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Topic: Breaking Research News from sources other than Breastcancer.org

Forum: Clinical Trials, Research News, Podcasts, and Study Results —

Share your research articles, interpretations and experiences here. Let us know how these studies affect you and your decisions.

Posted on: Nov 20, 2017 09:31PM - edited Nov 20, 2017 09:35PM by Lumpie

Lumpie wrote:

I watch for research news on breast cancer, treatments, etc., and frequently see interesting articles. There is a topic on BCO called "Breaking Research News from Breastcancer.org." One of the moderators suggested that another topic might be appropriate for posting links and synopses of reports on research found elsewhere. So here it is! Please post links to reports on research form reliable sources. Thanks for sharing!

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Surgery Lumpectomy: Right Surgery Lumpectomy: Right Radiation Therapy Whole-breast: Breast
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Jun 11, 2021 10:34AM 2019whatayear wrote:

Glad you popped in Lumpie. I really appreciate this thread. Glad you are out there living life!

5/6/2019 IDC 2cm, micromet 1/9 nodes, BRCA2+, ER+, PR+, HER- BMX 6/2019, A/C & Taxol 2019, Radiation, BSO - preventative 2/2020, Letrozole 3/1/2020, Started Lynparza for 1 year preventative on 7/18/2021
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Jun 11, 2021 11:00AM - edited Jun 11, 2021 11:00AM by Olma61

Yes, good to hear from you! Enjoy th well-deserved R and R , thanks for checking in <3.

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+ (IHC) Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/30/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/30/2019 External: Bone
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Jun 15, 2021 07:24PM - edited Jun 15, 2021 07:30PM by Lumpie

Consequences of DDT Exposure Could Last Generations

DDT continues to haunt human bodies. In earlier studies, she found that the daughters of mothers exposed to the highest DDT levels while pregnant had elevated rates of breast cancer, hypertension and obesity.

Cohn's newest study, on the exposed women's grandchildren, documents the first evidence that DDT's health effects can persist for at least three generations. The study linked grandmothers' higher DDT exposure rates to granddaughters' higher body mass index (BMI) and earlier first menstruation, both of which can signal future health issues.

Nice synopsis here: https://www.phi.org/press/consequences-of-ddt-expo...

Read the PHI press release on the study here.

{Study} ORIGINALLY PUBLISHED BY Scientific American

Also reported in Cancer Epidemiology, Biomarkers, and Prevention

https://cebp.aacrjournals.org/content/early/2021/0...

DOI: 10.1158/1055-9965.EPI-20-1456

{Journal article requires subscription or fee. Others should be accessable without charge.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Surgery Lumpectomy: Right Surgery Lumpectomy: Right Radiation Therapy Whole-breast: Breast
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Jun 16, 2021 11:00AM moth wrote:

New study will begin enrolling third quarter of 2021 - for Metastatic Triple Neg

testing Agents to boost Trodelvy action

Open label Phase 1b/2

"Open-label Phase 1b/2 study will evaluate the safety and preliminary efficacy of Anktiva (N-803) and PD-L1 t-haNK in combination with antibody-drug conjugate Trodelvy and low-dose chemotherapy in subjects with advanced triple-negative breast cancer (TNBC) after prior therapy"

https://www.bloomberg.com/press-releases/2021-06-1...

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/3/2021 External: Bone
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Jul 2, 2021 04:42AM debbew wrote:

Study finds breast cancer's response to tumor stiffness may predict bone metastasis

Tumor stiffening, which develops as diseased breast tissue becomes fibrotic, plays a major role in how breast cancer cells spread throughout the body. The paper, "Breast tumor stiffness instructs bone metastasis via maintenance of mechanical conditioning," published today in the journal Cell Reports, found that the stiffness of the breast tumor microenvironment can cause changes to cancer cells that make them more aggressively spread to the bone. The resulting changes are maintained as "mechanical memory," which instructs the cancer cells to send signals that lead to the breakdown of bone. Once this happens, patients often suffer debilitating complications like spontaneous fractures...

The study, which is the first to demonstrate the concept of mechanical memory during cancer metastasis, developed a novel mechanical conditioning, or "MeCo," score, to quantify the cellular changes. Eventually, researchers hope the MeCo score can be used to help identify breast cancer patients who might benefit from repurposed antifibrotic treatments to prevent bone metastasis.

https://www.eurekalert.org/pub_releases/2021-06/uo...

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Jul 2, 2021 04:46AM debbew wrote:

[Early research] New discovery could yield a potential new treatment for breast cancer

In a study published this month in Cell Reports, the team used small molecules known as peptides to disrupt a complex of two proteins, RBM39 and MLL1, that is found in breast cancer cells but not in normal cells.

The research team discovered that the abnormal interaction between RBM39 and MLL1 is required for breast cancer cells to multiply and survive. The team developed non-toxic peptides that prevent these proteins from interacting in breast cancer cells, disrupting their growth and survival.

https://www.news-medical.net/news/20210629/New-dis...


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Jul 4, 2021 12:04PM - edited Jul 4, 2021 04:10PM by debbew

[Early research] RNA-binding proteins represent a new class of drug targets for triple-negative breast cancer

The researchers systematically silenced RNA-binding proteins in these cancer cells one-by-one using the CRISPR gene editing technique. They found 57 RNA-binding proteins that, when inhibited, kill cancer cells with the known hyperactive cancer-driver. The advantage of the synthetic lethal approach is that normal cells, which don't produce that cancer-driving molecule, should be left untouched by the treatment. Of these 57 RNA-binding proteins, YTHDF2 appeared most promising...

The researchers [got a] detailed look at how the various cells that make up a breast tumor behave without YTHDF2. The approach revealed that YTHDF2-deficient cancer cells die by stress-induced apoptosis, a carefully controlled mechanism cells use to destroy themselves. Apoptosis is supposed to shut down malfunctioning cells so tumors don't arise, but it doesn't always work. By removing YTHDF2, they managed to re-activate this cell death signal.

To test how safe it might be to treat cancer by inhibiting YTHDF2, the researchers engineered mice that lack YTHDF2 in every cell of the adult body, not just transplanted breast cancer cells. The mice appeared completely normal -- not only did they not have tumors, there were no changes in body weight or behavior.

https://www.news-medical.net/news/20210702/RNA-binding-proteins-represent-a-new-class-of-drug-targets-for-triple-negative-breast-cancer.aspx


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Jul 4, 2021 12:49PM HomeMom wrote:

ddebbew - I saw where RNA may help with cancer, I didn't see which kind. That's great news, now if it only helped ALL cancers

Dx 3/31/2014, IDC, 2cm, Stage IIB, Grade 1, 3/29 nodes, ER+/PR+, HER2- Surgery 4/14/2014 Lumpectomy: Left Surgery 5/5/2014 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left; Reconstruction (left): Tissue expander placement Chemotherapy 5/29/2014 AC Chemotherapy 7/24/2014 Taxol (paclitaxel) Radiation Therapy 10/15/2014 Hormonal Therapy 12/14/2014 Arimidex (anastrozole)
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Jul 4, 2021 04:15PM - edited Jul 7, 2021 04:11AM by debbew

HomeMom,

I had the wrong link for the last article I posted. I've fixed it now. The testing was done on TN BC using human cells and mouse models. The study identified an RNA-binding protein which was needed for the cancer cells to survive but not needed by normal cells. The next step would be to target this protein with a drug.

ETA: Here's a more detailed article that came out today: https://www.genengnews.com/news/rna-binding-protei...


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Jul 6, 2021 01:37PM - edited Jul 8, 2021 08:32PM by LillyIsHere

I found this article very interesting:

Seed and Soil: Tracing the Journey of Spreading Cancer Cells

https://www.mskcc.org/msk-news/summer-2021/seed-and-soil-tracing-journey-spreading-cancer-cells?utm_source=Twitter&utm_medium=Organic&utm_campaign=070621MSKNewsTracingMetastasis&utm_content=Expertise

“Within five years, cancer will have been removed from the list of fatal maladies.” That was the optimistic promise to U.S. President William Howard Taft in 1910 when he visited Buffalo’s Gratwick Laboratory, “What’s taking so long?” Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 11/29/2019 Femara (letrozole)
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Jul 6, 2021 02:28PM KarPC wrote:

Oral paclitaxel may still be a future option despite being denied FDA approval a few months ago. "The FDA was supportive and encouraged the Company to continue development of oral paclitaxel and encequidar for the treatment of metastatic breast cancer. The FDA also agreed that a well-designed and well-conducted trial may adequately address the deficiencies raised in the CRL." https://www.obroncology.com/news/athenex-provides-update-from-fda-type-a-meeting-regarding-oral-paclitaxel?ap=334&vhid=

Interesting article LIllyishere

​May 2021 lung nodule flipped from ER+ to triple negative. Liver tumor may still be ER+ Dx 4/2016, IDC, Both breasts, 2cm, Stage IIA, Grade 3, 0/14 nodes, ER+/PR-, HER2- Surgery 5/17/2016 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Chemotherapy 6/9/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 9/30/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 2/1/2018, IDC, <1cm, Stage IV, metastasized to liver/lungs, Grade 3, ER+/PR-, HER2- Radiation Therapy 2/1/2018 External: Liver Targeted Therapy 2/15/2018 Ibrance (palbociclib) Hormonal Therapy 2/17/2018 Faslodex (fulvestrant), Femara (letrozole), Zoladex (goserelin) Chemotherapy 2/18/2020 Xeloda (capecitabine) Targeted Therapy 10/14/2020 Afinitor (everolimus) Targeted Therapy 6/1/2021 Piqray (alpelisib)
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Jul 8, 2021 07:06PM - edited Jul 8, 2021 08:03PM by santabarbarian

this sounds interesting - early trials

https://www.umassmed.edu/cancer-center/about/blog/blog-posts/2021/06/umass-selected-as-clinical-trial-site-for-new-experimental-cancer-drug/

pCR after neoadjuvant chemo w/ integrative practices; Proton rads. Dx 7/13/2018, IDC, Left, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (FISH) Chemotherapy 8/13/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 12/27/2018 Lumpectomy: Left Radiation Therapy 2/11/2019 Whole-breast: Breast, Lymph nodes
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Jul 9, 2021 02:35PM Lumpie wrote:

COVID Vaccine Protects Cancer Patients -- Second Dose Key — Study reinforces need to prioritize these patients for vaccination, authors say

MedPage Today July 8, 2021

The Pfizer-BioNTech mRNA COVID-19 vaccine achieved satisfactory levels of seropositivity in patients undergoing treatment for cancer, although protection occurred later compared with a healthy population, Israeli researchers found.

Just 29% of cancer patients were seropositive after the first dose of vaccine compared with 84% of controls, with median titer scores of 42.3 and 72.0, respectively. However, the seropositivity rate climbed to 86% among cancer patients after the second dose...

"Although the immunogenicity pattern was gradual and slower than in the noncancer population, after the second dose most patients were seropositive and no documented cases of COVID-19 infection were determined," they wrote in JAMA Oncology. "Our study lends credence to the widely adopted recommendation to prioritize patients with cancer for SARS-CoV-2 vaccination."

The objective of this study was to evaluate the serologic status and safety of the Pfizer-BioNTech vaccine in patients with solid tumors who were receiving active cancer treatments.

Types of treatment included chemotherapy (58%), biologic agents (35%), and immunotherapy (36%), with some patients receiving more than one type of treatment.

... patients with breast cancer comprised 29% of the seronegative group, and 74% of these patients were treated with chemotherapy, with treatments being diverse. "Hence, we cannot assume that a specific class of drugs may hamper immunogenicity but rather that lympho-suppressive agents may induce a lack of effective seroconversion,"

Any intention to forego a second vaccine dose in some jurisdictions because of a shortage of vaccines "warrants reevaluation of unique populations, such as patients with cancer, in view of lagging immunogenicity,"

Primary Source: JAMA Oncology

Source Reference: Ben-Aharon I, et al "Serologic status and toxic effects of the SARS-CoV-2 BNT162b2 vaccine in patients undergoing treatment for cancer" JAMA Oncol 2021; DOI: 10.1001/jamaoncol.2021.2675.

Reporting: https://www.medpagetoday.com/infectiousdisease/cov...

{Access to reporting should be free but may require registration. I was also able to access the full article without charge.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Surgery Lumpectomy: Right Surgery Lumpectomy: Right Radiation Therapy Whole-breast: Breast
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Jul 9, 2021 02:42PM Lumpie wrote:

First-Line Pertuzumab Plus Trastuzumab Plus a Taxane for HER2-Positive Locally Recurrent or Metastatic Breast Cancer
Annals of Oncology
  • In this multicenter, single-arm study, the authors evaluated the safety and efficacy of investigator-selected taxanes in combination with pertuzumab and trastuzumab for the management of HER2-positive, locally recurrent or metastatic breast cancer as first-line therapy. There was no difference in overall survival among taxanes, but patients treated with paclitaxel had fewer side effects compared with those treated with docetaxel or nab-paclitaxel. HR-positive disease was associated with improved outcomes; the presence of visceral disease was associated with poor outcomes.
  • These results are consistent with the findings of the CLEOPATRA trial but expand the taxanes that can be effectively combined with trastuzumab and pertuzumab in HER2-positive breast cancer. Treatment with paclitaxel may result in less toxicity.
  • CONCLUSIONS: Mature results from PERUSE show a safety and efficacy profile consistent with results from CLEOPATRA and median OS exceeding 5 years. Results suggest that paclitaxel is a valid alternative to docetaxel as backbone chemotherapy. Exploratory analyses suggest risk factors that could guide future trial design.
Source:

Open Access Published: July 01, 2021 DOI:https://doi.org/10.1016/j.annonc.2021.06.024

Reporting at: https://www.practiceupdate.com/c/120482/67/13/?els...

{Access w/o charge.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Surgery Lumpectomy: Right Surgery Lumpectomy: Right Radiation Therapy Whole-breast: Breast
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Jul 19, 2021 02:27PM AlabamaDee wrote:

great article about oligometastes and local treatment

https://ascopubs.org/doi/full/10.1200/JCO.21.00445

Oligometastases (<=5 lesions in one location) is getting more attention and guidelines.

The treatment of patients with oligometastatic disease is and must remain individualized and based on multidisciplinary decisions.

size could become part of the definition: metastatic lesions should be considered oligometastatic (ie, potentially eligible for local treatment) only when the size of the smallest lesion has reached a certain threshold, which could be proposed around 8-10 mm in diameter

Dee

Primary neuroendocrine breast cancer, on SERD trial ARV-471, failed Pfizer’s CDK 2/4/6 trial after 8 weeks Dx 5/23/2013, Right, 1cm, Stage IIB, Grade 2, 1/22 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 7/29/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 4/2019, Stage IV, metastasized to liver, ER+/PR+, HER2- Targeted Therapy 10/7/2020 Radiation Therapy External Chemotherapy Doxil (doxorubicin) Targeted Therapy Afinitor (everolimus) Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Arimidex (anastrozole), Aromasin (exemestane), Fareston (toremifene), Femara (letrozole) Hormonal Therapy Faslodex (fulvestrant) Targeted Therapy Verzenio Chemotherapy Xeloda (capecitabine)
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Jul 19, 2021 06:00PM Olma61 wrote:

Yes, this is good news, the more they consider making this standard treatment or at least, justifiable, the better.

I am disappointed that they ruled out oligoprogressive disease rather strongly - because I wasn’t oligo at diagnosis but I was oligoprogressive/persistent with one lesion under 10mm and did have local treatment which put me back to NED. And two years later I’m still NED.

Hopefully more research can justify local treatment for small instances of progression

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+ (IHC) Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/30/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/30/2019 External: Bone
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Jul 20, 2021 12:16AM BSandra wrote:

Guys, from what I read and see around, de novo multiple involvement/progression in one organ might also be seen as oligo-disease, as usually these tumors, although abundant, are of a very uniform genomic setting and systemic treatments, if they work, they work for all tumors. So, this has nothing to do with local treatments, but with definitions of what oligo might be in the future. Maybe they will come up with another term too. Saulius

Since May'21:NED. Mar'21:axilla LN surgery. Sep'19-Mar'21:NED. Feb'19:recurrence, left breast,IBC. May'18-Feb'19:NED. Jun'18:DC/CIK. Aug'17:stage IV de novo at age 33. Dx 8/4/2017, IDC, Left, 6cm+, Stage IV, metastasized to liver, Grade 2, ER-/PR-, HER2+ (IHC) Chemotherapy 8/27/2017 Taxotere (docetaxel) Targeted Therapy 8/28/2017 Herceptin (trastuzumab) Targeted Therapy 8/28/2017 Perjeta (pertuzumab) Chemotherapy 3/12/2019 Taxotere (docetaxel) Surgery 7/22/2019 Mastectomy: Left Radiation Therapy 9/9/2019 Whole-breast: Lymph nodes, Chest wall Surgery 4/15/2021 Lymph node removal: Underarm/Axillary
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Jul 20, 2021 06:51AM - edited Jul 20, 2021 06:51AM by cowgal

So, do I understand this correctly that they are defining oligometastic by diameter of lesion rather than length?

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Jul 20, 2021 07:15AM - edited Jul 20, 2021 07:17AM by AlabamaDee

cowgal- If I understand the article, they are looking at the age of the tumors as represented by the tumor growth/size. The thought is if the smallest tumor is less than 8mm diameter it is not mature and there could be others lurking close by. If the smallest tumor is greater than 8mm then there is more confidence of oligometastes due to the tumor cell doubling time. Which would potentially qualify you for the local treatments. It's a bit confusing but still progress in some ways.

Olma was not in that parameter but responded. I was in that category but was refused surgery at MDACC -they insisted on a systemic working first. Can’t look back though

BSandra-good point.

Dee

Primary neuroendocrine breast cancer, on SERD trial ARV-471, failed Pfizer’s CDK 2/4/6 trial after 8 weeks Dx 5/23/2013, Right, 1cm, Stage IIB, Grade 2, 1/22 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 7/29/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 4/2019, Stage IV, metastasized to liver, ER+/PR+, HER2- Targeted Therapy 10/7/2020 Radiation Therapy External Chemotherapy Doxil (doxorubicin) Targeted Therapy Afinitor (everolimus) Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Arimidex (anastrozole), Aromasin (exemestane), Fareston (toremifene), Femara (letrozole) Hormonal Therapy Faslodex (fulvestrant) Targeted Therapy Verzenio Chemotherapy Xeloda (capecitabine)
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Jul 20, 2021 09:07AM moth wrote:

cowgal, my understanding of lesion measurement from pathology peeps is that it is the longest cross section measurement. That's how they always report right now & that oligo editorial seemed to say the same thing. It's diameter in a round lesion but since most things are not perfectly round, it's longest x section...

It's an interesting article. It is an editorial, so it's an opinion, a guidance from some experts. I imagine others will disagree with definition parameters etc. and with the recommendations as a whole.

I think the idea of waiting until a lesion is a certain size to see if others crop up or whether it truly is oligo is interesting. I also noted down the tumor doubling times - they seemed higher than I've seen in past articles but I might have just jumbled up the numbers in my head.

There was also an interesting comment about thoracotomy finding more small lesions than thoracoscopy but that although the studies on superiority of one procedure over the other hadn't given OS results yet, they thought the removal of the small ones would not be beneficial.

I can see it's a big dilemma for oncologists and oncology surgeons now. If presented with a de novo pt, how aggressively do we cut?

I think we're missing a piece of the puzzle about overall tumor burden and overall inflammation... if reducing tumor burden drastically reduces inflammation then perhaps the next mets are more controlled (both by systemic treatments and by the pts own immune system) which should yield a longer OS.

& I did not like at all the dismissal of oligoprogression for a surgical approach. Booo, raspberries at the authors.


I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/3/2021 External: Bone
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Jul 20, 2021 11:38PM - edited Jul 20, 2021 11:44PM by BSandra

Moth, Dee, these articles never really explain how they define that something is oligo. What they want to say probably is that oligo-lesion is sort of in-situ metastatic tumor. But if it is not in-situ, then it is invasive, and even several mm can contribute to further spread (as also noted in the article), so I do not get the idea of "waiting". You notice a lesion that is 2 mm, and then wait until it is 8 mm, and then suddenly other 2 mm satellite lesions occur nearby because of that 8 mm lesion, and then you are like "you were curable 2 months ago but now, ups, you are incurable, sorry". Would it not be smarter to start asap with treatment of 2 mm lesion and then see if others pop-up? This way most more patients would be cured: those who are "oligo", and those who aren't "oligo" but whose tumor did not spread into surrounding environment. I never liked the "oligo" hypothesis. Too many flaws and no real criterion to define it. One of the flaws again is the denial of "oligo-progression". What if someone has achieved pCR in distant organs, and not in initial tumor (a few undetected cells left), and then initial tumor once again metastasizes with only few lesions in the beginning and they are detected? Saulius

Since May'21:NED. Mar'21:axilla LN surgery. Sep'19-Mar'21:NED. Feb'19:recurrence, left breast,IBC. May'18-Feb'19:NED. Jun'18:DC/CIK. Aug'17:stage IV de novo at age 33. Dx 8/4/2017, IDC, Left, 6cm+, Stage IV, metastasized to liver, Grade 2, ER-/PR-, HER2+ (IHC) Chemotherapy 8/27/2017 Taxotere (docetaxel) Targeted Therapy 8/28/2017 Herceptin (trastuzumab) Targeted Therapy 8/28/2017 Perjeta (pertuzumab) Chemotherapy 3/12/2019 Taxotere (docetaxel) Surgery 7/22/2019 Mastectomy: Left Radiation Therapy 9/9/2019 Whole-breast: Lymph nodes, Chest wall Surgery 4/15/2021 Lymph node removal: Underarm/Axillary
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Jul 21, 2021 05:27AM AlabamaDee wrote:

Sailuis- I agree. The article doesn’t make clear on definitions or parameters for treatment, but does attempt to put oligo in the spot light. I like our discussion and it makes me wonder how the professionals are viewing this article.

BTW-I had oligo progression and had SBRT to a lung met that lit up on my PET while the liver was quiet. No more progression in the lung now.

Dee

Primary neuroendocrine breast cancer, on SERD trial ARV-471, failed Pfizer’s CDK 2/4/6 trial after 8 weeks Dx 5/23/2013, Right, 1cm, Stage IIB, Grade 2, 1/22 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 7/29/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 4/2019, Stage IV, metastasized to liver, ER+/PR+, HER2- Targeted Therapy 10/7/2020 Radiation Therapy External Chemotherapy Doxil (doxorubicin) Targeted Therapy Afinitor (everolimus) Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Arimidex (anastrozole), Aromasin (exemestane), Fareston (toremifene), Femara (letrozole) Hormonal Therapy Faslodex (fulvestrant) Targeted Therapy Verzenio Chemotherapy Xeloda (capecitabine)
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Jul 21, 2021 06:46AM - edited Jul 21, 2021 06:56AM by BSandra

You see, Dee, you are a real example. Now take the scenario if your lung nodule would have not been treated (I am pretty sure your lungs would have progressed more as that lesion came up being under treatment)... but it was treated and today we see that decision was absolutely correct, although according to oligo-hypothesis you did not fall into "oligo" a category and would have not qualified for local treatments. From what I read, whether lesions are 5, or 25, if the drug/local treatment works, they can be obliterated, so "oligo" (meaning "few") does not make sense, as well as waiting - not only primary tumor causes metastases but also metastatic tumors spread further, so why wait? Stage 3C (let's say it is some stage 3.5:) is curable in practice with multiple lymph node metastases and has survival rate of ~40% at 15 years, so maybe some stage 4 are also more like 3.8, and also are curable, therefore you cannot give up on any patient and curative strategies have to be in mind as much as possible. There might be a huge difference between, let's say, these two cases: case 1 - T4N3M1 with 3 genetically nonuniform metastatic lesions >1 cm in the liver, and case2 - T4N3M1 with 20 genetically uniform (for example, de novo) metastatic lesions <1 cm in the liver. Oligo theory says that case1 has more chances for a cure than case2, but actually there's no real evidence for that, as we do not know genomic arrangement of every lesion or micromet. Just remember - we usually biopsy 1 or 2, and then give treatments, and they don't work. Why? Most probably because disease is nonuniform, and remaining 3 mets have different genomic arrangement. Local treatments "do not care" of non-uniformity, and that is why they are amazing. Our immunologist said surgery lives its golden age - he said, if I recall correctly, Norwegians cyberknifed 120 metastases in one person's lung, and the person is alive and doing ok, so actually local treatment possibilities have a big future and some 20 lesions with image recognition and AI a few years ahead might be an "easy" surgery.

I also love these discussions but I think professionals would be reluctant to discuss such things - they are too afraid to be viewed as unprofessional!:) Saulius

Since May'21:NED. Mar'21:axilla LN surgery. Sep'19-Mar'21:NED. Feb'19:recurrence, left breast,IBC. May'18-Feb'19:NED. Jun'18:DC/CIK. Aug'17:stage IV de novo at age 33. Dx 8/4/2017, IDC, Left, 6cm+, Stage IV, metastasized to liver, Grade 2, ER-/PR-, HER2+ (IHC) Chemotherapy 8/27/2017 Taxotere (docetaxel) Targeted Therapy 8/28/2017 Herceptin (trastuzumab) Targeted Therapy 8/28/2017 Perjeta (pertuzumab) Chemotherapy 3/12/2019 Taxotere (docetaxel) Surgery 7/22/2019 Mastectomy: Left Radiation Therapy 9/9/2019 Whole-breast: Lymph nodes, Chest wall Surgery 4/15/2021 Lymph node removal: Underarm/Axillary
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Jul 21, 2021 09:29AM AlabamaDee wrote:

Saulius- you have great thought provoking points! Cyberknife(SBRT) to 120 lesions😳. They must have been tiny.

My oligo story started with 2 liver tumors both 2mm and under so I qualified for liver surgery but they would have to take the whole right lobe. My local clinic was ready to proceed but I wanted a second opinion at MDACC. They said no due to potential micrometastisis. After 4 failed systemic treatments the 2 tumors turned in to 3 in both lobes with suspect tiny lesions. They would not do SBRT to my liver at MDACC because at the time lesions (4.5cm 3cm 2.5cm) would require too much radiation. but I did get the y90 to those. Unfortunately more tumors grew in the liver but Y90 bought me time to find a systemic that would work.

my local RO only allowed a few lung lesions that are less than 3cm because of the amount of radiation involved. My lung lesion was almost 2cm. Glad it’s dead.

My current 2 larger liver lesions are heterogeneous and the larger one could use Y-90 or some other ablation to whack-a-mole it down, reduce tumor burden etc. but I am on a trial and they said no. I am going to push for it again if that tumor is wobbling in size while the other one is shrinking. Scan & plan Aug 9.

So you can see why oligo articles interest me 😉

Dee

Primary neuroendocrine breast cancer, on SERD trial ARV-471, failed Pfizer’s CDK 2/4/6 trial after 8 weeks Dx 5/23/2013, Right, 1cm, Stage IIB, Grade 2, 1/22 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 7/29/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Dx 4/2019, Stage IV, metastasized to liver, ER+/PR+, HER2- Targeted Therapy 10/7/2020 Radiation Therapy External Chemotherapy Doxil (doxorubicin) Targeted Therapy Afinitor (everolimus) Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Arimidex (anastrozole), Aromasin (exemestane), Fareston (toremifene), Femara (letrozole) Hormonal Therapy Faslodex (fulvestrant) Targeted Therapy Verzenio Chemotherapy Xeloda (capecitabine)
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Jul 21, 2021 11:57AM Olma61 wrote:

Great analysis, guys! Interesting discussion

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+ (IHC) Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/30/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/30/2019 External: Bone
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Jul 21, 2021 02:34PM Lumpie wrote:

Moving Away From the Maximum Tolerated Dose

The FDA recently expressed a new commitment to testing cancer drugs at lower doses, rather than defaulting to the highest dose most people can tolerate.

CANCER DRUGS ARE ROUTINELY tested and approved for use at the maximum tolerated dose (MTD), which is defined as the highest dose most people can take without experiencing unacceptable side effects. But the MTD may not be the right dose for every cancer patient, especially if side effects and toxicity associated with cancer treatment can cause a person to stop taking the drug altogether.

To minimize the negative side effects of cancer treatment, Winer and colleagues published guidance for conducting dose de-escalation studies in the Dec. 1, 2020, Journal of Clinical Oncology. The roadmap is intended to describe how to better design and implement clinical trials to study lower drug dosages—without compromising the clinical benefit to the patient.

https://www.cancertodaymag.org/Pages/cancer-talk/M...

{No charge, and I was not required to log in, to read coverage article.}

Article contains a number of links to additional articles/coverage of the topic.

There was a report on the MBC Patient Survey at the American Society of Clinical Oncology's (ASCO's) annual worldwide meeting. You can read about it here in Medicine Matters / Oncology.

The PCDI will be talking about the results of both the Patient and Oncologists Surveys at a complimentary SHARE Cancer Support presentation on June 28, 2021 at 3PM ET, so if you're interested, please register. {No charge.}

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride." Dx 2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Chemotherapy 1/14/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 1/14/2016 Herceptin (trastuzumab) Dx 2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+ Surgery Lumpectomy: Right Surgery Lumpectomy: Right Radiation Therapy Whole-breast: Breast
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Jul 22, 2021 12:14AM BSandra wrote:

Dear Dee, wow, I cannot believe MDACC said no to surgery. Potential micromets, I understand, but still... crazy... Saulius

Since May'21:NED. Mar'21:axilla LN surgery. Sep'19-Mar'21:NED. Feb'19:recurrence, left breast,IBC. May'18-Feb'19:NED. Jun'18:DC/CIK. Aug'17:stage IV de novo at age 33. Dx 8/4/2017, IDC, Left, 6cm+, Stage IV, metastasized to liver, Grade 2, ER-/PR-, HER2+ (IHC) Chemotherapy 8/27/2017 Taxotere (docetaxel) Targeted Therapy 8/28/2017 Herceptin (trastuzumab) Targeted Therapy 8/28/2017 Perjeta (pertuzumab) Chemotherapy 3/12/2019 Taxotere (docetaxel) Surgery 7/22/2019 Mastectomy: Left Radiation Therapy 9/9/2019 Whole-breast: Lymph nodes, Chest wall Surgery 4/15/2021 Lymph node removal: Underarm/Axillary
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Jul 22, 2021 06:45AM cp418 wrote:

https://news.illinois.edu/view/6367/339688859

New approach eradicates breast cancer in mice Researchers discovered a small molecule, ErSO, that eradicates breast cancers in mice by targeting a pathway that protects cancer cells.
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Jul 22, 2021 07:05AM GoKale4320 wrote:

CP418 - Wow, great article! I would love to sign up for a clinical trial.


Dx: January 2017, IDC, Stage IIa, 1/23 nodes, <1cm Chemo 2/16/17 Cytoxan Taxotere x4 Radiation 6/8/2017, natural alternative to tamoxifen 3/2021 Stage 4 - mets to bones. Ibrance and Letrozole and Xgeva Dx 1/2017, IDC, Right, <1cm, Stage IIA, Grade 2, 1/23 nodes, ER+/PR+, HER2-
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Jul 23, 2021 07:00AM GoKale4320 wrote:

https://www.biospace.com/article/releases/bayer-an...

I did a quick online search for more information about the ErSO therapy that CP418 posted about, and I found the article (link above). The research team and Bayer Company have agreed to work together on this.



Dx: January 2017, IDC, Stage IIa, 1/23 nodes, <1cm Chemo 2/16/17 Cytoxan Taxotere x4 Radiation 6/8/2017, natural alternative to tamoxifen 3/2021 Stage 4 - mets to bones. Ibrance and Letrozole and Xgeva Dx 1/2017, IDC, Right, <1cm, Stage IIA, Grade 2, 1/23 nodes, ER+/PR+, HER2-

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