Submitted by Dr. Robert Mocharnuk, MD, Associate Professor of Hematology/Oncology & Director of The Breast Center at SIU
There is some good news on the horizon bout breast cancer based on recently published studies and new research. Amazing things have happened in the breast cancer field over the last year.
Prevention is a key factor in the fight to eradicate breast cancer. A recent study rst presented at the annual American Society of Clinical Oncology (ASCO) meeting in 2011 and then published in the New England Journal of Medicine, enrolled women who were at higher risk for developing breast cancer to receive either the anti-hormone therapy Exemestane (trade name Aromasin) versus placebo.
High-risk individuals included individuals whose mothers, sisters or daughters had been diagnosed with breast cancer, women with previous breast biopsies for benign disease, women who have never been pregnant or had their first child after the age of 30, women who have taken oral contraceptives or used hormone replacement therapy, women who started menstruating late and/or continued having periods well into their 50s, and women exposed to previous chest radiation.
Compared with the placebo group, the women who took exemestance experienced a 65% relative reduction in the annual incidence of invasive breast cancer. Since the majority of women who developed breast cancer are post-menopausal, use of exemestane for breast cancer prevention could have a huge impact on the number of breast cancer cases in this country, greater than the benefits of surgery, radiation therapy or chemotherapy combined.
Surgical management of early breast cancer has also changed. Based on results from an International Breast Cancer Study Group Trial presented by Dr. Vivianna Galimberti at the San Antonio Breast Cancer Symposium in December 2011, there is no difference in five-year disease-free and overall survival for women with smaller primary breast tumors who do not have full lymph node dissections in their underarm after sampling demonstrates only minimal involvement of the axillary lymph nodes through a technique known as sentinel node biopsy.
Traditionally, all women with positive sentinel lymph nodes were urged to undergo additional axillary lymph node removal. The results of this study mean that fewer women will develop lymphedema (excessive accumulation of fluid in connective tissue), pain or loss of arm function after-surgery because they can safely avoid more extensive axillary surgery.
A study known as the “Cleopatra Trial” combined a targeted drug named Pertuzumab with trastuzumab (Herceptin) for women with metastatic HER2-positive breast cancer.
HER2-positive breast cancers tend to be much more aggressive and have a higher rate of recurrence compared with HER2-negative breast cancers. Fortunately, in the late 1990’s, the targeted therapy Herceptin was approved for the treatment of metastatic HER2-positive breast cancer and subsequently approved for earlier-stage HER2-positive breast cancer in the mid-2000s. In the Cleopatra trial, Pertuzumab in combination with Herceptin plus docetaxel chemotherapy produced a 6.1 month extension progression-free survival advantage over Herceptin plus docetaxel chemotherapy alone, an increase of nearly 50%.
We were also given glimpses into therapies that are likely to be approved in the very near future. Data regarding a new type of “stealth bomb therapy” for women with HER2-positive breast cancer presented at the 2012 ASCO (American Society of Clinical Oncology) meeting demonstrated how “smart medicine” can target cancer cells and avoid damaging healthy cells. Dr. Kimberly Blackwell from the Duke Cancer Institute in North Carolina presented data on delivery of a toxic drug known as T-DM-1 directly into the cancer cell. T-DM1 (trastuzumab emtansine) links Herceptin with the toxic drug emtansine. Women whose cancer had eventually progressed on Herceptin and were treated with T-DM1 and emtansine and enjoyed a median progression free interval 3.2 months longer than patients who received chemotherapy plus an oral form of Herceptin.
Science is moving rapidly. Research in breast and other cancers has really taken off and more has been discovered about cancer in the past 10 years than in the entire history of cancer research. It is my hope that cancer treatments will eventually consist of drug cocktails targeting key components of cancer cells that control their growth and spread.
Many of the research techniques developed during the darkest days of the AIDS epidemic have paved the way for current cancer research and drug development targeting the molecular mechanisms of cancer development. We owe a real debt of thanks to those patients and the researchers who studied this disease and began to unravel common pathways of cell growth, survival and spread.
Although things are moving ahead rapidly in cancer research, the United States still lags behind European research efforts, due to a lack of funding, excessive rules and regulations regarding research, bureaucratic restrictions, funding shortages, and the enormous time and effort that it takes to conduct both laboratory and clinical research.
Knowledge can empower anyone who has been diagnosed with cancer. Ask your doctor as many questions as you need to better understand your disease, and read about new developments and cancer treatments. Be informed about what clinical trials are available and ask your oncologist if you might be eligible. And remember, not all clinical trials involve the use of experimental drugs. Some trials are designed to figure out the best way to deliver therapy with treatments that are currently in use.
Do you know what Elizabeth Taylor and Senator Edward Kennedy had in common? They both developed brain tumors. According to Dr. Jeffrey Cozzens, Professor and Chair of SIU School of Medicine’s Division of Neurosurgery, there are two types of brain cancers, malignant (cancer) or benign (non-cancerous). Elizabeth Taylor’s tumor was not cancerous; however, Senator Kennedy wasn’t as fortunate. Brain cancer can arise from many different types of brain cells (primary brain cancer) or occur when cancer cells from another part of the body spread (metastasize) to the brain.
Causes of brain cancer are difficult to prove and symptoms of brain cancer vary from weakness, difficulty walking, seizures and headaches to nausea, vomiting and blurred vision. Dr. Cozzens has dedicated his practice to the specialized surgery required to remove tumors from the brain and spine. He has also developed a surgical trial which involves making tumors fluorescent and glow red under a deep blue light. This helps to better distinguish brain tumors from normal brain and enables the complete removal of the tumor. “We are one of only six medical centers in the country that have the capability of doing this” stated Dr. Cozzens. Brain tumors affect all ages and all races. Different brain tumors are more common in different ages and races; but overall, all people can be affect by brain or spinal tumors. “Benign menigiomas (tumors) are more common in older women, and malignant glioblastomas multiforme (very malignant tumor) is rare amongst African Americans. And, although any tumor is rare in children, brain tumors are the most common,” said Dr. Cozzens.
Treatment for brain and spinal tumors are numerous but most are treated with a combination of therapies. Surgical therapies include computer-guided needle biopsy, surgical resection using computer guidance, and stereotactic radiosurgery which is a special form of computer-guided focused radiation which burns the tumor cells deep in the brain without need for an incision of the skin. There is also conventional radiation therapy which kills rapidly growing cells and spares the nerve cells.
New chemotherapy drugs, some which can be taken in pill form, have proven to be very effective. Vaccines and antibodies created specifically to target brain tumor cells is a new experimental treatment being utilized. In each instance, the neurosurgeon must weigh the benefits of surgery verses the risks of surgery, including the risks of not having surgery. Dr. Cozzens’ philosophy is that “the neurosurgeon should not be interested in making the MRI scan look better but should be more interested in making the patient better.”
Dr. Cozzens doesn’t stop researching after the tumor removal, however. He works with a Neuropathologist that studies the tumor cells that were removed to find certain genetic traits which may change the treatment for the tumor. Dr. Cozzens uses these results to guide further therapy. He feels that there is a major promising area of research in neuro-oncology where the genetic traits of brain and spine tumors are identified and treatments are tailored specifically to target specific tumors. This research is on-going in a number of centers including SIU School of Medicine. Brain and spine tumors Dr. Cozzens has treated in central Illinois are larger and at a later stage than other locations. This may occur because patients wait longer to seek medical attention when they have symptoms. “I hope to develop a regional program that will bring a greater awareness of the early signs of brain tumor so that people with these tumors can be treated more effectively. It is important to start treatment for these tumors at an early stage where the tumor may be more responsive to treatment.”
An aggressive attack on the tumor, using all the resources of a Comprehensive Cancer Care Center such as the Simmons Cancer Institute (SCI) at SIU should be used in dealing with malignant brain and spinal tumors. “The treatment of brain tumors is a team effort. I am just one part of this team. Other members are Dr. Espinosa (Neurosurgery), Dr. Amin (Neurosurgery), Dr. Omar (NeuroOncology), Dr. Brian Moore (Neuropathology), the radiation oncologists, the general oncologists and all the nurses and staff of the SIU Simmons Cancer Institute. SCI is a huge resource for central Illinois,” said Dr. Cozzens, “to have a team of dedicated physicians at the Simmons Cancer Institute who are so knowledgeable in their individual fields that they teach others the latest scientific and evidence-based techniques in cancer care. If you have a brain tumor, this is the team that you want to have on your side.”
Southern Illinois University School of Medicine in Springfield, Southern Illinois Healthcare (SIH) Cancer Institute in Carbondale and the Illinois State Cancer Registry will collaborate on a two-year study that will explore disparities in the treatment of lung cancer in southern Illinois. SIH Cancer Institute is an affiliate of Simmons Cancer Institute at SIU. Studies have shown that lung cancer mortality rates and cases of lung cancer are higher in southern Illinois than other Illinois counties. Dr. David Steward, chair of the internal medicine department at SIU, is the principal investigator for the $249,998 project that is funded by the American Cancer Society, Illinois Division. The two-year project, “Collaboration to Reduce Lung Cancer Disparities in Southern Illinois Delta,” will include the 16 most southern counties in Illinois: Alexander, Franklin, Gallatin, Hamilton, Hardin, Jackson, Johnson, Massac, Perry, Pope, Pulaski, Randolph, Saline, Union, White and Williamson. “On behalf of the HealthySI (Southern Illinois) Delta Network, we are elated with the news of the award of this important funding. The research will be an integral part of addressing lung cancer disparities that exist in our region. In Franklin County alone, lung cancer mortality rates and cases of lung cancer that are diagnosed at a later stage have long been higher than even surrounding counties. We are looking at groundbreaking work here that will mean earlier diagnosis and longer life,” said Robin Koehl, administrator of Franklin/Williamson Bi-County Health. An additional benefit to the collaborative lung cancer study is the ability to identify other cancers that may be occurring more often or are causing a disproportionate number of bad outcomes in the area, and then design specific actions to address these problems. “A subsequent part of the study focuses on working with existing community coalitions to identify barriers that might prevent people in the region from getting proper attention for medical issues that might be related to cancer,” Steward said. SIU School of Medicine will also work with SIH to support a lung nodule evaluation program to ensure that suspicious lesions found on CT scans (computerized tomography that provides a 3-D view of bones and soft tissue) get appropriate diagnostic evaluation and treatment. “We hope the result is that, by finding lung cancers at an early stage, these patients can receive treatment that may cure them, rather than letting some early cancers spread and become less treatable,” Steward added. The SIH Cancer Institute Lung Cancer Team has long noted how often patients with the disease do not follow through with diagnostic efforts prior to their diagnosis being made, according to Dr. Mary Rosenow, medical director. “This grant will make it possible for the group to achieve its goal of establishing the Pulmonary Nodule Clinic, where patients can be seen by specialists at the very first sign of a problem, and where a navigator and office staff will track every patient from the start to the finish of the evaluation. We are grateful for the award of this grant,” Rosenow added.
A scientist at Southern Illinois University School of Medicine in Carbondale has been awarded a five-year federal grant from the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, to study dietary interventions to suppress ovarian cancer. The total budget for the grant is $1,804,202.
Dale B. Hales, Ph.D., professor of physiology and gynecology/obstetrics, chair of the physiology department and a member of Simmons Cancer Institute at SIU, is the principal investigator for the project.
"Ovarian cancer is the leading cause of cancer deaths from gynecological malignancies due to the late stage at which it is usually detected. This research will test the effectiveness of a flaxseed-enriched diet in the suppression of ovarian cancer, using the laying hen as a model of ovarian carcinoma," said Hales.
Flaxseed is the richest vegetable source of omega-3 fatty acids. The research also will determine which component of flaxseed provides the therapeutic effect. The long-term goal of the research, which uses a dietary intervention by natural products, is to reduce the prevalence and severity of ovarian cancer.
Hales's research has been funded for more than 25 years by the NIH, Department of Defense, American Institute for Cancer Research and the American Cancer Society. His research has focused on the role of inflammation and oxidative stress in the etiology of hormonal carcinogenesis and the prevention and treatment of ovarian cancer with functional food-based diets rich in omega-3 fatty acids.
Hales joined the SIU faculty in 2009. He completed his doctoral degree in biochemistry, biophysics and genetics at the University of Colorado (UC) Health Sciences Center in Denver (1983). Hales earned his bachelor's at the UC in Boulder (1977).
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