely dense breasts and at high risk of breast cancer, advanced cancer rates were significantly lower per 1,000 examinations for DBT versus digital mammography, but not for women at low-to-average risk."Screening with DBT versus digital mammography was associated with a significantly lower risk of advanced breast cancer (prognostic pathologic stage II or higher) among women with extremely dense breasts and high risk of breast cancer," the authors write.Several authors disclosed financial ties to industry.Reporting: https://www.practiceupdate.com/C/137546/56?elsca1=...Article: doi:10.1001/jama.2022.7672{Access to reporting and abstract are w/o charge but registration may be required. Subscription or payment may be required for full article access.)
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Getting closer to a vaccine for cancer
Scientists have worked for years to harness the power of the immune system. New approaches make researchers optimistic about success.
June 14, 2022
...scientists studying cancer vaccines believe they now are closer than ever before. While these vaccines are still a long way from approval, researchers think they represent the future of cancer care.
{a few quotes re breast cancer...}
MUC1, is present in several types of cancers, including colon, breast, prostate, lung and pancreatic. An MUC1-based vaccine she and her team developed showed a strong response from the immune system in clinical trials in patients with premalignant colon polyps, leading them to believe the vaccine could help prevent the growth of new polyps and keep existing ones from turning cancerous.
The vaccine reduced polyp recurrence rates by 38 percent in their clinical trial
"We and other groups are paying attention to premalignant lesions and focusing on trying to boost the immune system to stop the progression from premalignant to malignancy," Finn says, adding that her group is about to begin a trial of the same vaccine in patients with ductal carcinoma in situ — an early stage of cancer that is confined to breast milk ducts and not yet invasive — to see whether the vaccine can stop it from spreading.
Many cancers also share common antigens, meaning a personalized vaccine isn't always necessary. HER2, a molecule found in about 25 percent of breast cancers is one example. Berzofsky's lab is testing therapeutic vaccines for several cancers, including one that targets HER2.
"It's a 'driver' antigen, which means the cancer can't do without it," Berzofsky says. "It keeps telling the cell: divide and multiply, so going after it with a vaccine would be very effective." Early clinical trials have been promising, he says. There is a drug, Herceptin, available to treat HER2-positive breast cancer patients, but "the patient has to come back to get an IV drip every few weeks," Berzofsky says. "If we had a vaccine that caused a patient to make her own HER2 antibodies, she wouldn't need to come back for the drug."
Knutson and Amy Degnim, a breast surgeon at the Mayo Clinic in Minnesota, also designed a HER2 vaccine and recently completed a small clinical trial in 22 patients with invasive breast cancer. The vaccine, based on four fragments of the HER2 protein, provoked both antibodies and T cells in all the patients, Degnim says. The vaccine was given in six doses, each one a month apart.
After a little more than two years, only two patients had recurrences: one developed another tumor in the same breast, the second patient experienced a recurrence in the lymph nodes, "but that patient did not complete the full vaccination course," having received only four doses, Degnim says.
They are also developing another vaccine they hope will completely prevent breast cancer in women at high risk for the disease. Initially, however, it will be tested — for safety reasons — only in women who already have breast cancer.
https://www.washingtonpost.com/health/2022/06/14/c...
https://doi.org/10.1073/pnas.2200200119
{The Post generally puts stuff behind a pay wall. PM me if you have questions. The journal will let you see the abstract, but there is a pay wall for full access.}
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Drug combination could be less invasive treatment for [mbc], study finds
Researchers from the National University Cancer Institute, Singapore (NCIS) at the National University Hospital and the Cancer Science Institute of Singapore (CSI Singapore) at the National University of Singapore found that combining two drugs - letrozole and lenvatinib [pill form] - might help those with advanced stage metastatic breast cancer achieve better control of the disease.
The researchers conducted a study of 43 patients with stage four breast cancer who had failed multiple prior therapies.
Half of those given the combined therapy either saw their tumours shrink or experienced good control of the disease for more than six months, with many able to continue normal daily activities.
https://www.straitstimes.com/singapore/health/drug...
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An article was just published in the May/June edition of Cancer Journal by Dr Bluming entitled 'HRT After Breast Cancer - It is Time.' Happy to email the pdf to anyone or figure out how to share here. Short version is that oncologists should look at current study results about this topic, 24/25 studies indicate no increase in recurrence after using hormone replacement therapy, as well as the often-severe health effects of estrogen suppression. Yes, even for women who had ER+ breast cancer, although the risk may be slightly higher. Vast majority of symptoms we attribute to treatment (chemo brain, ongoing fatigue, severe depression) are often from the temporary or permanent suppression of our hormones, but doctors still don't really understand what causes cancer or the role of estrogen in breast cancer at all. What they do know is that estrogen greatly increases protection from top three killers of women - heart disease, bone fractures, and dementia.
He also cowrote a book called Estrogen Matters where he disputes the connection that was made from a flawed study in 2002 (Women's Health Initiative) indicating it might increase beast cancer risk and leading to very few women wanting or being prescribed HRT after that time, even for severe quality of life issues brought on by perimenopause and menopause. Really well done and interesting.
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https://www.fiercebiotech.com/medtech/fda-clears-k...
FDA clears Koios Medical's ultrasound-reading AI that spots breast, thyroid cancer in 2 seconds
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(early research)
'Masked' cancer drug [IL-12] sneaks through body to deliver anti-tumor treatment with fewer side effects
In models of breast cancer studied in the lab, masked IL-12 was even more effective than anti-PD1 antibody, an immune therapy commonly used in humans.
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FDA finalizes guidance on including patients with incurable cancers in oncology trials
In their guidance, the agency recommended sponsors include patients with incurable cancer—defined as unresectable, locally advanced, or metastatic disease in solid tumors and/or hematologic malignancies with unfavorable long-term overall survival—in oncology clinical trials even if they met criteria that would otherwise exclude them, such as in situations where a patient had previously received an available therapy in a non-curative setting. The recommendation by FDA emphasizes that sponsors still need to follow regulations around informed consent before enrolling patients with incurable cancer in clinical trials.
https://www.raps.org/news-and-articles/news-articl...
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Interesting, I was told my cancer is "locally advanced" (3B IDC) but was not told that it is considered "incurable" (although what breast cancer is?). I had a large localized tumor with no nodes and no detectable spread anywhere. I knew it was real bad, but I hadn't realized that that apparently puts me in the same category as metastatic and unresectable? You learn something every day.
Thanks for your post, Debbew.
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Locally advanced, as in lymph nodes, is not regarded as Stage 4 metastatic bc in everything I’ve ever read. This would be a Stage 3B or Stage 3c diagnosis. Lymph nodes are always resectable, too. And can b radiated. Curious.
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FDA Approves First Targeted Therapy (Enhertu) for HER2-Low Breast Cancer
https://www.fda.gov/news-events/press-announcement...
Threetree, I agree with TravelText.
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I was just reading this. I'm curious if the are going to start considering Her2 Equivocals as HER2 low?
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Dear Bluegirl27 - absolutely, HER2 Equivocals are in HER2Low category.
Saulius
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Circulating Tumor DNA and Late Recurrence
– Personalized assays identified high-risk patients
by Jeff Minerd , Contributing Writer, MedPage Today August 16, 2022
Personalized circulating tumor DNA (ctDNA) assays identified women with HR-positive, HER2-negative breast cancer who had late recurrences, suggesting that these high-risk patients can be identified for potential interventions, researchers said.
"To our knowledge, these are the first data on plasma ctDNA analysis for MRD [minimal residual disease] detection in late adjuvant HR+ breast cancer, a major and understudied cause of more than 40,000 annual breast cancer-related deaths in the United States," Heather Parsons, MD, MPH, of Dana-Farber Cancer Institute in Boston, and colleagues wrote in a "Rapid Communication" article in the Journal of Clinical Oncology.
Parson's group performed whole-exome sequencing on primary tumor samples from 103 patients with high-risk stage II-III HR+ breast cancer who were diagnosed more than 5 years prior and had no clinical evidence of recurrence. The somatic mutations detected were used to design, for each patient, a personalized ctDNA RaDaR [residual disease and recurrence] assay.
Over the next 2 years, the team collected plasma and performed the personalized ctDNA tests at routine visits every 6-12 months. Eight patients (10%) had positive MRD testing. Of these, six (7.2%) developed distant metastatic recurrence. The median ctDNA lead time was 12.4 months. One patient had a local recurrence not identified by the test.
"Here, 10% of patients were MRD-positive more than 5 years from diagnosis despite no clinical evidence of metastatic recurrence at the time of first plasma sample," Parsons and colleagues said. "Importantly, ctDNA analysis identified MRD in all cases of distant recurrence. ctDNA analysis did not identify MRD in the case of local recurrence in this study, consistent with previous reports. Additionally, ctDNA was detected in two patients who had not experienced clinical recurrence at the time of last follow-up, although imaging had not been obtained in these cases."
In addition, "these data suggest that there may be a period in which MRD is detectable via ctDNA before overt, late breast cancer recurrences. This will inform future studies of liquid biopsy to personalize treatment and prevent or delay late recurrence of early-stage breast cancer," the researchers concluded.
In the following interview, Parsons discussed additional details of the study and other relevant ongoing research.
Can you give us more details on how the individualized RaDaR assay is created for each patient?
Parsons: RaDaR is a tumor-informed, patient-specific assay. First, each patient's archival primary tumor sample underwent whole exome sequencing (WES). Then, from mutations identified in the WES, up to 51 variants were selected for assay design.
Next, each patient-specific assay was applied to cell-free DNA isolated from a patient's plasma, to the leukocyte DNA and to the tumor DNA. Samples underwent high-depth sequencing, variants were confirmed, and ChIP [clonal hematopoiesis of indeterminate potential] was filtered. Each test was then reported as either MRD+ or MRD-. For positive MRD tests, eVAF (estimated variant allele fraction) was reported.
Do you plan to continue this study with longer follow-up or additional patients?
Parsons: Yes, we are continuing to follow these patients clinically and to draw research blood samples. We believe this is an important, understudied group of patients – those with a history of HR+ breast cancer diagnosed more than 5 years prior.
Have the two patients who were MRD positive but without recurrence during the study period experienced recurrence subsequently?
Parsons: We have not yet gone back to assess follow-up for the overall cohort but plan to do this in the coming months.
You mentioned that several clinical trials are underway to investigate the efficacy of interventions based on MRD detection. Are there any results yet from these trials, or any information about when can we expect them?
Parsons: In HR+ breast cancer, there are a few trials underway evaluating intervention based on MRD detection. The DARE and LEADER studies are both enrolling patients with history of HR+ breast cancer with an MRD positive test. Patients are screened and then undergo staging scans if the MRD test is positive. If metastatic disease is not detected, they enter the study.
In both trials, investigators are evaluating the efficacy of a CDK4/6 inhibitor together with hormonal therapy.
You mentioned that researchers at the Dana Farber Cancer Institute are investigating patient understanding of and attitudes toward late recurrence in a survey study. Can you tell us more about this study and what it hopes to find?
Parsons: This is the POWER study, led by Shoshana Rosenberg. In investigating patients with HR+ breast cancer with risk of late recurrence, we found very little data available evaluating patient understanding of and attitudes toward this risk. The POWER study, which is complete and undergoing data analysis currently, enrolled participants at least 5 years from diagnosis with HR+ breast cancer.
We look forward to the results of this study to help us design patient-centered interventions and approaches to the problem of late recurrence in HR+ breast cancer.
Read the study here and expert commentary about the clinical implications here.
The study was funded by AstraZeneca, the National Cancer Institute, and Susan G. Komen.
Parsons reported research funding from Puma Biotechnology (Inst).
Primary Source
Journal of Clinical Oncology
Journal: DOI: 10.1200/JCO.22.00908 Journal of Clinical Oncology 40, no. 22 (August 01, 2022) 2408-2419.
Reporting: https://www.medpagetoday.com/reading-room/asco/bre...
{Both full text and reporting are available w/o charge.}
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Replying to Mar 18, 2022 10:34AM sarahmaude wrote:
Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors
Have any of you farther along found a good way to advocate for survivorship care? Either for yourself individually, or to help other women have a better experience?
I was cut loose with major treatment damage, high risk of recurrence, and no plan. My oncologist's office shamed me when I pressed for more information or help. They think it is the primary care doctor's problem. He says he does not have the expertise. Current status: no support for dealing with damage, no screening, no care. And I was treated at a major center that advertises itself as patient-centered. I don't think my situation matters much. (If it metastasized it will kill me no matter when I catch it, and the damage done is done.) But I feel like it might help me to advocate for others.
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lenaaz,
I am not happy with your oncologist's office for shaming you when you pressed for more information and help! Not acceptable! This was a very reasonable request.
A few thoughts: I think that NCCS (National Coalition for Cancer Survivorship) is a non-profit doing the best advocacy around the survivorship issue. Their web page is http://canceradvocacy.org/ and their unique focus is that *every* cancer patient should leave treatment with a written survivorship plan which clearly explains the treatments they have had and on-going monitoring that is the current standard of care. This way, it can be made a part of their chart and it is easy to share with a Primary Care doc who can help you stay on track with monitoring.
Another resource that may be of help to you: https://www.cancer.net/survivorship This is the ASCO (American Society of Clinical Oncology) website targeted to patients and dealing specifically with questions related to survivorship. The resources here may be helpful.
NCCN (National Cancer Care Network) publishes the definitive standards on cancer care. They have versions for both patients and professionals. Needless to say, the professional version is much more technical and detailed. I quickly looked through the materials to see what it might have to say about survivorship care. Disappointingly, it did not say much. I did not dig into the professional version. You may want to go here and take a look https://www.nccn.org/guidelines/guidelines-detail?...
Clearly, a great deal more advocacy is needed around this issue. Sometimes, the farther you get into the breast cancer world, the more you find there is to do to make care better. Some, of course, is medical or scientific, but *we* are the experts on the patient experience and sometimes, we have to be the voice advocating for improved care. If and/or when you feel up to it, consider being a voice for improvement. We - and our loved ones - will all be healthier if we can improve cancer care. Thanks for raising this important issue.
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Here is another resource on how to put together your own survivorship (they call it "thrivership") package: https://pinklotus.com/powerup/resources/thrivership-care-plan/
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