Breaking Research News from sources other than Breastcancer.org
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i refuse to register/create accounts just to read an article (pet peeve). Can someone that is already registered tell me what vaccine they're talking about for HER2+? Is it the one presented at SABCS 2020 or something else? I'm in a Moffit run Vaccine Trial, getting the DC-1 vaccine.
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this is almost the whole transcript. I hope this would lead to something that helps those of us who are already MBC as well
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thanks!
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cancer immunotherapy & increased risk of venous embolism (blood clots)
https://www.cell.com/med/pdf/S2666-6340(21)00063-5.pdf
Roopkumar et al., Med 2, 423–434 April 9, 2021 ª 2021 Elsevier Inc. https://doi.org/10.1016/j.medj.2021.02.002
Cancer itself raises riks of blood clots. Now it seems immunotherapy treatment adds additional risk. This study found 24% of pts on immunotherapy developed embolism.
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SBRT Safe for Cancer Patients With Multiple Metastases
Given the critical need, NRG Oncology NRG-BR001 trial sought to determine the safety of delivering curative-intent SBRT to patients with 3 to 4 metastases or 2 metastases within close proximity to each other.
https://www.medpagetoday.com/radiology/therapeutic...
Love the phrase curative-intent!!
Dee
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woooh nice one Dee!
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Cryoablation Promising for Early Breast Cancer
Almost all patients and physicians report satisfaction from cosmetic results; overall recurrence rate 2.06 percent
Cryoablation seems promising for early breast cancer and has minimal risks, according to a study presented at the annual meeting of the American Society of Breast Surgeons, held virtually from April 29 to May 2.
Richard E. Fine, M.D., from the West Cancer Center & Research Institute in Germantown, Tennessee, and colleagues examined the safety and efficacy of cryoablation for women aged 60 years and older with unifocal, ultrasound-visible invasive ductal carcinoma ≤1.5 cm in size; tumors were hormone receptor-positive, human epidermal growth factor receptor 2-negative. One hundred ninety-four patients (mean age, 75 years; mean tumor size, 7.4 mm) met the eligibility criteria and received successful cryoablation treatment per protocol, receiving a freeze-thaw-freeze cycle for 20 to 40 minutes. Patients were followed up at six months and then annually to five years.
The researchers observed no significant device-related adverse events or complications reported among the protocol-treated patients. Most adverse events were minor. Fifteen patients underwent sentinel lymph node biopsies; one had breast cancer-related positive sentinel lymph nodes, with no recurrence at 60 months of follow-up. Overall, 27, one, and 148 patients underwent adjuvant radiation, received chemotherapy, and began endocrine therapy, respectively. During the follow-up visits, more than 95 percent of patients and 98 percent of physicians reported satisfaction from the cosmetic results. Only four of the protocol-treated patients had recurred at a mean of 34.83 months of follow-up (2.06 percent overall recurrence rate).
"Cryoablation potentially represents a dramatic improvement in care for appropriate low-risk patients, and at three years' posttreatment, the ICE3 trial results are extremely positive," Fine said in a statement.
https://www.practiceupdate.com/C/117648/56?elsca1=...
https://www.breastsurgeons.org/meeting/2021/docs/p...
{Report based on presentation at the annual meeting of the American College of Breast Surgeons. Reporting and access to press release are free. While this approach was targeted to a specific subset of patients, further de-escalation of treatment and fewer side effects sure would be a plus for those able to benefit.}
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This is the second recent study to come out showing BETTER breast cancer survival from lumpectomy + rads than from mastectomy
"The cohort included all women diagnosed as having primary invasive T1-2 N0-2 breast cancer and undergoing breast surgery in Sweden from 2008 to 2017"
almost 50,000 Swedish pts
"Breast conservation seems to offer a survival benefit independent of measured confounders and should be given priority if both breast conservation and mastectomy are valid options."
https://jamanetwork.com/journals/jamasurgery/fulla...
My editorial comment: We urgently need to add this evidence into discussions of pt decision making about surgery. My perception is still that too many pts make a non evidence based decision, and that a system which financially rewards surgeon + cosmetic surgeons teams for more aggressive surgery might be contributing to poorer outcomes for women.
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moth you are right. So many women are afraid to keep their breast; a knee jerk fear.
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I, too, have talked with SO many friends, colleagues... even medical professionals.... who automatically assume that a mastectomy is more effective. I hope that better information gets to the people who need it. Part of the problem is that people are often obliged to make a decision quickly and with inadequate information. It can also be difficult to get insurance coverage to correct post-partial cosmetic issues. I wonder if this may impact some patient decisions.
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I completely agree that this information needs to be made known to newly diagnosed patients.
Will BCO be making content on this? I hope so.
Unfortunately the mastectomy vs lumpectomy w/radiation decision is often made when people are in the shock and awe phase, and under pressure to act quickly. To make matters worse, I think our culture of celebrity plastic surgery leads a few women to believe that they will get Hollywood results from their reconstruction, which is just not usually the case when it comes to breast cancer.
My personal opinion (having done both surgeries, and lived with the consequences) is that unless it is medically necessary for some reason, a mastectomy should not generally be offered when a lumpectomy with radiation is a viable alternative. Just my opinion! I know others will disagree, and that's okay.
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I posted about this in another thread but will repeat here, since here is where this discussion is getting more traction. I don't think we know enough of why patients choose one option or the other to conclude that there is this widespread, uninformed, knee-jerk decision process. It is not unreasonable to want a breast (or both) removed after a breast cancer diagnosis. That was my case, I had very dense breast tissue that rendered any screening, including 3D mammograms and MRIs, completely useless. Also, we don't know the reasons for the better outcomes in that study, and it could be that radiation is behind the better outcomes, and which surgery one chooses, lumpectomy or mastectomy, is irrelevant, and that what should be reviewed is when to offer radiation. I am very happy I had a mastectomy. Down the road I chose to have a prophylactic one on the non cancer side. For one thing, I went through 20+ years of useless cancer screening, and I am happy I will never get another mammogram. We shouldn't jump to conclusions so quickly.
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LaughingGull, I do think that situations like yours where screenings risk being ineffective or too burdensome can be good reasons to opt for a mastectomy. It's certainly not a one size fits all matter.
As an aside, I think you raise an interesting point that if the radiation is in fact responsible for the better overall survival, maybe radiation should be offered after some mastectomies, where it currently is not, as you say.
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Just to be clear that study compared 3 groups.
Lumpectomy + rads had better outcomes than mx + rads. Mx - rads was worst.
Certainly there are many other reasons why someone might want a mx.
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The truth is, we don't know the cause for the better outcomes, right? Not clear from the study.
I was offered radiation after the mastectomy. There is some criteria for radiation post-mastectomy (which I dont remember precisely but related to how widespread the cancer was) and I qualified. Insurance didn't complain.
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The outcomes are regarding deaths from recurrence and it doesn't include deaths from heart damage from radiation. I belong to the group of women who asked to have BMX for several reasons that are unique for me (us): difficult to read mammograms of very dense breast, to avoid radiation on the left side next to the heart to avoid future heart disease, to reduce anxiety for future 6 months scans, to reduce local recurrence in the other breast, etc. So, there is no size fits all.
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clarifying further, this study looked at both breast cancer specific mortality & overall mortality so damage from radiation would also have been captured
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I thought I would post this caveat re post-op mammograms:
"Mammograms will be recommended if you had a special type of mastectomy called nipple-sparing mastectomy, also known as subcutaneous mastectomy. In this surgery, you keep your nipple and the tissue just under the skin. Enough breast tissue remains to warrant the continued use of screening mammograms.
"Breast MRI is another and possibly more effective way to screen women who have had breast reconstruction and are at high risk for recurrence."
Obviously, your care team should be providing guidance on on-going screening, but recommendations change so it is good to go in "forearmed" with up to date research and recommendations, especially if you are high risk or have had a more complex case or surgery and have been transitioned back to your PCP for post-early stage care.
Source: https://www.breastcancer.org/symptoms/testing/type...
PS: I knew I had read about post-mastectomy mammograms so I went searching for when those were recommended. It must be the particular subset noted above. Surgical options change... recommendations change.... take care & stay healthy out there!
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Survival is not the only criteria when choosing MX vs lumpectomy. I have extremely dense breasts. I have been going through regular (every 6 months) ultrasounds for the last couple of years and at the end I found the tumor myself. I don't want to have to go through this ever again and so MX is the best choice in my case. I don't believe choosing either approach should be restricted.
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Went back to the study and indeed, it says that lumpectomy + rads had better outcomes than mx + rads. My bad. However, it also says: "It remains unclear whether this is an independent effect or a consequence of selection bias"
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Thank you Lumpie. I had a nipple-sparing mastectomy and my doctors told me I no longer need mammograms. I should ask on the next appointment. I wonder what other women like me are recommended.
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Lilly I also had a nipple sparing mastectomy, and no one has mentioned getting a mammogram at all. I have had one MRI however but that was related to determining an issue with a neuroma. I, too, had extremely dense tissue, cancer on left side close to chest wall. I really didn't want the radiation, although I knew it was still on the table depending on margins. I would love to be able to see more of the data from this study. As a previous poster stated it may be the radiation itself is the key driver. Thanks, Moth, for sharing this.
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I apologize that I'm out of sequence, but I'm chiming in on the heart disease / negative impacts from Tamoxifen in this article. It states - "Anti-estrogen therapy with tamoxifen also increases the risk for metabolic syndrome." I am living proof of that. I didn't even know what this was until I got it from Tamoxifen. My HbA1C went from 5.0 to 5.7 within 3 months on the drug. Unfortunately, I stayed on Tamoxifen for 3 months more because I didn't grasp what was happening to my liver and my PCP just breezed over it. Now, I have to severely restrict my carbs in the hope that I can circumvent diabetes, tiny amounts set off a blood sugar spike. I wish I had never taken the drug because it did nothing for my DCIS and may have permanently damaged my liver. Just a warning to all women that there are always those who fall into the "unintended side effects" camp.
May 2, 2021 11:27AM - edited May 2, 2021 11:28AM by Lumpie
In breast, prostate cancer survivors, hormonal therapies may raise CV risk
Hormonal therapies for the treatment of breast and prostate cancers may improve survival among patients with cancer, but also may confer poor CV {cardiovascular} outcomes among survivors.
3 minute read with links.
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Dear all, I am sure you all know it but ESMO2021 is so much about this drug, another big TROP2 gamechanger for mTNBC (and not only!): Dato-DXd, build on same platform as Enhertu (T-DXd) by Daiichi Sankiyo! Saulius
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Any knowledge or experience with unintended SEs with Exemestane/Afinitor? I was alarmed to read one article about very rare instances of lung damage. I'm off Afinitor during radiation, last day is Thrusday (hooray!), Other risks - kidneys, blood-sugar, BP..... Somewhere I saw a graph comparing Exemestane with/wiithout Afinitor, and it seems like the benefits drop rapidly
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BlueGirlRedState, check out the pneumonitis thread started by DogersGirl https://community.breastcancer.org/forum/8/topics/...
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Thanks moth, I've added it to my favorites
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BlueGirlRedState- Ref Afinitor and pneumonitis: Report ANY sense of shortness of breath to your MO so they can monitor your lungs
Thanks Moth for sharing the link. I shared my struggles hoping to help othet
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When I was diagnosed with DCIS in 2017, I felt somewhat pressured to go with lumpectomy/radiation. One of the questions I asked my MO was—if I get a future recurrence, won’t reconstruction be more difficult? She kind of scoffed at my silly question. Well, recurrence happened about 18 months later. Had a mastectomy which took a long time to heal due to radiated skin. I wasn’t able to consider any reconstruction due to Covid and I’m not even sure that I was able to get any other surgery due to radiated skin. Now, lo and behold recent mammogram identified suspicious lesion on right breast. I’m getting biopsy in a couple days. If I had been brave enough to get bilateral mastectomy in 2017, I believe I would be much better off today. Right now I’m just scared and sad. Hindsight is 20/20 but I think individuals need to be given enough info to make a truly informed decision that’s right for them. I was sold on the notion that DCIS doesn’t spread, etc, etc. I’m learning that the rate of subsequent cancer occurrence is higher than I really understood.
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CDK inhibitors may boost the effectiveness of immune therapy in metastatic breast cancer
Reviewed by Emily Henderson, B.Sc.May 10 2021A class of drugs that inhibits breast cancer progression when used with hormonal therapy might also boost the effectiveness of immune therapy in cases of recurrent, metastatic breast cancer, according to a new study led by researchers at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James).
Published in the journal Cell Reports, the findings of the animal study suggest that drugs called CDK4 and CDK6 (CDK4/6) inhibitors might improve the effectiveness of immune therapies for metastatic, estrogen-receptor-positive (ER+) breast cancer.
We know that CDK4/6 inhibitors effectively slow the progression of newly diagnosed breast cancer, but they don't kill cancer cells. Consequently, the disease often recurs, and then it is usually fatal because we have no effective therapies for recurrent disease. Our findings suggest that combining CDK4/6 inhibitors with immunotherapy might offer an effective treatment for recurrent, metastatic ER+ breast cancer."
Anna Vilgelm, MD, principal investigator, a member of the OSUCCC - James Translational Therapeutics Program and assistant professor at the Ohio State College of MedicineSpecifically, the study shows that CDK4/6 inhibitors can improve the efficacy of T-cell-based therapies such as adoptive T-cell transfer or T-cell-activating antibodies in animal models of breast cancer.
Immune therapies are proving to be effective treatments for a variety of cancers but not for advanced breast cancer. One problem is that breast tumors often have low numbers of cancer-killing T lymphocytes within the tumor. Such tumors tend to respond poorly to immune therapies.
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"In addition, breast cancer patients with low numbers of tumor-infiltrating lymphocytes often have worse survival compared to patients with high numbers of infiltrating lymphocytes in their tumors," says Vilgelm.
The new study shows that CDK4/6 inhibitors cause breast tumors to secrete small proteins called chemokines that attract T cells. This can help to improve patients' response to cancer immunotherapies.
For this study, Vilgelm and her colleagues used the oral CDK inhibitor palbociclib, mouse models, breast cancer cell lines and analyses of The Cancer Genome Atlas (TCGA) to study the influence of CDK4/6 inhibitors and chemokine production in the tumor immune microenvironment and on patient outcomes.
Key findings include:
- Pre-treatment with a CDK4/6 inhibitor improves recruitment of T cells into tumors and improved the outcome of adoptive cell therapy in animal models;
- CDK4/6 inhibitor-treated human breast cancer cells produce T-cell-recruiting chemokines;
- TCGA analysis showed that chemokine expression is a favorable prognostic factor in breast cancer patients;
- mTOR-regulated metabolic activity is required for chemokine induction by CDK4/6 inhibition;
- T-cell-recruiting chemokines may be useful prognostic markers for stratifying patients for immunotherapy treatment.
"Overall," Vilgelm says, "our findings suggest that CDK4/6 inhibitors may offer a therapeutic strategy that can attract T cells into breast cancer tumors, which may increase their sensitivity to immune therapies."
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