By BECKY GILLETTE
It the past, the average survival rates for a woman diagnosed with metastatic breast cancer used to be two to three years.
“Now we have added a year or two to the median survival rates for metastatic breast cancer,” said Dr. Shou-Ching Tang, associate director of Clinical and Translational Research and professor of Medicine and Pharmacology /Toxicology at the University of Mississippi Medical Center (UMMC). “Some patients are living longer. That is because of all the wonderful drugs we have that are more efficacious. And many of them are less toxic than in the past. A lot of drugs in the past were very toxic to the patient. We have fewer complications with the newer drugs. As a result, women are living longer.”
The goal now is converting metastatic disease into a chronic disease. Like AIDs, metastatic breast cancer used to be a death sentence.
“Now people are living with AIDs comfortably,” Tang said. “We are hoping to do that with metastatic breast cancer so the patient can live with quality of life and with dignity.”
Survival rates for someone with metastatic breast cancer really depend on the type of breast cancer, said Dr. John (Bo) S. Hrom, F.A.C.P, hematologist/oncologist at Hattiesburg Clinic and Clinical Trial Director at Forrest General Hospital.
“People who have positive estrogen receptor and progesterone receptor breast cancer, which is sometimes referred to as hormone receptor positive (HR positive) breast cancer, generally have a better prognosis due to newer targeted therapies such as CDK 4/6 and anti-hormonal therapies,” Hrom said. “Patients who have HER-2/neu positive breast cancer also can have a longer survival due to newer innovative drugs that block HER-2/neu including Herceptin, Perjeta, and Kadcyla.”
However, Hrom said metastatic triple-negative breast cancer continues to be a challenging disease with a poor prognosis due to limited therapies other than standard cytotoxic chemotherapy. Newer therapies such as PARP inhibitors may improve survival in this area, as well.
“Areas of research are going into all types of metastatic breast cancer currently with new discoveries being made frequently,” Hrom said. “The five-year survival for all metastatic breast cancer patients is around 27 percent as compared to those with localized or regional breast cancer with an over 90 percent survival rate at five years. The death rate from breast cancer has continued to decline over the last 20 years.”
There are many variables that influence the types of treatment used. Hrom said the stage of the disease is probably the most important factor.
“Patient preference is certainly a priority, as well,” Hrom said. “Certainly, the patient’s support system can influence their treatment plan. Age as well as overall physical health and comorbidities play a role. We use something called a performance status that help us determine the patient’s ability to tolerate therapy.”
Tang said in terms of research, they have learned a lot from studying the biology of metastatic breast cancer by looking at the genes that turns a cell into cancer and make the cancer spread.
“The new area of research is to identify driver mutations, the key mutations, so we can treat them with targeted therapy,” Tang said. “With whole genome sequencing, we are discovering new genes that are druggable mutations–mutations that respond to drugs–and allow us to identify biomarkers that can tell us which patient will respond to what particular therapy or drug leading to so-called personalized precision medicine.”
The technology is moving fast. In the past, it took several decades and millions of dollars to sequence one genome. Tang said now a couple thousand genomes can be sequenced in a couple of weeks.
“You can sequence a patient’s entire genome,” Tang said. “And the price is continuing to drop. Also, another area that is hot with metastatic breast cancer is immunotherapy. There are many drugs discovered which can wake up the suppressed immune system. And several drugs have been discovered that play an important role in triple-negative breast cancer, including the so-called checkpoint inhibitors.
“Also, we are actually starting to use a new class of drug—PARP inhibitors–for patients who have DNA repair defect, certain mutations like BRCA mutations. And for hormone receptor positive metastatic breast cancer, in addition to novel hormonal therapy we have, there is a new generation of targeted therapy on the market, cyclin inhibitors and others, that will help reduce the resistance to hormonal therapy.”
There is also active research ongoing to identify biomarkers that will help physicians select specific chemotherapy for a particular patient’s subtype, which will help to improve efficacy and reduce toxicity. Tang said this can be likened to different size shoes for different people rather than one pair of shoes for everyone, which is what has been done in the past.
UMMC is doing active breast cancer research. For metastatic breast cancer, they are studying novel PARP inhibitors in patients with BRCA mutations and anti-heregulin antibodies in patients with hormone positive metastatic breast cancer.
Tang said it is exciting that UMMC has started a phase one research program to offer breast cancer patients cutting-edge clinical trials with novel drugs that have not been on the market before to patients in Mississippi.
“So, they don’t have to go to out-of-state hospitals to get these types of drugs,” Tang said. “And, as of early October, we started our first trial using a novel monoclonal antibody as immunotherapy for metastatic breast cancer. We are also doing similar phase one trials on other novel drugs developed in Mississippi in Oxford at the National Center for Natural Products Research (NCNPR) using a natural product to boost the immune system in breast cancer.”
Tang calls the drugs being developed at NCNPR at Ole Miss “a goldmine.”
“They have several homegrown drugs ready to be tested in clinical trials,” he said.
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