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High-Dose Radiation in Less Time
After a 12-year study, Canadian researchers have not discovered any difference between women who received hypofractionated radiation and those treated on a standard schedule. Hypofractionated radiation, which is common in the United Kingdom and Canada, uses larger doses of radiation on a shorter schedule, sparing women weeks of radiation treatments. After breast surgery, patients typically undergo radiation therapy five times a week for five to six weeks. With hypofractionated radiation, doses are higher, but treatment time is cut in half to three weeks. But many American doctors have hesitated to adopt it, concerned that the higher doses may have worse long-term results, especially on the heart.
But at least four randomized trials have not found major differences in either the effectiveness or side effects between the two approaches. The latest study, presented Thursday afternoon, found that results were practically identical, both in the risk of recurrence, breast appearance, and survival.
Risk of recurrence was about 6 percent in both groups, and survival was 84 percent. The study involved more than 1,000 women whose cancer had not moved into the lymph nodes. At the meeting, Tim Whelan, MD, of McMaster University said he believed it was “extremely unlikely” that differences would surface with even longer follow-up.—Laura Beil
Stem Cells in Breast Cancer
Drug resistance in breast cancer has traditionally been explained by acquired or inherent mutations in tumor cells. However, a growing body of research suggests an alternative hypothesis, that of a subpopulation of drug-resistant cancer "stem cells" which gives rise to and maintains the primary tumor and recurrences. Although controversial, this hypothesis is supported by significant preclinical research validating the existence of a self-renewing tumor cell subpopulation that can repopulate tumor growth from a small number of residual cancer cells. Specific treatment strategies that target these cancer stem cells may allow for more robust clinical outcomes than traditional drugs currently provide, and optimistically may result in a permanent cure.
In Thursday morning's mini-symposium on stem cells in breast cancer, Jenny Chang, MD, and Michael Lewis, PhD, co-moderated an overview of this fascinating and contested topic. Max Wicha, MD, discussed the latest scientific data supporting the existence of the "cancer stem cell" subpopulation, including the use of ALDH (aldehyde dehydrogenase, a known stem cell marker) as a method of identifying cancer stem cells, in addition to the previously reported markers CD-44 and CD-24.
Jeremy Rich, MD, provided a neuro-oncologist's perspective on potential treatment strategies targeting the purported cancer stem cell subpopulation, and recommended that mechanisms of resistance within this group of cells should be targeted, while being sensitive to the potential systemic toxicity inherent in antagonizing any stem cell population.
Finally, Peter Laird, MD, focused on the importance of epigenetics (the mechanisms regulating genetic function) to the understanding of breast cancer, and provided evidence that the transition from a non-cancerous to a cancerous state involves epigenetic modifications. —Zach Moore, PhD
New Website Aims to Help Patients with Brain Metastases
In conjunction with the symposium, a new website (www.brainmetsbc.org) has been launched for breast cancer patients with brain metastases. The site is a Center of Excellence project, meaning cancer centers and researchers across the country who are experts in all aspects of brain metastases collaborate.
The website has been in the works for about nine months, says Musa Mayer, a breast cancer survivor, author, and independent advocate involved with the project. "This is just the beginning, really," she says, noting that the need for a resource for patients with brain metastases, especially those who have HER-2 positive breast cancer, is growing.
That's because brain metastases used to be more of a late effect in breast cancer patients, but now, with the disease being controlled better elsewhere in the body, more and more women are found to have the cancer spread to the brain. Currently, 25 to 48 percent of women with metastatic HER2-positive breast cancer have brain metastases.
The website, which provides a host of resources and scientific and medical information, also aims to be a virtual support group, Mayer says. The site highlights the experiences of a variety of women living with brain metastases. "If metastatic recurrence is terrifying to women," Mayer says, "brain metastasis terrifies them most."
—Karen Patterson
HER2 Vaccine Shows Promise in Preliminary Testing
A vaccine designed to prompt the immune system to target a specific portion of the HER2 protein in breast cancer patients has shown some promise in preliminary research, scientists reported Thursday.
Steven Limentani, MD, of the Blumenthal Cancer Center in Charlotte, North Carolina, says that he and colleagues tested a molecule they had designed in patients with stage 4 metastatic breast cancer. A total of 38 patients received a series of vaccinations in the form of injections to the leg. Among those newly diagnosed patients receiving first-line treatment for metastases, one patient had a complete response and two patients saw their disease stabilize, Dr. Limentani reported.
In a second-line treatment group, four patients saw their disease stabilize. This phase II study, along with even more preliminary research testing the molecule as an adjuvant treatment (after surgery), suggested that it did not cause serious side effects in most patients. Dr. Limentani noted that the test vaccine evoked a more powerful and sustained response in the metastatic study than in the adjuvant one. "We believe that this observed clinical activity warrants further investigation," he concluded. —Karen Patterson
CURE and Heal would like to give a special thanks to the following non-profit partners
for making this information available to their constituents:
American Cancer Society • People Living with Cancer
HER2 Support • Inflammatory Breast Cancer Research Fund • Men Against Breast Cancer
National Breast Cancer Coalition • Pink-Link
