Breaking Research News from sources other than Breastcancer.org
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How breast cancer uses exosomes to metastasize to the brain
...In the case of cancer cells, EVs [extracellular vesicles, a.k.a. exosomes] carry factors that help create a more hospitable environment for both the primary tumor and its metastases, as Moses and Morad detailed recently in a review article. Primary tumors can secrete EVs into the circulation, allowing them to travel to distant organs and help spread the cancer.
"The main question we had was, how can EVs reach the brain in the first place?" says Morad. "The blood brain barrier doesn't allow anything larger than 400 daltons to passively get into brain tissue. Exosomes are more than two thousand times larger than the size cutoff limit."
...Bottom line, Morad and Moses showed, for the first time, that rather than squeezing in between the cells in the BBB to get into the brain, the EVs trick the endothelial cells into taking them up. Using a standard biological pathway called transcytosis, the cells simply engulfed the EVs, bringing them inside and releasing them into brain tissue like so many Trojan horses...
Having discovered what EVs do to help breast cancer metastasize to the brain, the Moses Lab hopes to turn the tables -- and use EVs (or synthetic versions) to deliver anticancer drugs that home to the metastatic site.
Article: https://www.sciencedaily.com/releases/2019/09/190912153454.htm
Reference: https://pubs.acs.org/doi/10.1021/acsnano.9b04397
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Gaps Exist In Understanding of Genomic Tests
A majority of cancer patients don't understand key aspects of the genomic test results they receive as participants in biomarker-driven clinical trials, according to a first-of-its-kind pilot study...
September 9, 2019
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Study backs genetic testing for all metastatic breast cancer patients
Genetic testing for all metastatic breast cancer patients may be an optimal strategy for identifying additional patients with increased risk as well as response to targeted therapies, according to research published Aug. 29 in JAMA Oncology.
In the study, 100 patients were tested regardless of whether they met the current National Comprehensive Cancer Network (NCCN) guidelines. Among the 14 patients who did test positive for a pathogenic or likely pathogenic variant, 43% (six patients) did not meet the NCCN guidelines.
The study has clinical significance because of the recent approval of a PARP inhibitor for patients with HER2/ERBB2 negative breast cancer with germline BRCA1 and BRCA2 pathogenic variants.
The U.S. Food and Drug Administration in October 2018 approved the PARP inhibitor talazoparib for that breast cancer.
"We found almost twice as many mutations than what we would have found if we adhered to NCCN guidelines, and some of those patients could go on clinical trials that could therapeutically help their disease,"Participants in the study included 76 white patients, 12 black patients, six Asian patients, three Hispanic patients and three of other racial/ethnic identification. Two of the patients were male.
Sep. 5, 2019
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Liquid biopsies reveal genetic alterations linked to cancer drug resistance
A clinical study comparing liquid and tissue biopsies finds multiple resistance mechanisms in individual patients, which could explain why targeted therapies often fail.
Many patients see their tumors shrink in response to a drug, only to have them come back with a vengeance as they evolve to fend off the treatment. Oncologists want to be able to quickly detect cancer drug resistance as it emerges in their patients and identify another drug the tumors will still respond to.
"This study is the largest to date to directly compare liquid biopsy to tumor biopsy in the setting of cancer resistance," said Corcoran. "Our findings suggest that liquid biopsy may be the preferred clinical modality for assessing how patients' tumors have evolved after they've become resistant to therapy."
Although this new study turned up some tantalizing findings, the authors emphasize that larger, more comprehensive efforts are needed to fully understand cancer drug resistance. "To really map out the full landscape of cancer resistance mechanisms, we need much larger studies that span a variety of drugs and cancer types,"
https://www.broadinstitute.org/news/liquid-biopsie...
https://www.nature.com/articles/s41591-019-0561-9
Nature Medicine volume 25, pages1415–1421 (2019)
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Many Cancer Drugs Don't Work Like Scientists Say They Do, New Study Suggests
Cancer therapies often fail to work when tested in clinical trials. As a result, a startling 97 percent of drugs designed for specific cancer treatments do not receive approval from the Food and Drug Administration. Now researchers say they may have figured out part of the reason why.
Drugs may not do what we think they do
The majority of proposed anticancer treatments do not succeed in advancing to clinical use because of problems with efficacy or toxicity, often for unclear reasons. Lin et al. discovered that a drug candidate in clinical development was effective at killing cancer cells even when its target protein was knocked out, suggesting that its proposed mechanism of action was incorrect. The researchers then identified multiple drugs with similar problems and also discovered the correct target for one of them, suggesting that more research and more stringent methods are needed to verify the targets of potential drugs before advancing them to the clinic.
http://blogs.discovermagazine.com/d-brief/2019/09/...
https://stm.sciencemag.org/content/11/509/eaaw8412
DOI: 10.1126/scitranslmed.aaw8412
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Bias against single people affects their cancer treatment
New research reveals the dangerous bias that's been buried in the fine print of academic and medical journals for more than 30 years. Unmarried patients with cancer are less likely to get potentially life-saving surgery or radiotherapy than their married counterparts, as medical providers may rely on stereotypes that discount sources of social support other than a current spouse.
Although this disparity has been attributed in studies to such factors as patients' treatment preferences or a weaker will to live among unmarried people, DelFattore found that those speculations are not only unsupported by data but actually conflict with extensive research findings. Rather, her article suggests that cultural stereotypes inappropriately influence the treatments recommended for unmarried patients with cancer.
it's been known since at least 1987 that cancer patients with a current spouse are more likely to get surgery or radiotherapy than those who are divorced, separated, widowed or never married.. It's about asking people to examine their assumptions -- in this case, with respect to potentially life-or-death decisions. Medicine has to evolve, not only in science and technology, but also with respect to an evolving society."
https://www.sciencedaily.com/releases/2019/09/1909...
Joan DelFattore. Death by Stereotype? Cancer Treatment in Unmarried Patients. New England Journal of Medicine, 2019; 381 (10): 982 DOI: 10.1056/NEJMms1902657
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FDA: Novel Breast Ca Drugs Linked to Severe Lung Illness
Reports of ILD, pneumonitis in patients on CDK4/6 inhibitors
The FDA issued a warning Friday that CDK4/6 inhibitors for advanced breast cancer may cause rare but severe lung inflammation, and said fatalities had been reported. Package warnings have been added to the three approved agents in the class -- palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio) -- and breast cancer patients taking these agents should be monitored for pulmonary symptoms indicative of either pneumonitis or interstitial lung disease (ILD).
https://www.medpagetoday.com/hematologyoncology/br...
https://www.fda.gov/drugs/drug-safety-and-availabi...
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Docs Want Say in How Prior Authorizations Work
"You would have much greater buy-in from physicians," House panel told
Practicing doctors should have input when it comes to deciding how prior authorization processes should work, an expert told members of a House committee on Wednesday. "Instead of pharmacy benefit managers deciding on how best to administer prior authorizations, have the physicians who are at the point of the spear weigh in," "The American Academy of Dermatology would love to have seat at the table in terms of defining what's reasonable in terms of different treatment algorithms, and you would have much greater buy-in from physicians if we could have that sort of collaborative arrangement." Rogers spoke at a House Small Business Committee hearing on the burdens to physician practices posed by prior authorization and step therapy.
https://www.medpagetoday.com/practicemanagement/re...
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Lumpie - Interesting comment on DRs wanting more say in how prior authorizations should work. 11 days ago my oncologist ordered a PET scan. The clinic is still waiting for authorization from my health insurance.
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BlueGirlRedState: That is so frustrating! 11 days! what are they thinking? The article made several other interesting points:
"There are Centers of Excellence that are having 90% of their prior authorization denials overturned on appeal"
Public dissemination of the utilization parameters that insurers use also would help, "since often they're not using national standards,"
"... generics should not have to go through the prior authorization process,"
Physicians who are in alternative payment models should be entirely exempt from prior authorizations... "We're being paid for the quality we deliver and there should be no prior authorization for those practices." {They are not being paid by the service! But insurance still wants to ration and delay care?!?! Who cares what the docs order as long as it is not unethical or dangerous!}
I have heard from many compatriots that their insurance is notorious for failing to pre-auth PET scans. Wishing you good luck with yours!!
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https://www.yahoo.com/lifestyle/early-breast-cance...
Anyone heard of the iBreastExam?
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Wow, Bounce, this is the first I've heard of it... how exciting! Comparable sensitivity to mammos without any radiation! The article says that it doesn't pick up microcalcifications, but one could keep one's mammo schedule and add additional scans with the iBreastExam to pick up any lumps earlier.
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A cohort study of breast cancer risk after 20 years of follow-up of women treated with fertility drugs
Sonia Guleria, Susanne K. Kjaer, Vanna Albieri, Kirsten Frederiksen and Allan JensenDOI: 10.1158/1055-9965.EPI-19-0652Abstract
Background: Using a nationwide cohort of Danish women, we investigated the association between use of fertility drugs and risk of breast cancer. Methods: The study cohort included women aged 20-44 years and living in Denmark between 1 January 1995 and 31 December 2011. Information on fertility status, use of fertility drugs, breast cancer, covariates and vital status was obtained from the Danish Infertility Cohort and various Danish national registers. Cox proportional hazard regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. Results: Of the 1,330,852 women included, 96,782 (7.3%) were infertile, and 20,567 (1.5%) were diagnosed with breast cancer during a median follow-up of 20.9 years. Compared with fertile women, infertile women who had used any fertility drugs did not have an increased hazard for breast cancer overall (HR 1.02; 95% CI 0.95-1.10), or for any of the histological types (ductal, lobular or mucinous) of breast cancer. Furthermore, no associations were observed between use of specific types of fertility drugs and breast cancer. Conclusions: No convincing associations between use of fertility drugs and breast cancer were observed after two decades of follow-up. Impact: Our results do not support a marked association between fertility drugs and breast cancer and are therefore reassuring for infertile women treated with fertility drugs.
- Received June 7, 2019.
- Revision received August 12, 2019.
- Accepted September 12, 2019.
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HER2-Positive Breast Cancer
Fixed-Dose Subcutaneous Pertuzumab Combo Shows Noninferiority in HER2+ Breast Cancer
The fixed-dose subcutaneous injection formulation plus intravenous chemotherapy had noninferior pharmacokinetics versus standard IV infusions of the regimen in patients with HER2-positive early disease.
FDA Accepts sNDA for Neratinib Combo for HER2+ Breast Cancer
Neratinib could become available for use in combination with capecitabine for select pretreated patients with HER2-positive metastatic disease.
Novel Approaches Push the Envelope in HER2+ Breast Cancer
Douglas K. Marks, MD, discusses key developments in the HER2-positive breast cancer space.
Pyrotinib Combo Delays Progression in Heavily Pretreated HER2+ Breast Cancer
A phase III trial is now being conducted to evaluate the efficacy and safety of this regimen compared with lapatinib/capecitabine.
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VERY IMPORTANT FINDINGS FOR MEN
Poor treatment outcomes, poorer survival.
Question To what extent are clinical characteristics and treatment patterns associated with the survival difference between male and female patients with breast cancer?
Findings In this large cohort study of 16 025 male and 1 800 708 female patients with breast cancer in the United States, the male patients had 19% higher fully adjusted overall mortality compared with their female counterparts. Clinical characteristics and undertreatments were associated with 63.3% of the excess mortality among male patients.
Meaning These results suggest a need for further research into biological features of breast cancer and tailored treatments for men with the disease to mitigate the sex-based disparity in mortality.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2751525
Conclusions and RelevanceThis study found that mortality after cancer diagnosis was higher among male patients with breast cancer compared with their female counterparts. Such disparity appeared to persist after accounting for clinical characteristics, treatment factors, and access to care, suggesting that other factors (particularly additional biological attributes, treatment compliance, and lifestyle factors) should be identified to help in eliminating this disparity.
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For those who use turmeric, this is worth reading
- Summary:
Turmeric adulteration with lead chromate was assessed in Bangladesh.
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Turmeric Pb concentrations exceeded the national limit by up to 500 times.
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Evidence of turmeric adulteration was found in 7 of 9 turmeric-producing districts.
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Turmeric adulteration was found to be driven by consumer demand for yellow roots.
https://www.sciencedirect.com/science/article/pii/S0013935119305195?via%3Dihub
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Hardly surprising, but:
Surgical technique helps breast cancer patients avoid repeat surgeries
In breast cancer surgery, taking just a little bit more healthy tissue initially can help patients avoid a return trip to the operating room...
"What we found in the study, by just taking a little more tissue, we could reduce the positive margin rate by 50 percent. It's very exciting," Chagpar said.
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Interesting and as you say, not surprising. At my hospital, they send the excision for examination DURING surgery. For me, they found they needed to take a bit more and did it right then. So it was one surgery. Takes a bit longer that way but still better than doing repeat surgery.
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After needing a re-excision in 2016, I told my BS in 2018 to "go big." :-)
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Before I went under for my excisional biop, I told my surgeon as well to "go big". When I woke up, he told me the margins were "close but clear".
So far so good.
Claire in AZ
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MIT AI tool can predict breast cancer up to 5 years early, works equally well for white and black patients
MIT's Computer Science and Artificial Intelligence Lab has developed a new deep learning-based AI prediction model that can anticipate the development of breast cancer up to five years in advance. Researchers working on the product also recognized that other similar projects have often had inherent bias because they were based overwhelmingly on white patient populations, and specifically designed their own model so that it is informed by "more equitable" data that ensures it's "equally accurate for white and black women."
https://techcrunch.com/2019/06/26/mit-ai-tool-can-...
{Thanks Ingerp for forwarding this link.}
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New blood test could detect more than 20 types of cancer
- Laura Donnelly, health editor
Anew blood test could detect more than 20 types of cancer, allowing cases to be identified and treated far earlier.
Experts said the breakthrough - which spots changes in the genes, as disease develops - could be used to improve screening for cancer, allowing treatment much sooner, when it is more likely to succeed.
Crucially, 99.4 per cent cases identified as cancer were correctly spotted - meaning just 0.6 per cent of cases were misdiagnoses of healthy patients.
The test was able to detect one third of patients with stage one disease, and three quarters of those with stage two disease.
Ministers have pledged to speed diagnosis, so that by 2028 three quarters of cancer patients are diagnosed at these two stages. Currently just half of patients can expect to receive a diagnosis before they reach stage three or four.
The advances, by US scientists, look for abnormal patterns of methylation in the DNA, which can indicate different types of cancer.
The study found the new method could even pinpoint the cancer source nearly 90 per cent of the time, including for diseases like ovarian and pancreatic disease, which are some of the most difficult to spot.
Study lead author, Dr Geoffrey Oxnard of Boston's Dana-Farber Cancer Institute, part of Harvard Medical School, said: "Our work indicated that methylation-based assays outperform traditional DNA-sequencing approaches to detecting multiple forms of cancer in blood samples.
"The results of the new study demonstrate that such assays are a feasible way of screening people for cancer."
In the study, researchers analysed cell-free DNA - which enters the bloodstream after becoming detached when its parent cell dies - in more than 3,500 blood samples.
The samples were taken from more than 1,500 cancer patients and more than 2,000 from people without cancer.
The patient samples comprised more than 20 types of cancer, including hormone receptor-negative breast, colorectal, oesophageal, gall bladder, gastric, head and neck, lung, lymphoid leukaemia, multiple myeloma, ovarian, and pancreatic cancer.
The test accurately detected 76 per cent of high mortality cancers.
Within this group, the test accuracy was 32 per cent for patients with stage one cancer; 76 per cent for those with stage two; 85 per cent for stage three; and 93 per cent for stage four.
Dr Oxnard said: "Detecting even a modest percent of common cancers early could translate into many patients who may be able to receive more effective treatment if the test were in wide use."
The research was presented today at the European Society for Medical Oncology Congress in Barcelona, Spain.
Britain is bottom of international league tables for cancer survival, with rates two decades behind some countries for some types of disease.
This week an independent review of NHS cancer screening will warn that "confusion and delays" is costing lives, as it calls for for Public Health England to be stripped of responsibility for the service.
Former cancer tsar Prof Sir Mike Richards was asked to examine the system following a series of scandals and a sharp decline in uptake of checks for breast, bowel and cervical disease.
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Adjuvant Chemotherapy ± Trastuzumab in Patients With T1, Node-Negative HER2-Positive Breast Cancer
- This retrospective analysis evaluated long-term survival data for patients with T1N0 HER2-positive breast cancer treated with adjuvant chemotherapy with or without trastuzumab. The addition of trastuzumab was found to provide benefit for patients with tumors at least 0.8 cm in size.
- The study authors concluded that adjuvant therapy with trastuzumab may not be required for tumors less than 0.8 cm in size.
https://www.practiceupdate.com/C/89468/56
https://clincancerres.aacrjournals.org/content/ear...
DOI: 10.1158/1078-0432.CCR-19-0463
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Antibiotic use before cancer treatment cuts survival time – study
Patients live longer if they do not take antibiotics in month before (Checkpoint Inhibitor) immunotherapy
https://www.theguardian.com/society/2019/sep/12/an...
Taking antibiotics in the month before starting immunotherapy dramatically reduces a cancer patient's chances of survival, according to a small but groundbreaking study.
Scientists at Imperial College London believe antibiotics strip out helpful bacteria from the gut, which weakens the immune system. This appears to make it less likely that immunotherapy drugs will boost the body's cancer-fighting capability.
In their study of nearly 200 cancer patients in two NHS hospitals, the researchers found that those who had taken broad-spectrum antibiotics for just a few days for common problems such as chest infections survived for a median of two months after immunotherapy, compared with 26 months for those who had not been on antibiotics.
Study published in the journal Jama Oncology
https://www.theguardian.com/society/2019/sep/12/an...
https://jamanetwork.com/journals/jamaoncology/arti...
doi:10.1001/jamaoncol.2019.2785
{Not breast cancer specific but concerning.}
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A twice daily helping of onions and garlic could reduce the risk of breast cancer by a massive 67 per cent, a study reveals.
...In their new study, scientists wanted to examine the association between onion and garlic consumption and breast cancer in Puerto Rico.
The researchers, from the University at Buffalo (UB) and the University of Puerto Rico, chose to study a group of Puerto Rican women who eat lots of onions and garlic which are key ingredients in sofrito, stews, and rice dishes.
Lead study author Gauri Desai, a PhD student from the University at Buffalo, said: "We found that among Puerto Rican women, the combined intake of onion and garlic, as well as sofrito, was associated with a reduced risk of breast cancer. "In fact, those who consumed sofrito more than once per day had a 67 per cent decrease in risk compared to women who never ate it.
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The Big Three Misdiagnosed Cases: Cancers, Vascular Events, & Infections
Recently, a study investigating misdiagnosis-related harms was published in the medical journal, Diagnosis, the official journal of the Society to Improve Diagnosis in Medicine (SIDM)... findings ... were ...presented at a Capitol Hill briefing ...in order to bring awareness and inspire healthcare-related changes when it comes to the serious harms of misdiagnosis.
The study identified "The Big Three" when it comes to misdiagnosis, and more specifically, misdiagnosis-related harms. These Big Three included cancers, vascular events, and infections.
{Findings} suggest that not only are the Big Three common in misdiagnosis situations, but they are also often associated with some of the most serious outcomes... nearly 38% were related to cancers... cancer-related misdiagnosis events were most commonly reported in the outpatient or clinic setting.
The researchers and the SIDM are hoping to use this information to inspire change and targeted initiatives in specific settings to help reduce misdiagnosis and misdiagnosis-related harms. The team of researchers are working on two more follow-up studies...
https://advancedbreastcancer.net/clinical/misdiagn...
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I wish we could find a cure to debunk this, but it rings terribly true
"Treating cancer with anything that actually works has been entirely outlawed in the United States, where 'healing has become a crime,' say independent observers. The conventional cancer industry isn't interested in curing the disease; it's interested in profiting from its continuation."
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Kanga the banner ad atop the article tells me this is a dubious source.
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Thanks Santabarbarian, still I think it’s worth the read to get different perspective - there is a lot of distrust out there of big pharma and how they sway health policy in their favour, rather than the patient’s. Cancer research is profit driven
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BigPharma conducts financial analyses of any potential new drugs and only pursues the profitable ones (nowadays, primarily by buying out startups rather than conducting early research themselves). That means a lot of promising drugs for cancer and many other diseases languish. But that statement about outlawing cures by "independent observers" was not supported in any way. It's not that I trust BigPharma; companies will do what they can to protect their profits, including ethically iffy tactics like pay-for-delay of generics. We need to try to balance the corporate incentives with publicly funded research.
BTW, I was talking to a semi-retired biotech lawyer last night. He thinks that due to costs in the US and government support in China, most drug development will be conducted in China within the next ten years. Even if that is true, profits for those companies would still drive the selection of potential drugs.
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