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Topic: Immunotherapy drugs for breast cancer

Forum: Immunotherapy - Before, During, and After —

Discuss your experiences with the benefits, risks, and side effects of immunotherapy treatment for breast cancer.

Posted on: Mar 18, 2015 06:13PM - edited Jan 3, 2017 01:50AM by JohnSmith

JohnSmith wrote:

Immuno-Oncology (IO) and Immunotherapy drugs are humanity's best shot at beating cancer.

During the last few years, IO has revealed impressive, durable responses in a variety of tumor types for which conventional therapies historically have had limited success (melanoma, leukemia, lymphoma, lung, liver, bladder, etc).
The power of this approach is highlighted in countless articles (like here and here) as well as a variety of TV broadcasts, including:
1. HBO's Vice TV special: "Killing Cancer", explored a subset of IO called "Virotherapy" and how the following three common viruses are genetically modified to find and kill cancer:
- A re-engineered Measles virus was used to treat patients with Multiple Myeloma.
- A re-engineered Adenovirus (like the common cold) to treat patients with Glioblastoma (GBM) brain tumors.
- A re-engineered HIV virus to treat patients with the blood cancer Leukemia.
2. 60 Minutes TV special: "Killing Cancer" focused on curing GBM by using a re-engineered Polio virus.
3. PBS TV special: "Cancer: The Emperor of All Maladies" tells the complete story of cancer, from its history to current breakthroughs. It's six hours long, broken into three videos, with the last part covering IO.

We've reached an inflection point to change the trajectory of breast cancer treatment.
In late 2015, an unprecedented coalition was formed to accelerate progress in IO.
Called the "Cancer Moon Shot 2020" (#CancerMoonShot), this endeavor will bring patients closer to Immunotherapies and precision medicine, by not only exploiting genetics (DNA), but also epigenetics (gene expression), proteomics (protein expression), metabolomics (cancer metabolism). Here's a couple video's discussing the effort:
4. Cancer MoonShot 2020, explained in very simple terms, here.
5. Cancer MoonShot 2020 Press Conference (Jan 2016), here. Listen to the experts.

If you're smart, you asked the question: how can immunotherapy be harnessed in Breast Cancer?

To answer this, I researched the usual resources and was surprised at the paucity of info.
Breastcancer.org's page, Using the Immune Response to Treat BC is outdated and extremely incomplete.
It only discusses these Monoclonal Antibodies (mAbs) used for HER2+ patients:
Herceptin (trastuzumab), Tykerb (lapatinib), Perjeta (pertuzumab), Kadcyla (Trastuzumab or T-DM1).

The Cancer Research Institute's webpage, "Immunotherapy for Breast Cancer", is the most comprehensive resource for US based research, although it was last updated Sept 2014. [Dr. Leisha Emens of John Hopkins reviewed and updated the webpage in March 2016].
It's written that "breast cancer has historically been considered immunologically silent". This statement may contribute to why breast cancer lags behind when compared to other cancers. This notion that breast cancer, in particular ER+ disease, is "not very immunogenic" is an antiquated view that needs to end.
I understand it's "early days", but the breast cancer industry needs a serious paradigm shift.
Listen to this comment at the 2016 CancerMoonShot press conference here). Priorities should be realigned towards the basic science of IO and then translated into cures that exceed the ~7% that standard therapies offer metastatic patients over 10 years (Source: Weissman, June 2015, ~10:00 minute mark).
As patients / caretakers, we should be discussing Immunotherapies with our doctors, encouraging breast cancer researchers to explore this approach and supporting funding efforts aimed at moving the field forward.

So, in a effort to advocate for this community, I wanted to start this topic and get others to ask these questions:

- What progress is being made in Breast Cancer Immunotherapy?
- Who are the thought leaders and researchers in Breast Cancer Immunotherapy?
- Most importantly, where are the Breast Cancer Immunotherapy clinical trials?

Who else shares this sense of urgency?

Wife was Age 45 at Dx 4/2014. BMX Surgery 6/2014 revealed: ILC, Stage 2 (Multifocal ILC, largest lesion 2.2 cm), Grade 2, ER+/PR+ (95%), HER2-, Ki-67 5-10%, Oncotype 11; Variant in the ATM gene Dx 4/8/2014, ILC, Left, 2cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2014 Mastectomy; Reconstruction (left); Reconstruction (right)
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Jun 15, 2018 08:02PM aterry wrote:

I've just read all of the updates. You all write such interesting posts. I haven't followed ASCO closely; I guess I should catch up on that. Zaraovka, what is TILs? Did I miss that in an earlier post? It's not on the list of abbreviations. Thanks.

Dx 10/13/2016, IDC, Left, 1cm, Grade 3, ER-/PR-, HER2- Surgery 4/18/2017 Radiation Therapy 5/23/2017 Chemotherapy AC + T (Taxol)
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Jun 15, 2018 08:17PM KPW3 wrote:

I'm on a Pd-1 and am wondering what is thought about taking ibuprofen with pd-1? Or supplements, I normally take cucurmin, melatonin, vit D3, multi vit, and Claritin.


MO says it's fine, but am concerned....

Dx 10/2014, IDC, 2cm, Stage IIB, Grade 3, 2/3 nodes, ER+/PR-, HER2- Surgery 1/27/2015 Lumpectomy Chemotherapy 3/1/2015 AC + T (Taxol) Surgery 7/21/2015 Lymph node removal: Underarm/Axillary Radiation Therapy 9/15/2015 Dx 11/29/2017, IDC, Left, Stage IV, metastasized to liver, Grade 3, ER-/PR-, HER2- Chemotherapy 6/12/2018 Halaven (eribulin) Chemotherapy Abraxane (albumin-bound or nab-paclitaxel) Hormonal Therapy Femara (letrozole), Zoladex (goserelin)
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Jun 17, 2018 11:57PM - edited Jun 18, 2018 06:29AM by zarovka

aterry - TILs are tumor infiltrating lymphocytes. These are white blood cells found in tumors.

The immune response to cancer has (at least) two important steps. First the immune system has to recognize the cancer as foreign, second the immune system has to launch an attack.

TILs are important because they indicate the immune system has identified the cancer as foreign. TILs enter the tumor ready to multiply and take out the tumor but the tumor shuts down the immune response through immune suppression. The presence of TILs suggests that an agent that suppresses immune suppression in the tumor microenvironment like PDL-1 might work. And, in fact, such agents are more successful in patients whose tumors have TILs.

KPW3 - this forum is mostly about discussing research. You will get a better response from a forum that discusses PDL-1 inhibitors, regardless of cancer type. PDL-1 inhibition is still not common for MBC. I am not on a PDL-1 inhibitor, but I can share my general strategy for thinking through the supplement interaction problem. I ask myself what is the drug trying to do and what is the supplement trying to do. PDL-1 is trying to enhance an immune response, which can promote inflammation, curcumin reduces inflammation. I think you may be working at cross purposes with that particular combination. Cannabis, for example is a powerful anti-inflammatory and I've seen smart people suggest it should not be combined with immunotherapy.

This is NOT a direct answer to your question. I am just supporting your intuition/concern.

Generally, when I start a new regime and I am not sure I understand what the interactions are, I stop all supplements but the multi-vitamin and let the standard of care drug do it's thing for a while. It helps me to understand how the Standard of Care treatment "feels"/works on its own. At some point I feel comfortable adding things back... I think that the fact that you are concerned indicates you might want to pull back supplements. Often there is no data driven, researched answers to these questions but going by your intuition should not be underestimated ...

>Z<

Ibrance/Letrozol Feb '16 -Sep '17. Adoptive Cell Therapy Oct 2017. Jan 2018 SBRT to sternum met and liver mets. Jan 2018 start Faslodex. Dx 12/28/2015, IDC, Left, 4cm, Stage IV, metastasized to bone/liver, Grade 3, ER+/PR-, HER2- Hormonal Therapy 1/16/2016 Femara (letrozole) Targeted Therapy 2/2/2016 Ibrance (palbociclib)
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Jul 12, 2018 05:03PM blainejennifer wrote:

Just spoke to Sarah Ramirez at the NIH about trial eligibility for the same trial that "cured" Judy Perkins. Of note - they have been slammed with trial enquiries because of the publicity. Also, only three patients, out of the entire cohort, have achieved remission. Just Judy, one colorectal patient, and one bile duct cancer patient. While that's great, the numbers are still not in our favor.

Also, if you are thinking about this trial, and I am, you should have a resectable tumor that is easy to get to, because they need to harvest cells from the tumor. Ms. Ramirez seemed to favor lung nodules (well, she talked about them a lot). And, it is four months from cell harvest to t-cell infusion, so you will need to line up a conventional treatment for the interim period. They need a 4 week washout before infusion, but I don't know too many of us that could go for four months without treatment.

Jennifer

ER/PR+, HER2-, Grade 3. Stage 4, July 2012. Currently on Doxil Dx 5/2006, IDC, 4cm, Stage IIB, Grade 3, 4/12 nodes, ER+/PR+, HER2- Dx 3/2012, IDC, Stage IV, 4/12 nodes, ER+/PR+, HER2- Chemotherapy 6/28/2012 Taxol (paclitaxel) Hormonal Therapy 6/5/2013 Faslodex (fulvestrant) Chemotherapy 7/1/2014 Xeloda (capecitabine) Hormonal Therapy 8/14/2015 Femara (letrozole) Chemotherapy 1/31/2016 Halaven (eribulin) Chemotherapy 8/31/2016 CMF Chemotherapy 11/1/2016 Halaven (eribulin)
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Jul 12, 2018 06:12PM Kidmanliang wrote:

thanks Jennifer. We also contacted them, since they have been slammed, they don’t even accept international patients. We already started looking into other clinical trials, I really hope that a real cure will be invented soon.

Dx 6/6/2017, IDC, Right, Stage IV, metastasized to other, Grade 3, ER+/PR-, HER2- (FISH) Dx 6/6/2017, IDC, Right, 3cm, Stage IV, metastasized to brain/bone, Grade 3, 5/26 nodes, ER+/PR-, HER2- (FISH) Chemotherapy 7/1/2017 Abraxane (albumin-bound or nab-paclitaxel) Chemotherapy 8/23/2017 Xeloda (capecitabine) Hormonal Therapy 3/1/2018 Femara (letrozole)
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Jul 18, 2018 03:42PM Moderators wrote:

We just opened a new forum on Immunotherapy, so are moving this over!

To send a Private Message to the Mods: community.breastcancer.org/mem...
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Aug 22, 2018 07:01AM nurseruthie wrote:

My 35 year old daughter, who was recently diagnosed with TNBC Stage IIB, is involved in the second tier of a drug trail using Abraxane and Durvalumab (a monoclonal antibody) as her initial neoadjuvant chemotherapy. Has anyone heard anything about this monoclonal antibody?

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Aug 26, 2018 11:51PM Kidmanliang wrote:

hi nurseruthie, Durvalumab seems to be a PD1 immunotherapy drug. I’m not familiar with it, but I hope someone else will give you some info soon

Dx 6/6/2017, IDC, Right, Stage IV, metastasized to other, Grade 3, ER+/PR-, HER2- (FISH) Dx 6/6/2017, IDC, Right, 3cm, Stage IV, metastasized to brain/bone, Grade 3, 5/26 nodes, ER+/PR-, HER2- (FISH) Chemotherapy 7/1/2017 Abraxane (albumin-bound or nab-paclitaxel) Chemotherapy 8/23/2017 Xeloda (capecitabine) Hormonal Therapy 3/1/2018 Femara (letrozole)

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