Breaking Research News from sources other than Breastcancer.org
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buttons machine,
Really interesting article that is readable and makes a lot of sense.
I had my initial recurrence as a single site metastasis in 2006. At the time, I urged my oncologist to hit it hard -- fulvestrant was just coming into the picture, and I asked her if we could try that. Her answer was no. But I found this interesting in the article:" However, our current understanding of metastatic dormancy, metastatic evolution, acquired resistance and metastatic niches suggests that detecting and treating recurrence earlier might be our best opportunity to improve patient outcomes." It does upset me to read that, and to know that the guidelines at the time were telling docs that they should only go so far in treating metastases.
However, there is hope on the horizon with the advent of ctDNA and other new methods of genomic testing that may help many of us. Hopefully our MOs will be up to date on the new technologies and use them to our advantage moving forward.
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Bev, 2006??? Are you kidding me? Science should be investigating you in and out - you are one of a kind!:) Best of luck for Friday again... Saulius
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buttonsmachine, thanks so much for posting the excellent article about the mysteries of metastasis.
My BC recurred after 26 years. I was on Tamoxifen for 12 years or so after my initial surgery/chemo in 1991 (my initial MO just didn't want to "mess with success" and kept me on it, even though then current guidelines said 5 years only), and when my original MO retired, I changed to a supposedly preeminent MO who immediately changed me from Taxoxifen to Evista (raloxifene). I remained on raloxifene until metastasis was discovered in my bones 14 years later. Look at what I found online:
Switched from tamoxifen to raloxifene:
This means that raloxifene reduces risk of non-invasive breast cancer by about 38 percent compared to tamoxifen reducing risk for this type of cancer by about 50 percent; or raloxifene is about 78 percent as effective as tamoxifen in reducing the risk of noninvasive breast cancer over almost 7 years.Apr 19, 2010
When I changed from the preeminent MO to my current one, he replied to my question as to whether changing from tamoxifen to faloxifene might have "unleashed the beast", "Yes, it surely could have".
Thanks for the very helpful article.
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Lynn,
Wow. I hadn't focused before on the fact that you were 26 years out when you had recurrence. That's a wild story. Saulius noted that scientists should follow me, now 16 years out from that first metastasis; likewise, they should be studying you. Your story and mine simply highlight how much science does not understand the mechanism of metastasis, especially metastasis after a long period of dormancy.
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Bev-Jen-
Agreed. I didn't realize how far out you were, either!
And on the length of my period of dormancy, my most recent MO, head of a cancer center, said that my 26 years was his longest period of dormancy in one of his patients. I just pray that the length of that dormancy may in some fashion bode well for holding it now at bay for a while. We shall see.....
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ctDNA in Neoadjuvant-Treated Breast Cancer Reflects Response and Survival
December 03, 2020
- The authors of this retrospective analysis evaluated circulating tumor DNA (ctDNA) levels in samples from high-risk, early-stage breast cancer patients in the neoadjuvant I-SPY 2 trial in order to correlate detection with therapeutic response and outcomes. In this analysis, ctDNA panels were informed by each patient's particular tumor genotype. The proportion of ctDNA-positive samples was significantly higher among HER2-positive (84%) and triple-negative (86%) subtypes compared with HR-positive/HER2-negative (48%) subtypes. The results indicate that clearance of ctDNA during the course of neoadjuvant chemotherapy was associated with improved survival even in patients who did not achieve pathologic complete response. Additionally, failure to clear ctDNA after neoadjuvant chemotherapy was correlated with risk of future distant metastases.
- The authors conclude that personalized ctDNA analysis can be used as a biomarker to predict therapeutic responses and outcomes for high-risk breast cancer patients.
- CONCLUSIONS: Lack of ctDNA clearance was a significant predictor of poor response and metastatic recurrence, while clearance was associated with improved survival even in patients who did not achieve pCR. Personalized monitoring of ctDNA during NAC of high-risk early breast cancer may aid in real-time assessment of treatment response and help fine-tune pCR as a surrogate endpoint of survival.
https://www.annalsofoncology.org/article/S0923-753...(20)43162-X/fulltext{free access to full article}0 -
2020 NCI Press Release
Postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer that has spread to a limited number of lymph nodes, and whose recurrence risk is relatively low, do not benefit from chemotherapy when it is added to hormone therapy, according to initial results from a clinical trial presented at the 2020 San Antonio Breast Cancer SymposiumExit Disclaimer.
Some postmenopausal women with breast cancer may forgo chemotherapy
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New Assay Platform Enhances Detection of Circulating Breast Cancer Cells
November 26, 2020
Detection of circulating tumor cells (CTCs) in a breast cancer model was improved by a novel assay platform that uses a dual-receptor recognition and signal amplification strategy, researchers say.
"Considering the urgent need for early diagnosis of metastatic breast cancer and recent advances in functional nucleic acid-mediated bioassays from our group, we designed the platform and demonstrated its feasibility for CTC detection," Dr. Zai-Sheng Wu of Fuzhou University in China told Reuters Health...
"...the newly developed...assay system is suitable for screening CTCs in complex environments and is expected to be a promising tool for estimating distant metastasis and predicting the recurrence of tumors."
Dr. Wu said, "The detection of CTCs from patients with breast cancer remains technically challenging because of their heterogeneity. Nevertheless, our group is already collaborating with scientists in Fujian Cancer Hospital to promote the transition from the laboratory to clinic trials."
The article contains discussion about methodology and shortcomings of the approach.
"The ability to detect rarer CTC populations would be helpful for risk stratification after surgery and to facilitate diagnosis or biomarker testing when there is limited tissue."
"Comparison of this technique using human blood samples from the clinic and CTC detection with this platform versus existing platforms would be a key step," he said, "then focusing on the clinical impact of more sensitive CTC detection, perhaps to determine need for adjuvant chemotherapy in certain post-operative settings."
https://www.medscape.com/viewarticle/941629?src=wn...
https://doi.org/10.1021/acssensors.0c01082
{Free access to full article.}
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Trastuzumab Interruption Linked to Worse Outcomes in ERBB2-Positive Disease
October 22, 2020
A single-center study of trastuzumab interruption in patients with ERBB2-positive breast cancer found that dose interruption was associated with higher rates of disease recurrence and death compared with uninterrupted treatment.
Researchers from Memorial Sloan Kettering Cancer Center conducted the study because "findings from the PHARE and PERSEPHONE trials on the noninferiority of 6- vs 12-month durations of trastuzumab are conflicting, thus the clinical significance of early trastuzumab interruption on breast cancer outcomes remains uncertain."
The study included 1396 patients who had been treated with trastuzumab between 2004 and 2013. Early interruption was defined as a 6-week or longer interval between scheduled trastuzumab doses.
Findings indicated that the total dose of trastuzumab "plays an important role in breast cancer outcomes." Trastuzumab interruption with a cumulative dose of 56 mg/kg or less was associated with a reduced recurrence-free survival (adjusted HR, 1.96; 95% CI, 1.16-3.33).
"Given that most patients in this study were treated with anthracyclines, our findings may not be generalizable to patients receiving nonanthracycline treatment regimens," the researchers noted.
https://www.oncologynurseadvisor.com/home/cancer-t...
Reference: Copeland-Halperin RS, Al-Sadawi M, Patil S, et al. Early trastuzumab interruption and recurrence-free survival in ERBB2-positive breast cancer. JAMA Oncol. Published online October 15, 2020.doi:10.1001/jamaoncol.2020.4749
{Reporting and abstract available free. Subscription or $30 per article charge for full journal article.}
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Thank you Lumpie. I do believe that giving cancer cells a "vacation time" makes them mutate and re-organize to metastasis. Sneaky disease.
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😳 Didn’t expect this from SABCS20. Looks like I will be going back on a low carb diet. Before metastasis I lost 50 lbs on KETO. Kept off 45 and eat what I want. I will ask Dr Hamilton what she thinks on Monday.
Dee
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AlabamaDee, thanks for posting this! More motivation for me to stick to my low carb eating plan! That was the only way I could lose any significant amount of weight post-menopause.
Some good info coming out of virtual SABCS
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I thought low glycemic isn't the same as low carb or keto?
I gotta say don't think much of animal models anyway so I'm ambivalent about this
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You are correct it isn't the same Moth, I would say it's more flexible.
Here is a handy chart-
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AlabamaDee, thanks. Yes, it's good motivation to eat a low glycemic diet. It partly depends on how much you are eating and what foods you're eating together, because of how food metabolizes. My registered dietician cousin recommends I eat a diabetic's diet to maintain stable blood sugar. My weight is healthy and stable; my glucose and A1c are high-normal but basically stable. But I could do a lot better job with what I eat. sigh...
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yes low glycemic and KETO are different. I just lived KETO for a year and know it worked for me. My A1c and glucose are fine and I have always been an overweight person. Not doing anything drastic until after Xmas.
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yes, more flexible and, by definition, with low carb, I am eliminating most if not all of those high glycemic foods on that list. And, I would not eat some of lower glycemic carbs on a daily basis either. When I do choose a grain product or a fruit, I do consider the glycemic index.
Most people I know who do full keto are doing the same...it is pretty much automatically a low glycemic diet.
Nice chart, 2019whatayear, thanks for the link.
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Dee, do you have a link to that article (if it was an article)? Thanks!
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Lots of BC information in this Oncology Business Review daily. I hope that the link will open. It is possible to subscribe to this daily oncology journal.
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Study can orient use of melatonin in the treatment of breast cancer
A Brazilian study published in the Journal of Pineal Research describes a group of genes potentially regulated by the hormone melatonin in some types of cancer, especially breast cancer. According to the authors, the results can be used to guide future personalized therapies for the disease...
As a result, they were able to understand how melatonin works in several cellular signaling pathways. "These genes targeted by melatonin relate to important biological processes in cancer, such as cell cycle regulation, cell death, and cell migration and senescence," he explained. "Melatonin appears to act more strongly on breast, oral, and stomach cancer...
According to Chuffa, genes regulated by melatonin in breast cancer are potential targets for the treatment of the disease. "Melatonin is a multitasking molecule and acts on various cellular substrates, so we're now taking the study deeper to find out how the hormone influences microRNA expression and hence the regulation of the cellular mechanisms identified," he said.
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JoynerL
The low glycemic study was a presentation at SABCS20 that my trial doc commented on in Twitter. I can’t search the abstracts right now. Sorry. I do plan to ask her more about it on Monday
Dee
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Wait, I just realized-- Dee, your doctor is Dr. Hamilton? She seems to be pretty awesome. I follow her on twitter.
There isn't an article to link the info was from a presentation at the San Antonio BC Symposium. There might be info here: SABCS News Or you can find some commentary from doctors and patients re. on twitter if you search the hastag #SABCS20
I'm sure more info will be coming out. The takeaway is really that a healthy diet is a low glycemic diet so the more you can follow that the better your overall health will be long term.
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Thanks, all!
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Re: whether common cholesterol drugs might improve the reach of immunotherapy--
https://www.cancer.gov/news-events/cancer-currents...
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Hi!
Can anyone weigh in on the results of today's RxPonder results? I was diagnosed in 2018 premenopausal 1/4 positive nodes and a low Oncotype of 9. I sought out 3 MO opinions and they all said chemo would have little to no benefit to me so I skipped it. The results from this study seem pretty clear that was a terrible decision as the premenopausal group that received chemo plus ET had a 46%!! reduction in metastatic reoccurrence compared to the arm that did ET only. Ugh.
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Garnersuz77: I read a summary really quickly, but the way I read it, it looked like it changed the risk by maybe 4%. Not nothing, but not huge either. And, of course, (as far as I know,) we didn't have studies before now showing this difference in prognosis. Of course, that is why we need more research. It is great to have all this "smart"/personalized medicine, but if we can't figure out the persons for whom it is smart, we don't really come out ahead. We will get there but... arg... it is to be on the long end of the wait.
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The doctors discussing it were really leaning toward chemo not being of benefit pre or post if 1-3 nodes . They think the difference is mostly due to younger women being thrown into menopause due to chemo so the perceived benefit is more due to the sudden menopause vrs the chemo itself
With a score of 9 the endocrine therapy is what you need -Take heart!
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Here's Dr. Kalinsky of Emory University on the subject:
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Thank you all very much! I feel better now that I understand it better. The ovarian suppression benefit as a result of chemo vs. a large benefit from the chemo itself make a lot of sense.
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hold your enthusiasm....
from Annals of Oncology Oct 2020
"Less than 20% (19.3%) of cancer science discoveries touted as breakthrough, landmark, groundbreaking, or highly promising translated into clinical therapy or practice with a median follow up of 15 years. Among clinically adopted treatments in our analysis, most were approved based on surrogate end points and only 9.1% found a survival benefit. Among 8 therapies with an OS benefit, the median benefit provided was 2.8 months. Our results suggest that claims of major discovery are associated only with modest rates of ultimate clinical success."
DOI:https://doi.org/10.1016/j.annonc.2020.10.484
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