Breaking Research News from sources other than Breastcancer.org
Comments
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Here are highlights from GreekNinja's article (thanks GreekNinja!)
New CRISPR-powered device detects genetic mutations in minutes
March 25, 2019
University of California - BerkeleyThe device, dubbed CRISPR-Chip, could be used to rapidly diagnose genetic diseases or to evaluate the accuracy of gene-editing techniques. ... "You just put your purified DNA sample on the chip, allow CRISPR to do the search and the graphene transistor reports the result of this search in minutes."... unlike most forms of genetic testing, .... CRISPR-Chip uses nanoelectronics to detect genetic mutations in DNA samples without first "amplifying" or replicating the DNA segment of interest millions of times over... This means it could be used to perform genetic testing in a doctor's office or field work setting without having to send a sample off to a lab. it is really point of care....you could ...do it at the bedside... Aran hopes to soon "multiplex" the device, allowing doctors to... simultaneously detect a number of genetic mutations in minutes. You could screen parents, or even newborns, for the presence or absence of ... mutations—and then, if the mutation is found, therapy could be started early, before the disease has actually developed...Rapid genetic testing could also be used to help doctors develop individualized treatment plans for their patients..."If you have certain mutations or certain DNA sequences, that will very accurately predict how you will respond to certain drugs"... the CRISPR-Chip can be used to ... test the effectiveness of CRISPR-based gene-editing techniques.
Reference: Detection of unamplified target genes via CRISPR–Cas9 immobilized on a graphene field-effect transistor, Nature Biomedical Engineering (2019). DOI: 10.1038/s41551-019-0371-x , https://www.nature.com/articles/s41551-019-0371-x
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Woop Woop for those of us in the UK in the 50-69 age range... although we’ll die of obesity and heart issues instead apparently. Lumpieyou are a star,as is everyone else on this thread who posts the stuff many of us might not fully understand ( that’ll be me then) or have the diligence to investigate.
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Loss of Lymph Node Metastases After Neoadjuvant Chemotherapy in Patients With Cytology-Proven Axillary Node-Positive Primary Breast Cancer
- This retrospective study evaluated the lymph node status after neoadjuvant chemotherapy in patients with initially lymph node–positive breast cancer. A total of 64.2% were considered ycN0; among these patients, three or more residual lymph node metastases were rare.
- Patients with ER-positive tumors had more numerous residual lymph node metastases than those with ER-negative tumors.
- BACKGROUND: Axillary lymph node (LN) dissection (ALND) after neoadjuvant chemotherapy (NAC) still remains a standard treatment of initially LN-positive primary breast cancer because of the difficulty of assessment of LN status. The aim of this study was to assess the LN status after NAC in initially LN-positive primary breast cancer patients who were assessed as ycN0 and identify factors associated with loss of LN metastasis.
- CONCLUSIONS: Three or more residual LN metastases were rare in patients with ER− tumors if assessed as ycN0 by US. Prospective studies are needed to confirm the prognostic impact of not performing ALND in such patients.
https://www.practiceupdate.com/C/81133/56?elsca1=emc_enews_topic-alert
https://www.clinical-breast-cancer.com/article/S1526-8209(18)30858-9/abstract
DOI: https://doi.org/10.1016/j.clbc.2019.03.001
{And thanks Karenfizedbo15!}
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What does " ycN0" mean? Anyone know?
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it means re-staging, after chemo, found no positive nodes though there may have been some at diagnosis
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I actually discussed this study w my BS and it's why she let me skip ALND and just took 4 nodes... one that was giant prior to chemo and the next 3. Only dead cancer was found in two nodes, two were clear. I had agreed to let her do a second surgery and take them all if I did not get pCR. (And I was planning on rads anyhow.) The trend is towards less invasive surgeries... Indeed there is a trial going now on NO surgery at all for people w pCR, per imaging... just taking some biopsies of the areas w known prior cancer without LX.
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Thank you! Very helpful and something I plan on discussing with my surgeon. I'm doing neoadjuvant chemo. Prior to starting I had two lymph nodes "light up" on the PET scan. My surgeon was recommending that we take those two out only for now and go back if I don't have a pCR, similar to what you seem to have done. I was wondering about the science behind his recommendation, but it seems to be aligned with recent research, which is reassuring.
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Free Housing for Patients Traveling for Cancer Treatment
On Tuesday, March 26, Airbnb announced a strategic partnership with the Cancer Support Community. Through this collaboration, the Airbnb community will provide free housing for cancer patients and caregivers, provided they meet certain geographic and income criteria. Airbnb made the announcement at an event in New York organized by the Biden Cancer Initiative and featuring Vice President Joe Biden.
As Cancer Support Community CEO Kim Thiboldeaux said in an Airbnb press release announcing the program: "The Cancer Support Community fields thousands of calls from individuals who are struggling to cover the cost of traveling for treatments, scans, clinical trials, and other medically necessary care. This grant from Airbnb is a game-changer for these patients and caregivers—and you can hear the relief and gratitude in their voices as they learn about the free housing from the Airbnb community."
According to Airbnb's announcement, the company is donating a total of $1.2M in grants to the Cancer Support Community, along with the Bone Marrow Foundation. These organizations will use the grants to help patients find warm, welcoming places to call home during difficult times.
{While not research, per se, this may be important news for many who must travel for cancer treatment. FAQ's regarding the program, income limits, etc., are available at the link.}
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Apologies if someone else has reported this hopeful news on TNBC from Stony Brook University: https://www.newsday.com/news/health/breast-cancer-gene-stony-brook-1.29041597 Usually Newsday has a paywall but I was able to read this whole article. The researchers name is Lori Chan and the data was published in the journal, Cell Death and Disease (according to the Newsday article).
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thanks for posting. I hadn’t seen the article before.
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Circulating Tumor DNA in HER2-Amplified Breast Cancer
- This substudy of a phase III trial was designed to evaluate the prognostic value of circulating tumor DNA in patients with HER2-amplified breast cancer treated with neoadjuvant HER2-directed therapy. Notably, patients with undetectable ctDNA at baseline had the highest pCR rates.
- The study authors conclude that, based on these results, treatment de-escalated strategies should be focused on patients with undetectable ctDNA at baseline.
- In the neoadjuvant treatment (NAT) setting, dual human epidermal growth factor receptor 2 (HER2) targeted therapy is associated with increased pathological complete response (pCR) rates compared to each therapy alone. Biomarkers allowing to predict treatment response during NAT are needed. We aim to evaluate whether circulating tumor DNA (ctDNA) is associated with response to anti-HER2 targeted therapy.
- CONCLUSIONS: CtDNA detection before neoadjuvant anti-HER2 therapies is associated with decreased pCR rates. Interestingly, patients with HER2 enriched tumors and undetectable ctDNA at baseline had the highest pCR rates, therefore appearing as the best candidates for treatment de-escalation strategies.
- Published Online First March 12, 2019 in Clinical Cancer Research
DOI: 10.1158/1078-0432.CCR-18-25210 -
Breast Cancer in Young Adults
video interview
we are seeing about ... 7% of patients with breast cancer diagnosed under the age of 45.
{Regarding genetic testing...} every year.... we're adding more genes to panels....we're still learning.
So patients who have a strong family history, we're certainly looking for that
has the incidence changed over time? Are you seeing more and more {young} patients?
.... we are seeing a younger shift. ...what we showed at MD Anderson....we're seeing on average 8 to 10 years earlier age of onset for the subsequent generation. So a lot of times, if there's a strong family history, even if there's not a BRCA mutation, we might look at the family history, look at the risk assessment, see if we need to do further screening.... We usually give a year of, well, let's start 10 years earlier looking.
we need to be asking patients about their family history. We need to offer genetic counseling and testing when appropriate. If someone has a strong family history and they test negative for one of these germline mutations, one of the biggest misconceptions I see is people think, oh, yeah, my mom had breast cancer but it wasn't genetic, so I'm not at risk. No, we looked at a couple known risk factors, but let's look at your whole family as a whole and make some individualized recommendations.
https://www.practiceupdate.com/C/77716/56?elsca1=emc_enews_topic-alert
{Important information for anyone with a family history and FYI for those under 45.}
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lumpie, thanks for that. It’s of particular interest to me because it’s my story. Maternal aunt dxd stage IV, my mom stage 1. My PCP ordered my mammo at 39, which was clear and moms genetic testing came back negative, so I planned on the next mammo in 24 mos but was dxd stage IV de novo just 16 mos later at age 41. The geneticist at MD Anderson said my other female relatives should begin screening at 31 yrs.
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my kids are to begin screening st age 26- 10 years younger than I was at diagnosis. We have no family history of BC. So far none of the genetic testing in my tumor have revealed anything they can work with.
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Lumpie, thanks for posting this. That is part of my story and a kind of justification for my decision to do a BMX. I am BRCA negative, but two maternal aunts had BC and my mum had a large precancerous cyst on her ovary. Doctors said no need for BMX in my case, but I knew I couldn't live with the breasts that are trying to kill me. This video somehow helps me to see my decision was not just an emotional one...
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Mom, sister, paternal aunt and paternal first cousin all had breast cancer as well. All my genetic testing is negative and I have been told there is no evidence that mine is genetic. (really??) you can imagine how excited my daughter is to have breasts.
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This is not about clinical trails but I'd thought I'd post anyway because I love walnuts and apparently everyone else on the forum should too! https://m.medicalxpress.com/news/2019-03-scientist...
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Estrogen May Trigger Brain Metastasis in Triple-negative Breast Cancer, Study Shows
Estradiol, a type of estrogen and the major female hormone, may drive the spread of cancer to the brain in women with triple-negative breast cancer (TNBC), a study in mice and human cells reports.
Researchers identified a chain of molecular events triggered by estradiol that appears to be behind tumor cells' ability to form brain metastases. This process involves increased production of a brain-specific protein called BDNF and the activation of its receptor molecule, TrkB, in tumor cells.
...researchers proved that, although cancer cells are not directly responsive to estrogen, the hormone can stimulate important brain cells called astrocytes to release factors (chemokines, growth factors, etc.) that promote brain metastases.
When mouse models of TNBC-derived brain metastasis were treated with estradiol, the number of cancer cell clusters in the brain significantly increased. ...a receptor for this factor, a molecule called tropomyosin kinase receptor B (TrkB), was overproduced in different human TNBC cell lines with increased propensity to form brain metastases and in transplants of human brain metastasis in mice.
These results establish a link between estradiol and a tumor's potential to invade the brain. Estradiol triggers an increased production of BDNF in brain astrocytes. In turn, this activates TrkB in cancer cells, turning on cellular pathways that make those cancer cells more prone to migrate and invade tissues, giving rise to metastases.
Based on these findings, the researchers reasoned that a therapy that blocks this process at some point could prevent the formation of brain metastasis.
"This may explain why breast cancers diagnosed in younger women are more likely to metastasize to the brain — pre-menopausal women have more estrogen, and it may be influencing the microenvironment of the brain in ways that aid cancer,"
"Historically, women with brain mets have been excluded from clinical trials due to overall poor prognosis," she added. "So we have never explored whether anti-estrogens will have benefit for these women. Our work shows there might be a benefit in anti-estrogen therapies in preventing brain metastasis in women with triple-negative breast cancer."
https://www.nature.com/articles/s41388-019-0756-z
https://doi.org/10.1038/s41388-019-0756-z
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A CLEVER NEW STRATEGY FOR TREATING CANCER, THANKS TO DARWIN
...cancer cells develop resistance to the powerful chemicals deployed to destroy them. Even if cancer therapies kill most of the cells they target, a small subset can survive, largely thanks to genetic changes that render them resistant. In advanced-stage cancer, it's generally a matter of when, not if, the pugnacious surviving cells will become an unstoppable force. Gatenby thought this deadly outcome might be prevented. His idea was to expose a tumor to medication intermittently, rather than in a constant assault, thereby reducing the pressure on its cells to evolve resistance....Gatenby's method would permit cancer to remain in the body as long as it doesn't spread further. {In a clinical trial} by using a precise drug-dosing scheme developed using evolutionary principles, they could slow the rise of the mutations that would endow some cancer cells with the fitness to survive. Gatenby's name for the approach was adaptive therapy. ...early results of their new trial trickled in, ...scientists were gratified and relieved. most {patients} were living longer than expected without their cancer progressing. "The effect was so big that it would be unethical not to report it immediately," Other oncologists might be doing something similar. ...adaptive therapy doesn't require government approval. The protocol uses already-approved medications, and the US Food and Drug Administration doesn't police specific dosing schedules. Experts urge caution. The prostate cancer study was very small, and without a randomly assigned control group the results aren't truly reliable. Years could pass before a large-scale test of adaptive therapy takes place. "...there is still a long way to go."
Evolution doesn't operate the same way within all cancers. It's still unclear whether adaptive therapy...would work well for cancers where the mutations arise continuously by chance. {In 2017, twenty-two researchers} published a statement outlining how cancers might be better classified. One important factor in the group's suggested classification scheme is a measure of how swiftly a cancer is mutating. There's some evidence that the more mutations there are, the more aggressive a cancer tends to be, suggesting a higher chance that one of these DNA changes will confer tumor cells with the potential to be drug-resistant. Given technological advances, it's not too far-fetched to think that within the coming decade, doctors will routinely measure the amount of mutations in their patients' tumors. Today most cancers are assessed using a system that dates back to the 1940s. this system ...doesn't... take a cancer's genetic mutations into account.
...trials at Moffitt are in the planning stages or underway for cancers affecting the breast...Across the country, in Arizona, {researchers} have secured a grant to begin a breast cancer trial using adaptive therapy in conjunction with a local branch of the Mayo Clinic.
The full article appears in the April issue of Wired magazine. Posted electronically 25 Mar 2019.
{Lengthy but very interesting article on research done by ROBERT GATENBY and colleagues. Citations to academic journals were not provided but could undoubtedly be located via a research database.}
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My Friend's Cancer Taught Me About a Hole in Our Health System
Caregivers aren't supported, and America overlooks their importance.
{Interesting article re the "collateral damage" of cancer.}
Americans spend so much time debating so many aspects of health care, including insurance and access. Almost none of that covers the actual impossibility and hardship faced by the many millions of friends and family members who are caregivers. It's hugely disrupting and expensive. There's no system for it. It's a gaping hole.
{NYT allows a limited number of visits/month without a subscription.}
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{Very small} Breast Cancer Risk Associated With Hormonal Contraception
- The possibility that hormonal contraception may increase cancer risk is a relevant topic for fertile women. Recent papers showed a statistically significant increase in breast cancer risk. This increase was, however, numerically very small.
- Hormonal contraception is associated with a reduction in ovarian cancer risk. This review provides physicians with a tool to discuss this important choice with their patients.
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FYI: https://sci-hub.tw/ is an amazing resource for getting free, full access to most scientific articles. Pretty much any full-text PDF you want you can get. I use it all the time.
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Combinatorial Biomarker Predicts Pathologic Complete Response to Neoadjuvant Lapatinib and Trastuzumab
- This biomarker study was designed to evaluate for predictors of pathologic complete response among patients with HER2-positive breast cancer receiving neoadjuvant therapy with lapatinib and trastuzumab (and omitting chemotherapy). Patients with high HER2 amplification and intact PI3K pathways were most sensitive to HER2-targeted therapy without chemotherapy.
- The study authors conclude that a clinical subtype of breast cancer exists that is highly sensitive to HER2-targeted therapies in the absence of chemotherapy.
https://www.practiceupdate.com/C/81440/56?elsca1=emc_enews_topic-alert
https://doi.org/10.1093/annonc/mdz076
{Egad! A possibility of HER2's skipping chemo!?!? That would be huge!}
PS: Thanks mellee.
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Surgery Tied to Improved Survival in Stage IV Breast Cancer
Women with human epidermal receptor 2–positive (HER2+) stage IV breast cancer who received surgery after systemic therapy were at a 44% reduced relative risk for death compared with women who did not undergo surgery. The finding comes from a retrospective analysis reported on April 3 at the American Association for Cancer Research (AACR) 2019 (abstract 4873).Whether surgery becomes routine practice for patients with stage IV breast cancer will depend on the results of the ECOG E2108 (NCT01242800) randomized trial..." The trial will answer the question whether surgery is beneficial in stage IV disease," ...
accrual for the trial is complete but ... results have not yet been published. "This study should have no impact on clinical practice at this time"... "These data support what we [already] do in clinical practice,"
https://www.medscape.com/viewarticle/911262?src=wn...
April 03, 20190 -
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Persons Living With Incurable Cancer a Growing, Neglected Group
People with metastatic cancer are living longer, thanks to better treatments, including immunotherapies and tyrosine kinase inhibitors (TKIs), yet few studies have addressed the nonbiomedical needs and challenges of this rapidly growing population.
"Unfortunately, the research community has failed to study and address the psychological, social, spiritual, and financial impact of living for years with incurable cancer,"
The article refers readers to
Time to Study Metastatic-Cancer Survivorship
https://www.nejm.org/doi/full/10.1056/NEJMp1901103
and to MBC Connect: https://www.mbcconnect.org/
https://www.medscape.com/viewarticle/911355?src=wn...
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nice one Lumpie...Hope is vital and you find us that!
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Some of you may be interested in this conference:
(MRS is Metastatic Research Society)
Register today for the METAvivor/MRS Metastatic Cancer Stakeholder Engagement Conference on June 7 and 8, 2019 at the University of North Carolina, Lineberger Cancer Center in Chapel Hill, NC. The conference is from 8:00 am - 4:00 pm on June 7 and 8:00 am - 2:30 pm on June 8, 2019. Once registered, click here to book your room at the Courtyard by Marriott Chapel Hill. Click Here To Register.
Engagement Conference Room Block
Courtyard Chapel Hill for $129 USD per night
Room Block Start Date: Thursday, June 6, 2019
Room Block End Date: Saturday, June 8, 2019
Last Day to Book: Monday, May 6, 20190 -
Do Breast Cancer Patients Skip Follow-Up?
Over 20% stopped seeing cancer docs 5 years after diagnosis
Follow-up guidelines vary widely among national organizations for patients with early-stage breast cancer treated with curative intent. The study sought to evaluate the patterns and predictors of provider follow-up care within the first 5 years after diagnosis.
Twenty-one percent of patients with early-stage breast cancer discontinued seeing any oncology provider over the 5 years after diagnosis. Coordination of follow-up care between oncology specialists may reduce discontinuation rates and increase clinical efficiency.
https://ascopubs.org/doi/abs/10.1200/JOP.18.00229
DOI: 10.1200/JOP.18.00229 Journal of Oncology Practice 15, no. 1 (January 1 2019) e1-e9.
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FDA: Breast Density Must Be Reported to Women During Mammograms
Proposed rule would also tighten FDA regulation of mammogram facilities
WEDNESDAY, March 27, 2019 (HealthDay News) -- Women with dense breasts who get mammograms must be told of their higher risk for breast cancer under new rules proposed Wednesday by the U.S. Food and Drug Administration.
The FDA proposal would also tighten its regulation of mammogram facilities, giving the agency the power to notify patients if problems are found at a center so that repeat mammograms can be done at another certified center.
https://www.practiceupdate.com/C/81637/56?elsca1=emc_enews_topic-alert
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