New Trends in Pre-Surgery Treatments for Breast Cancer


Non-metastatic breast cancers are most often treated with surgery, but if the tumors are fairly large, or involve nearby lymph nodes, neoadjuvant (pre-operative) treatments with chemotherapy (NAC) are done first. NAC often reduces the tumor size and kills cancer cells in lymph nodes, if present, prior to surgery, improving the outcome. The best possible result of neoadjuvant treatment is pCR (pathologic compete response), when the tumor is no longer visible in imaging studies. Here, I review the new directions in which neoadjuvant treatments are evolving.

Today, treatments for metastatic breast cancers are tailored for specific subtypes. Starting with the introduction of the drug trastuzumab (Herceptin) for HER2-positive cancers, new, more specific treatment options were eventually developed and approved for other types as well. Estrogen deprivation endocrine therapies, lately prescribed in combination with CDK4/6 inhibitors, are used in estrogen receptor (ER)-positive cancers. Triple negative cancers (TNBC) are still treated mostly with chemotherapy, but immune checkpoint drugs and PARP inhibitors are explored in clinical trials, with some successes reported.

However, neoadjuvant treatments (except for HER2+ cancers) remain largely limited to chemotherapy regimens. This is starting to change now, with new approaches tailored to the cancer type being investigated in clinical trials.

In this regard, it is important to mention the I-SPY2 trial, NCT01042379, which started in 2010 and is for women with stage II-III breast cancer. It offers about a dozen drugs that are chosen based on particular features of the newly diagnosed cancers. This trial has a unique design and has produced some important results. Additional treatments and trials for various types of breast cancer are discussed below. Continue reading…


ASCO 2017: Breast Cancer Treatment News


Last month, the annual American Society of Clinical Oncology (ASCO) meeting took place in Chicago. Thousands of oncologists, patients, and journalists gathered to learn about the most recent developments in cancer research and treatment. Here are some breast cancer highlights from the meeting:

Triple negative breast cancer (TNBC) is considered more responsive to treatment with immune checkpoint drugs than any other type of breast cancer. So far, these drugs have primarily been explored in metastatic TNBC, in combination with chemotherapy. The combination of “anti-PD-L1” and “anti-PD-1” immune checkpoint drugs with chemotherapy has now been examined in early-stage TNBC, in which a breast tumor can be surgically removed after neoadjuvant chemotherapy. Continue reading…


Testing for Tumor Mutations: Liquid Biopsy Versus Traditional Biopsy


Liquid biopsies, virtually unknown even a year or two ago, are becoming common tools in precision diagnostics for cancer. Here, I will try to explain some of the more important differences between liquid and “traditional” tumor biopsies.

Biopsies of solid tumors (e.g., lung, breast, or brain tumors) involve surgically removing a small part of a tumor and sending it to pathology lab. In the last few years, doctors have also started to send some tumor samples to special service labs that analyze tumor DNA for the presence of cancer-related mutations.

By definition, regular biopsies can be intrusive and are sometimes associated with side effects, such as bleeding or infection. However, they provide some really essential information; i.e., the histology and grade of the tumor and other tumor characteristics necessary to determine the best choice of treatment. For lung cancer, for example, a biopsy determines the type of tumor—adenocarcinoma, squamous cancer, small-cell lung cancer, or another, less common type. For breast cancer, a routine test will determine if the tumor expresses estrogen, progesterone receptors, and a protein called HER2. These tests are critically important in guiding treatment choices. If mutational analysis of cancer-related genes is also performed (which doesn’t always happen, unfortunately), it may guide treatment with targeted drugs. Continue reading…


Super Patient: Terry Arnold Starts an All-Volunteer Charity to Improve Treatment for Inflammatory Breast Cancer


Terry Arnold has always identified as an advocate. “It’s my way,” she says. When she was younger, she helped establish the first rape crisis program in Fort Bend County, Texas. She is also a founding member of a center that works on missing children’s cases, often partnering with FBI task forces.

“I always joke that I was doing it all with a baby on my hip,” says Terry, who raised five children with her husband.

So it is no surprise that being diagnosed with inflammatory breast cancer (IBC), a rare and deadly disease, propelled Terry into her next chapter of advocacy work. “I was actually misdiagnosed for four months,” Terry says. “I was very fortunate to be alive at all.”

Her treatment regimen, which lasted from 2007 to 2008, was brutal but ultimately successful. Soon, her phone rang frequently with calls from other women with IBC who wanted her advice. Meanwhile, she became increasingly aware of the lack of adequate IBC education for both doctors and patients, as well as the lack of funding for IBC research.

“I hadn’t been that long out of treatment when I had gone to four funerals in six weeks, and not one of the girls was over 40, all with IBC,” Terry says. “I couldn’t take it. I reached out to organizations, but nobody wanted to talk about IBC. They’d say, ‘It’s too rare, they all die, there’s no early detection, what do you want us to do?’ ” Continue reading…


In Metastatic Breast Cancer Treatment, Not All CDK Inhibitors Are Equal


Doctors prescribe drugs known as CDK inhibitors to treat some women with estrogen-receptor-positive (ER+) metastatic breast cancer. Research into these drugs is ongoing, and new, promising CDK inhibitor options are on the horizon. Here, I address the current outlook for CDK inhibitors in ER+ breast cancer.

First, some background: ER+ breast cancers comprise about 70% of all breast cancers. The name reflects the fact that cells of these cancers express estrogen receptors (ERs), which are protein features targeted by many treatment strategies for this cancer type. The estrogen receptor (ER) protein is a treatment target not only because “it is there,” but mainly because it drives tumor cell proliferation in ER+ breast cancer. The activity of the ER depends on its binding to the hormone estrogen, and treatments known as endocrine drugs aim to prevent this interaction. Some endocrine drugs inhibit the synthesis of estrogen in the body (e.g., aromatase inhibitors, such as letrozole and anastrozole), and others prevent the interaction of estrogen with ERs (e.g., ER modulators such as tamoxifen, or the pure anti-estrogen drug fulvestrant). The problem of course is that, in metastatic breast cancer, resistance develops to each and every endocrine drug used. Continue reading…


Super Patient: Honesty and Openness Help Lori Through the Holidays


When it comes to the holiday season, Lori Wallace, a mother of two sons, is accustomed to being in charge. “I’m the mom, I’m kind of the epicenter of my family,” she says. “So I make Christmas.”

But in early April of 2011, Lori woke up with pain in her breast from what she thought was a small toy left in her bed by her five-year-old. No toy was there, and the pain persisted. She soon had her diagnosis: stage IIA invasive ductal carcinoma. Continue reading…


Super Patient: Jessica Leip Makes an Impact on Metastatic Breast Cancer Research

Jessica Leip was diagnosed with metastatic breast cancer in 2013. Since then, she has become very active with the Metastatic Breast Cancer Project, an organization that collects samples and data from patients in order to accelerate research. We asked Jessica about her own cancer experiences and her involvement with the MBCProject: Continue reading…


Super ASK Patient: Strategically Selecting a Clinical Trial to Treat Triple-Negative Breast Cancer

Update:  We are deeply saddened to report that Angela passed away on June 26, 2017. It is a privilege to continue to share her story and help keep her memory alive.

Angela was diagnosed with de novo stage IV triple-negative breast cancer in September 2015. Before her diagnosis, she worked as a director of research and evaluation at a national organization that supports young inventors and entrepreneurs and advances technology commercialization. She lives with her husband, son, and daughter in western Massachusetts. We asked her how she navigated enrolling in her first clinical trial, which began in May 2016. Continue reading…


New Research on Triple Negative Breast Cancer Emerges at ASCO 2016


The American Society of Clinical Oncology (ASCO) meeting of 2016 is behind us, but oncologists, patients, and journalists are still analyzing the most interesting presentations made there. Below, we describe some of the more prominent results in triple negative breast cancer (TNBC), both promising and disappointing.

Continue reading…