Trial Explores Eliminating Breast Cancer Surgery in Exceptional Responders to Neoadjuvant Therapy

Excerpt:

“A prospective study is investigating whether breast cancer surgery can be eliminated in patients who respond well to neoadjuvant systemic therapy.

“The phase II single-center trial, conducted out of The University of Texas MD Anderson Cancer Center (NCT02945579), aims to determine how often breast cancer recurs in patients who previously received chemotherapy and follow-up radiation therapy, but not surgery, and have no evidence of disease. Forty patients with early-stage, triple-negative or HER2-positive breast cancer care underwent image-guided biopsy after completing chemotherapy and before beginning radiation therapy to see if surgery is necessary.”

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'Exceptional Responders' to Cancer Drugs Draw Scrutiny from Scientists

“Grace Silva and Karen Coakley are both 59, mothers living in the Boston suburbs and patients at Dana-Farber Cancer Institute, where they have spent years wrestling with daunting diagnoses.

“While they have never met, the two women are connected in a way that goes beyond their similar stories and their struggles with cancer. They share an intimate and uncommon link, the sort of genetic bond possible only in an age of precision medicine.

“Silva is what researchers call an ‘exceptional responder,’ the rare patient who has a surprising, dramatic response to a drug. Coakley is the unsuspecting beneficiary of what scientists are now learning from these unique patients.”


Finding Clues in Genes of ‘Exceptional Responders’

“Grace Silva has a horrible form of thyroid cancer that is considered untreatable — usually, patients are sent to a hospice and die within months of learning they have the disease. But she is still alive four years after her diagnosis. She is what cancer doctors call an exceptional responder: someone who defies all expectations by responding dramatically to a drug tried not with a real rationale but more out of a doctor’s desperate urge to do something.

“The annals of medicine are full of stories of exceptional responders, but until recently, they were just that: stories. Case histories that could not be generalized because there was no way to know why these patients got better when others did not.

“But now, with the advent of rapid and inexpensive gene sequencing, theNational Cancer Institute has started a nationwide search for people like Mrs. Silva to try to figure out the genetic changes that allowed them to respond. And The New England Journal of Medicine published her story on Wednesday as a case history in the new genetic era. It concludes with a lesson that may help doctors treat thousands of patients with more common cancers, like breast and bladder cancer, and even find an alternative when a drug stops working.”


Six Fast Facts About Exceptional Responders

“They are, unfortunately, a rarity — the so-called “exceptional responders” who are particularly sensitive to certain cancer treatments when most others fail to respond at all. According to the National Cancer Institute, an “exceptional responder” is a patient who has a complete or partial response that lasts at least 6 months post-treatment, in a clinical trial in which fewer than 10% of patients responded.

“Because they are exceptional, and because they do exceptionally well, oncologists are eager to better understand these patients. And while genomic sequencing appears to be yielding some answers, the implementation of this approach is not yet cost-effective.”

Editor’s note: If oncologists can learn why certain patients respond exceptionally well to cancer treatment, they may get insight into how to treat other patients.


Six Fast Facts About Exceptional Responders

“They are, unfortunately, a rarity — the so-called “exceptional responders” who are particularly sensitive to certain cancer treatments when most others fail to respond at all. According to the National Cancer Institute, an “exceptional responder” is a patient who has a complete or partial response that lasts at least 6 months post-treatment, in a clinical trial in which fewer than 10% of patients responded.

“Because they are exceptional, and because they do exceptionally well, oncologists are eager to better understand these patients. And while genomic sequencing appears to be yielding some answers, the implementation of this approach is not yet cost-effective.”

Editor’s note: If oncologists can learn why certain patients respond exceptionally well to cancer treatment, they may get insight into how to treat other patients.


Six Fast Facts About Exceptional Responders

“They are, unfortunately, a rarity — the so-called “exceptional responders” who are particularly sensitive to certain cancer treatments when most others fail to respond at all. According to the National Cancer Institute, an “exceptional responder” is a patient who has a complete or partial response that lasts at least 6 months post-treatment, in a clinical trial in which fewer than 10% of patients responded.

“Because they are exceptional, and because they do exceptionally well, oncologists are eager to better understand these patients. And while genomic sequencing appears to be yielding some answers, the implementation of this approach is not yet cost-effective.”

Editor’s note: If oncologists can learn why certain patients respond exceptionally well to cancer treatment, they may get insight into how to treat other patients.


Study of ‘Super Responder’ Reveals Possible New Gene Target for Lung Cancer

“A potential new gene mutation that might drive lung cancer development and growth has been identified by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James).

“A multi-institutional team led by OSUCCC-James researchers reports the findings in the Journal of Clinical Investigation. The study describes a patient with advanced lung cancer who was treated with the targeted drug sorafenib while on a clinical trial. Within two months, she demonstrated a near complete response, and she remained progression-free and asymptomic for five years while continuing to take sorafenib by mouth.”


Researchers Intensify Efforts to Solve Mysteries of Exceptional Responders

“Exceptional responders — those patients with cancer who demonstrate sustained benefit from a therapy on which almost all others fail — have been observed in clinical trials for decades.

“ ‘This is the basis of the urban legend story that everyone has heard — someone was given 2 months to live, but was given a drug and had a miraculous recovery,’ William C. Hahn, MD, PhD, chief of the division of molecular cellular oncology at Dana-Farber Cancer Institute, told HemOnc Today.

“Because of recent strides in genomic sequencing, however, the phenomenon has evolved from a series of unexplained individual success stories into a collection of tremendously valuable case studies.”


Researchers Intensify Efforts to Solve Mysteries of Exceptional Responders

“Exceptional responders — those patients with cancer who demonstrate sustained benefit from a therapy on which almost all others fail — have been observed in clinical trials for decades.

“ ‘This is the basis of the urban legend story that everyone has heard — someone was given 2 months to live, but was given a drug and had a miraculous recovery,’ William C. Hahn, MD, PhD, chief of the division of molecular cellular oncology at Dana-Farber Cancer Institute, told HemOnc Today.

“Because of recent strides in genomic sequencing, however, the phenomenon has evolved from a series of unexplained individual success stories into a collection of tremendously valuable case studies.”