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2017-10-11 / News

New advances in breast cancer detection, treatment and recovery

BY DONNA GREGORY BURCH CONTRIBUTING WRITER

Every September for more than a decade, I’ve emailed my media contacts at the local medical centers and asked them to update me on what’s going on in the areas of breast cancer research and treatment.

I always wonder if this will be the year when they’ll finally come up empty-handed, but somehow, they never disappoint. There are always new clinical trials and treatments to give hope, and this year is no exception. Read on to find out what’s new in breast cancer locally.

3-D tattoos

The art of tattooing is helping to restore a sense of normalcy to women who have lost their nipples to breast cancer (see “In post-mastectomy tattoos, women find healing and beauty”). Three-dimensional tattooing is an option for women who are not candidates for nipple reconstruction.

“The three-dimensional tattoo involves tattooing the surface of the breast so that it appears as if a nipple projects off of the breast even though there is no nipple there, and then the areola is tattooed around it,” explained Dr. Santosh Kale, a plastic and reconstructive surgeon with VCU Health. “It’s sort of like a painting that’s designed to give you that three-dimensional appearance.”

Tattooing can also be used in women who have undergone nipple reconstruction.

“We can rearrange skin like origami to create the nipple,” Kale explained. “Then once that’s healed, we will come back and tattoo the nub to give the appearance of a nipple and the areola around it.”

Fortunately, with advances in treatment, nipple-sparing mastectomies are becoming more common. But for those whose nipples can’t be saved, three-dimensional tattooing helps to give a more natural appearance.

Immunotherapy

A new Virginia Commonwealth University study is testing a recently approved immunotherapy drug to see if it might weaken certain aggressive forms of breast cancer, making them more susceptible to post-surgical chemotherapy.

Dr. Harry Bear, director of VCU Massey Cancer Center’s Breast Health Center, is heading up the phase II clinical trial that’s administering pembrolizumab alongside decitabine, a chemotherapy drug, to patients with newly diagnosed triple negative or hormone receptor positive breast cancers. Researchers hope the drug combination will sensitize cancer cells and shrink tumors before patients undergo surgery and post-surgical chemotherapy.

“Patients who have evidence of a very brisk and strong immune response in their breast cancer tissue are much more likely to have an excellent response to chemotherapy and much more likely to live a long time after treatment,” Bear said. “Drugs like pembrolizumab work by taking the brakes off the immune response. The point of doing the trial is to see if we can make the immune response in the tumor … more brisk, and therefore make the cancer more responsive to chemotherapy afterwards.”

Biopsies will be performed before and after four weeks of the pembrolizumab/decitabine combo to see if there are changes in the tumor. Researchers will also review patient outcomes after post-surgical chemotherapy.

VCU is recruiting around 50 patients with newly diagnosed triple negative or hormone receptor positive breast cancers who have not yet begun treatment. To inquire about participating in the study, call (804) 828-5116 or (804) 828-9325.

Bear expects to publish trial results by the end of 2020.

Genetic testing

In 2013, actress Angelina Jolie made headlines when she proactively had a double mastectomy after genetic testing revealed she was at increased risk for breast cancer. Jolie tested positive for BRCA1, one of the first genetic mutations known to increase one’s risk for breast and ovarian cancers.

Since then, genetic testing has continued to advance and is now helping local doctors customize treatment for breast cancer patients.

“We’re testing for a lot more genes,” said Dr. James Pellicane, director of breast oncology at Bon Secours Cancer Institute Richmond. “We used to just test for [the] BRCA1 and BRCA2 [genetic mutations]; now we’re able to test for a whole panel of genes.”

Depending on a patient’s personal and family history, saliva-based genetic testing is available to assess risk of breast, ovarian, colon, gastric, pancreatic and other cancers.

“By checking these gene mutations, what we’re assessing is risk,” Pellicane said. “What we’re able to do [with that information] is better counsel patients.”

For example, if genetic testing shows an increased risk of colon cancer, patients will be advised to begin screening earlier than the usually recommended age of 50.

Insurance companies are covering genetic testing in patients who meet certain guidelines. However, for those who don’t meet the requirements, “the good news is that the cost of these tests has come down so low that many people can afford to pay for them out of pocket now,” Pellicane said. “They’re not thousands of dollars anymore; they’re hundreds of dollars.”

Another genetic advancement is the DCISionRT (pronounced decision RT) test for patients with ductal carcinoma in situ (DCIS), the most common form of noninvasive breast cancer (see “Are doctors too aggressive on noninvasive breast cancer?”).

“In breast cancer, [DCIS] is probably one of the biggest areas of overtreatment that we see,” Pellicane said. “There are 60,000 new cases of DCIS a year, and a lot of those women would never progress to invasive breast cancer even if we didn’t do surgery on them.”

DCISionRT helps doctors personalize treatment to each patient.

“What DCISionRT has done is combine clinical factors with protein biomarkers in genomic testing to determine risk and benefit of radiation therapy,” Pellicane said. “When we get the results back, we get a risk assessment of what the risk of recurrence is without radiation therapy and what the risk of recurrence is with radiation therapy, and we’re able to counsel patients on whether radiation is going to benefit them or not. We now have the ability to over treat less women without under treating anybody, so that’s really where the push is.” ¦

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