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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 03:13PM - edited Jan 2, 2017 11:50PM 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Breastcancer.org's page, Using the Immune Response to Treat BC is outdated and extremely incomplete.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 6/25/2014 Mastectomy; Reconstruction (left); Reconstruction (right)
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Posts 181 - 195 (195 total)

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Jun 15, 2018 05:02PM 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 5/22/2017 Chemotherapy AC + T (Taxol)
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Jun 15, 2018 05:17PM 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 1/28/2015 Lumpectomy Chemotherapy 3/2/2015 AC + T (Taxol) Surgery 7/22/2015 Lymph node removal: Underarm/Axillary Radiation Therapy 9/16/2015 Dx 11/29/2017, IDC, Left, Stage IV, metastasized to liver, Grade 3, ER-/PR-, HER2- Chemotherapy 6/13/2018 Halaven (eribulin) Chemotherapy Abraxane (albumin-bound or nab-paclitaxel) Hormonal Therapy Femara (letrozole), Zoladex (goserelin)
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Jun 17, 2018 08:57PM - edited Jun 18, 2018 03:29AM 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 1/17/2016 Femara (letrozole) Targeted Therapy 2/2/2016 Ibrance (palbociclib)
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Jul 12, 2018 02:03PM 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 Navelbine 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 6/27/2012 Taxol (paclitaxel) Hormonal Therapy 6/4/2013 Faslodex (fulvestrant) Chemotherapy 6/30/2014 Xeloda (capecitabine) Hormonal Therapy 8/14/2015 Femara (letrozole) Chemotherapy 1/31/2016 Halaven (eribulin) Chemotherapy 8/30/2016 CMF Chemotherapy 10/31/2016 Halaven (eribulin)
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Jul 12, 2018 03:12PM 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 12:42PM 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 04:01AM 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 08:51PM 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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Oct 21, 2018 02:56PM funthing42 wrote:

Hi

Just wondering what to expect next.

They told me immunotherapy is not for me only triple neg breast ca. Than gave some 5% effective statistic statement. Told me I didn't have 30 days to figure out trials etc.

They are ready to give chemo again. Abraxane?

No Biopsy of the liver just juice me.

I want to survive. I feel like they are looking in a book and throwing their hands up figuring it might work with no analysis.

Ibrance and fasoldex gave me 2 years remission.

Tumors shrunk to nothing markers normal.

I still do lupron also.

Last week I was told my markers went up.

Hx below I don't have time to figure out whats going to work.

Liver 3 large 1 small

4cm largest

x 6/1/2009, IDC, <1cm, Grade 2, ER+/PR+, HER2-

Hormonal Therapy 6/5/2009 Arimidex (anastrozole)

Surgery 6/5/2009 Lumpectomy: RightRadiation Therapy 8/1/2009 Whole-breast: BreastHormonal Therapy 11/1/2009 Arimidex (anastrozole)

Dx 11/1/2013, IDC, 1cm, Stage IA, Grade 2, ER+/PR-, HER2+

Surgery 1/1/2014 Mastectomy: Right; Prophylactic mastectomy: Left

Targeted Therapy 2/1/2014 Herceptin (trastuzumab)

Chemotherapy ,Carboplatin (Paraplatin), Taxotere (docetaxel)

Dx 10/1/2014, IDC, <1cm, ER+/PR-, HER2-Hormonal Therapy 11/1/2014 Aromasin (exemestane)

Skin mets Sept 2015

3/2016, IDC, Right, ER+, HER2-Metastatic treatmentTypeExternalSiteChest wall radiation was finished . Pet scan then revealed left lymph node involvement. Her2- estrogen + progesterone-

Ibrance and fasoldex 2yrs

It shrunk to nothing markers normal no Ca.

But now on

10.10.18 markers up

Liver mets

Dx 6/1/2009, IDC, <1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 6/5/2009 Arimidex (anastrozole) Surgery 6/5/2009 Lumpectomy: Right Radiation Therapy 8/1/2009 Whole-breast: Breast Hormonal Therapy 11/1/2009 Arimidex (anastrozole) Dx 11/1/2013, IDC, 1cm, Stage IA, Grade 2, ER+/PR-, HER2+ Surgery 1/1/2014 Mastectomy: Right; Prophylactic mastectomy: Left Chemotherapy 2/1/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/1/2014 Herceptin (trastuzumab) Dx 10/1/2014, IDC, Right, <1cm, ER+/PR-, HER2- (FISH) Hormonal Therapy 11/1/2014 Aromasin (exemestane) Dx 2/2016, IDC, ER+/PR-, HER2-
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Oct 21, 2018 06:14PM KPW3 wrote:

funthing42, How are your liver enzymes? My liver met changed to triple negative (primary ER+,) and they would not have known if they hadn't done a biopsy. I think I would really push for a biopsy, unless your liver enzymes are high. Have you gotten a second opinion? I always get a second opinion when my treatment changes and have gotten a third.

My 2 cents......

Here is a clinical trial for what I think you are asking.....

Atezolizumab and Cobimetinib or Idasanutlin in Participants With Stage IV or Unresectable Recurrent Estrogen Receptor Positive Breast Cancer

https://clinicaltrials.gov/ct2/show/NCT03566485


I think there may be others with keytruda, these are the clinical trial #s.

NCTT01772004 and NCT02054806


Dx 10/2014, IDC, 2cm, Stage IIB, Grade 3, 2/3 nodes, ER+/PR-, HER2- Surgery 1/28/2015 Lumpectomy Chemotherapy 3/2/2015 AC + T (Taxol) Surgery 7/22/2015 Lymph node removal: Underarm/Axillary Radiation Therapy 9/16/2015 Dx 11/29/2017, IDC, Left, Stage IV, metastasized to liver, Grade 3, ER-/PR-, HER2- Chemotherapy 6/13/2018 Halaven (eribulin) Chemotherapy Abraxane (albumin-bound or nab-paclitaxel) Hormonal Therapy Femara (letrozole), Zoladex (goserelin)
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Oct 21, 2018 06:57PM funthing42 wrote:

Thank you for caring. It is crazy how much work is on the patient. Lol.

I'm exhausted. With out all of us here on this forum, I would have been one flew over the cuckoo nest.

My enzymes are great. I look at my urine for change every chance I get. Lol not brown yet.

Dx 6/1/2009, IDC, <1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 6/5/2009 Arimidex (anastrozole) Surgery 6/5/2009 Lumpectomy: Right Radiation Therapy 8/1/2009 Whole-breast: Breast Hormonal Therapy 11/1/2009 Arimidex (anastrozole) Dx 11/1/2013, IDC, 1cm, Stage IA, Grade 2, ER+/PR-, HER2+ Surgery 1/1/2014 Mastectomy: Right; Prophylactic mastectomy: Left Chemotherapy 2/1/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/1/2014 Herceptin (trastuzumab) Dx 10/1/2014, IDC, Right, <1cm, ER+/PR-, HER2- (FISH) Hormonal Therapy 11/1/2014 Aromasin (exemestane) Dx 2/2016, IDC, ER+/PR-, HER2-
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Nov 3, 2018 01:27PM Kidmanliang wrote:

funthing42, have you noticed this thread yet? Y90 seems to work for liver mets


https://community.breastcancer.org/forum/8/topics/832767?page=17#idx_481

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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Nov 7, 2018 09:42PM funthing42 wrote:

Hi

Thank you Im looking into the y90.

I start xeloda this week.Smile

Dx 6/1/2009, IDC, <1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 6/5/2009 Arimidex (anastrozole) Surgery 6/5/2009 Lumpectomy: Right Radiation Therapy 8/1/2009 Whole-breast: Breast Hormonal Therapy 11/1/2009 Arimidex (anastrozole) Dx 11/1/2013, IDC, 1cm, Stage IA, Grade 2, ER+/PR-, HER2+ Surgery 1/1/2014 Mastectomy: Right; Prophylactic mastectomy: Left Chemotherapy 2/1/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/1/2014 Herceptin (trastuzumab) Dx 10/1/2014, IDC, Right, <1cm, ER+/PR-, HER2- (FISH) Hormonal Therapy 11/1/2014 Aromasin (exemestane) Dx 2/2016, IDC, ER+/PR-, HER2-
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Nov 9, 2018 05:17AM Kattysmith wrote:

I'm being vetted for a Phase 1 Immunotherapy clinical trial at MDA that will combine Optivo (Nivolumab) with a new targeted therapy known only by its initials so far. I am not triple-neg, but I do have two mutations in my liver mets, so that may be why they are considering me for this trial. I've been playing message tag with the head of the study. My baseline biopsy will be Tuesday, then I should know if I'll be moving forward with this trial in two weeks!

I've sailed through two courses of IV chemo without severe side-effects, but I must admit, the list of possible side-effects for both of these drugs is DAUNTING.

First diagnosed borderline Stage 2 IDC, left breast in 2003. No problems until a surprise (!) Stage IV recurrence in 2015! In addition to treatments listed below, I started monthly injections of Xgeva for bone support in July 2016. Dx 10/23/2015, Left, Stage IV, metastasized to other, Grade 3, 0/3 nodes, ER+, HER2- Chemotherapy 11/4/2015 AC Hormonal Therapy 2/5/2016 Femara (letrozole) Targeted Therapy 2/5/2016 Ibrance (palbociclib) Hormonal Therapy Faslodex (fulvestrant)
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Nov 9, 2018 08:59PM funthing42 wrote:

I called MD Anderson as a back up. I normally shy away from trials. I'm ready now to keep the option open.

Good luck. Your brave and encouraging. :)

Dx 6/1/2009, IDC, <1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 6/5/2009 Arimidex (anastrozole) Surgery 6/5/2009 Lumpectomy: Right Radiation Therapy 8/1/2009 Whole-breast: Breast Hormonal Therapy 11/1/2009 Arimidex (anastrozole) Dx 11/1/2013, IDC, 1cm, Stage IA, Grade 2, ER+/PR-, HER2+ Surgery 1/1/2014 Mastectomy: Right; Prophylactic mastectomy: Left Chemotherapy 2/1/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/1/2014 Herceptin (trastuzumab) Dx 10/1/2014, IDC, Right, <1cm, ER+/PR-, HER2- (FISH) Hormonal Therapy 11/1/2014 Aromasin (exemestane) Dx 2/2016, IDC, ER+/PR-, HER2-

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