Treatment Options
BEAT Cancer Trial
Exercise often improves the health and well-being of breast cancer patients after a diagnosis of cancer. Unfortunately, women with breast cancer frequently exercise less after their cancer diagnosis and may not ever become as physically active as they were before being diagnosed with cancer. Investigators at Southern Illinois University (SIU) School of Medicine are hoping to address this decline in activity through a recent study that evaluates the feasibility and effectiveness of an exercise program specifically designed to help breast cancer patients exercise regularly. In collaboration with local oncologists and international expert consultants, Dr. Laura Rogers is the principal investigator for the program.
If you meet the following criteria, you may qualify as a participant:
• Female between the ages of 18 and 70
• History of stage I, II, or IIIA breast cancer
• No presence of metastasis
• Currently taking aromatase inhibitors, such as anastrozole (Arimidex®), letrazole (Femara®), or exemestane (Aromasin®), or estrogen receptor modulators, such as tamoxifen (Nolvadex®), and will be for the next 8 months.
• No physical or psychosocial contraindication to participating in an exercise program
If you would like more information about the BEAT Cancer Trial, you may contact Cathy Naritoku, SIU of Medicine, 545-7750 or email BEATcancer@siumed.edu.
Sentinel Node Mapping
Traditionally during breast cancer surgery, 10 to 20 lymph glands in the armpit are removed and analyzed to determine whether or not the initial cancer has spread. Even though studies show that less than half of all women with breast cancer have lymph node involvements, most women go through this surgery which can cause such negative side effects as swelling of the arm, discomfort or pain around the shoulder or arm, or numbness around the upper arm.
New technology is being developed that allows surgeons to only sample the most likely glands where the cancer is going to spread - the sentinel lymph nodes. This procedure involves injecting a radioactive material near the tumor during surgery. A special machine then traces the radioactive material to the lymph node of the armpit. Only those lymph nodes showing signs of possible cancer are removed, usually one or two nodes, and sent to a pathologist for detailed examination. If no cancer is detected, no further surgery is necessary.
Only if cancer is detected is it necessary to complete the traditional procedure of removing many of the lymph nodes. The advantage for the woman is minimal surgery, quicker recovery time and virtually none of the side effects of the more traditional lymph node biopsy.
This procedure, called sentinel node mapping, is now being used by Breast Center surgeons. Thirty to forty women will be enrolled in this clinical trial and these women will undergo sentinel node biopsy followed by the standard lymph node removal to determine the reliability of this new procedure.
This research will help determine the effectiveness and long term benefits of this procedure. Hopefully, at the conclusion of this research, routinely removing and sampling all lymph nodes will be a surgical procedure of the past.
Ductal Lavage
When a woman has one or more family members who developed breast cancer, especially at an age less then 50, she may be concerned about her own chance of getting cancer. Women who perceive an increasesd personal risk have inquired at the Breast Center whether there were any additional screening or preventative measures in which they could participate.
We have designed a program, which combines a complete risk assesment with the opportunity for women with an increased risk of breast cancer to participate in a prevention trial. The risk assesment will go beyond the simple history form by adding the technique of mammary duct lavage, a non-invasive test which obtains ductal cells for study by traditional microscopic examination as well as molecular tests for genes associated with proliferation and dysregulation that may proceed the development of cancer.
The prevention trial will make use of the known prevention drug tamoxifen and molecular markers of breast cancer risk in subsequent ductal lavage. There are two advantages of this trial compared to existing national trials. One is that premenopausal women are eligable to participate, which is important because younger women are more difficult to screen mammographically, and have a worse prognosis if they get breast cancer.
The other advantage is that some women will be relieved to learn that their ductal lavage results show normal cells and that they have only an average risk of getting breast cancer.
We look to this program as an example of a specialty service, which will make available the most advanced screening techniques to women of Central Illinois while finding the best prevention measures for women in the future.
Elizabeth Peralta, MD
Surgical Oncologist
Breast Center at SIU
STAR -- Study of Tamoxifen and Raloxifene
The Breast Center at SIU, in cooperation with the Regional Cancer Center at Memorial Medical Center in Springfield, is one of 445 site of this important breast cancer prevention study sponsored by the National Cancer Institute.
STAR is a clinical trial comparing the effectiveness of tamoxifen with raloxifene for breast cancer prevention. In STAR, the two drugs will be compared for their effectiveness in reducing the occurrence of breast cancer in postmenopausal women age 35 or older who are at increased risk for the disease. About 22,000 women will take part in this trial. They will be randomly assigned to receive either tamoxifen and raloxifene. Neither the women nor their doctors will know which drug they will be taking. Trained health professionals will closely monitor all participants through regularly scheduled health examinations during the trial.
The health of participants in this study will be carefully monitored by medical professionals committed to fighting breast cancer. Taking part in STAR is one way participants can have an active role in their own future health. Participants will also be a partner in a study that is contributing to medical knowledge about ways to decrease the occurrence of breast cancer in future generations of women.
Please call STAR coordinator Sidney Shonkwiler at 217-788-4248 with any questions or for additional information.
Anastrozole
Hormonal therapy has played an important role in reducing the risk of recurrence and improving the chances of survivial for women with early receptor positive breast cancer. Tamoxifen has been the mianistay of hormonal therapy since it's approval in 1985 for breast cancer recurrence risk reduction. Post menopausal women with early receptor positive breast cancer now have anew option, anastrozole (Arimidex). Recent data form the ATAC trial presented at the San Antonio Breast Conference in December, 2001 suggested anastrozole provided women with 17% fewer recurrences compared to women who took Tamoxifen. Women taking anastrozole also had less hot flashes, endrometrial carcinoma, and clotting complications. Women taking anastrozole did have more fractures.
So far survival is the same in both groups.
An ASCO (American Society of Clinical Oncologists) expert panel recommended in May, 2002, that Tamoxifen remain the standard of care for prevention of breast cancer recurrence following surgery. They felt data from the ATAC trial presented in December was promising, but that it is premature to recommend anastrozole for routine use outside of clinical trials.
The FDA has reviewed the data from the ATAC trial. It was approved September 5, 2002, for the adjuvant (to prevent recurrence) treatment of receptor positive postmenopausal women with breast cancer. Anastrozole has been available for women with advanced disease since 1995.
The NCCN (National Comprehensive Cancer Network) clinical practice guidelines provide that anastrozole be offered to recptor-positive postmenopausal women with breast cancer.
Hormonal therapy for breast cancer is evolving as we analyze and review new information from important clinical trials.
The goal is improved efficacy with fewer side effects. It is hoped that anastrozole will be an important advance in that goal.
Karen Hoelzer, MD
Medical Oncologist
Springfield Clinic
A Prospective Study to Evaluate the Risk of Local Relapse in Sentinel Lymph Node Negative Patients with Breast Cancer
Principal Investigator: Gary Dunnington, M.D.
A Prognostic Study of Sentinel Node and Bone Marrow Micrometastases in Women with Clinical T1 or T2 N0 M0 Breast Cancer (ACOSOG Z0010)
Principal Investigator: Elizabeth Peralta, M.D.
Surrogate Endpoint Biomarkers in the Nutritional Prevention of Breast Cancer
Principal Investigator: Elizabeth Peralta, M.D.
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