Best of Breast: news for week ending 10 October 2014

News for week ending 10 October 2014, covering medical developments in the world of breast cancer and cancer.

Earlier this year there was a furore in the UK about a cancer campaign featuring a patient with pancreatic cancer and the caption: “I wish I had breast cancer”, the cack-handed message of course being that at least there’s a better chance of curing breast cancer than pancreatic cancer [I’d like to see them say this to a metastatic Stage 4 breast cancer patient!!!].

But looking at the chart below, it’s glaringly-obvious that although the % number of deaths from breast cancer at 7.7% is only slightly-higher than pancreatic cancer’s 5%, the spending on breast cancer is £40.32 million vs pancreatic cancer’s £5.21m.  As for lung cancer which is number 1 at 22% of cancer deaths, the spending is a mere £14.15 million.

Well, I guess I’m grateful for all the spending on breast cancer, disproportionate though it may be.  And although people moan about the glamorisation and prettification of breast cancer with pink ribbons, I am glad for every penny donated to breast cancer research.  And trying not to feel guilty for not having a more difficult cancer.  At the end of the day, cancer is cancer, and whether we beat it or not is sometimes not in the hands of the doctors, or the scientists coming up with novel cures or money being poured into research, but on some fluke of our immune system beating it and keeping it away.

Just two more items of note this week:  lucky Australia again – the berry of the Blushwood tree has been shown to have amazing anti-tumour properties – we’re talking dissolving tumours within days.  Unfortunately at the moment they only work for more surface tumours which can be injected.  Before y’all rush out and order a tree, please note that it is very fussy about where it grows, which is currently on the Atherton Tablelands in Australia.  Let’s hope they find a way to grow more quickly.

The other item of note is the discovery that drugs may work better against cancer cells, when taken at night.

Graphic supplied by Statista

1.  Graphic: How much we spend on cancers against how deadly they are

http://i100.independent.co.uk/article/graphic-how-much-we-spend-on-cancers-against-how-deadly-they-are–eyZmwivdBl

• Some types of cancer receive more funding than others.
• But this discrepancy can be explained with the fact that areas where advances are being made sometimes means they get more money funnelled towards them.
• A cancer charity source said this means that in some cases, cancer death rates could become a self-fulfilling prophecy, where cancers with low survival rates received comparatively less funding as a result.
• That was why when it announced its new funding strategy in April, Cancer Research UK said it was targeting four types of cancer with “substantial unmet need” – lung, pancreatic, oesophageal and brain.
• The more difficult a cancer is to treat, the more difficult it is to research – patients may be too ill to take part in trials and it can be more difficult for researchers to collect tumour samples.
• But with all that said, survival rates are improving. In the 1970s fewer than a quarter of people with cancer survived, but survival rates have doubled over the last 40 years, and the target is now three-quarters of people surviving within the next 20 years.

Image credit: http://www.tassiedevil.com.au

2.  Scientists discover cancer-fighting berry on Australian Blushwood tree

http://www.abc.net.au/news/2014-10-07/queensland-scientists-discover-cancer-fighting-berry/5796106

• An eight-year study led by Dr Glen Boyle, from the QIMR Berghofer medical research institute in Brisbane, found a compound in that a berry from the Blushwood tree could kill head and neck tumours as well as melanomas.
• An experimental drug derived from the berry, EBC-46, has so far been used on 300 animals, including cats, dogs and horses.
• In 75 per cent of cases, the tumour disappeared and had not come back.
• “There’s a compound in the seed – it’s a very, very complicated process to purify this compound and why it’s there in the first place, we don’t know.”
• “The compound works by three ways essentially: it kills the tumour cells directly, it cuts off the blood supply and it also activates the body’s own immune system to clean up the mess that’s left behind.”
• There were no side effects, but what amazed scientists most was how fast it worked: the drug took effect within five minutes and tumours disappeared within days.
•  “Usually when you treat a tumour it takes several weeks for it to resolve, but this is very, very rapid.  There’s a purpling of the area, of the tumour itself, and you see that within five minutes and you come back the next day and the tumour’s black and you come back a few days later and the tumour’s fallen off.
• The berry grows on the blushwood tree, which only grows in pockets of Far North Queensland.
• The tree is very, very picky on where it will grow.  It’s only on the Atherton Tablelands at the moment and they’re trying to expand that to different places of course because it’d be nice to be able to grow it on a farm somewhere
• But Dr Boyle warned the drug could only be used for tumours that can be accessed by direct injection and was not effective against metastatic cancers.
• Biotechnology company QBiotics has obtained ethical approval to begin human trials.

For more information: http://www.qbiotics.com/index.php/human-pipeline/ebc-46-a-humans

3.  Why Cancer Drugs May Work Better While You Sleep

http://time.com/3486220/why-cancer-drugs-may-work-better-while-you-sleep/

• Researchers at the Weizmann Institute of Science discovered that some of the body’s molecular functions during the day may interfere with the effectiveness of certain cancer medication.
• Specifically, they found that the normal day-time production of some steroid hormones in the body actually inhibited the work of epidermal growth factor (EGF) receptors—which are the proteins targeted by a class of anti-cancer drugs.
• Tumor cells plant these receptors on their surfaces to attract nutrients that help them survive and grow.
• Drugs, including the breast cancer agent lapatinib, can block these receptors on tumors, and such medications are a popular way to treat breast cancers expressing epidermal growth factor.
• The team found that when the tumor cells simultaneously bind to something else—such as steroid hormones—the EGF receptors are less active, making drugs like lapatinib less potent.
• The findings are still preliminary, but there is other evidence that the day-night cycle may be a potentially important factor in determining cancer treatment dosing in coming years.
• Some studies showed, for example, that when the 24-hour rest and activity cycle is broken metabolically, and the EGF receptors aren’t given enough time to be active, certain tumors in animals grow two to three times faster.
• “The study developed out of a mistake. We accidentally omitted a synthetic steroid…from the medium in which we routinely grow mammary gland cells.  And we noticed that the cells acquired a faster rate of migration when we followed them under a microscope.”

For more information:  Nature Communications 5, Article number: 5073 doi:10.1038/ ncomms 6073, Diurnal suppression of ​EGFR signalling by glucocorticoids and implications for tumour progression and treatment

4.  Circulating tumor cells provide genomic snapshot of breast cancer

http://medicalxpress.com/news/2014-10-circulating-tumor-cells-genomic-snapshot.html

• The genetic fingerprint of a metastatic cancer is constantly changing, which means that the therapy that may have stopped a patient’s cancer growth today, won’t necessarily work tomorrow.
• Although doctors can continue to biopsy the cancer during the course of the treatment and send samples for genomic analysis, not all patients can receive repeat biopsies. Taking biopsies from metastatic cancer patients is an invasive procedure that it is frequently impossible due to the lack of accessible lesions.
• Research published October 10th in the journal Breast Cancer Research suggest that tumor cells circulating in the blood of metastatic patients could give as accurate a genomic read-out as tumor biopsies.
• The researchers compared tissue biopsies surgically removed from two patients with inflammatory breast cancer with circulating tumor cells (CTCs).
• Breast tissue samples from both patients showed a specific mutation in a region of a cancer-driving gene, p53.
• The authors studied this mutation in several CTCs isolated from both patients.
• They found that in several of the CTCs collected, the mutations matched with the tumor biopsy, however in one patient, some of circulating tumor cells had an additional mutation.
• “Since inflammatory breast cancer is a very rapidly changing disease, we think this additional mutation may have been acquired after the original surgical biopsy was taken.”

For more information:  Breast Cancer Research, 16:445, 2014.,  TP53 mutations detected in circulating tumor cells present in the blood of metastatic triple negative breast cancer patients

5.  Mantis Shrimp Inspires a New Camera for Detecting Cancer

http://www.smithsonianmag.com/innovation/mantis-shrimp-inspires-a-new-camera-for-detecting-cancer-180952927/?no-ist

• A group of researchers has been working on a way to model the mantis shrimp’s compound eyes and polarized vision to create a camera that can detect various forms of cancer.
• They now have a proof-of-concept camera sensor that is smaller, simpler and more precise than previous attempts at polarized imaging.
• The mantis shrimp can see differences in polarized light—that is light that that is radiating in different planes of direction—in a similar way that we might see the contrast between a black wall and a white table.
• But polarized light can also be used to see things the human eye can’t, such as cancer cells. The team’s research shows that its sensor has the ability to detect cancerous lesions before the cells become numerous enough to appear as visible tumors.
• While researchers have created polarized imaging devices in the past, they tend to be large, using multiple sensors, and complex, in that they require optics, engineering and physics experts to operate properly. That, of course, also means the instruments are very expensive.
• But by combining advancements in nanotechnology, the tiny CMOS (complimentary metal-oxide-semiconductor) sensors common in smartphones and the fundamentals of how the vision system of the mantis shrimp works, the team was able to make a much simpler imaging sensor. Smaller than a penny, the sensor is very sensitive and can detect cancer cells earlier than previous attempts at polarized imaging, using both still images and video.

In this endoscopy image of a mouse colon, the sensor shows the tumor tissue in blue, while the healthy tissue shows up as yellow.

• With colon cancer, for instance, a doctor would normally use an endoscope to look for any tissue that looks cancerous, then take a biopsy. But the cancer has to be at a certain stage of development before it looks different to the human eye. Polarized imaging can spot cancer cells much earlier, but previous imaging devices have been too large to be used in this way before.
• Simpler polarization scopes are already being used to check for skin cancer in Australia, where two in three people are diagnosed with the disease before the age of 70.
• The researchers are also experimenting with using polarized light to increase tissue contrast to help doctors tell where to start and stop cutting during surgery.
• Because the shrimp-inspired chip is so compact and easy to use, the technology could make its way into portable devices and even smartphones.

For more information:  Proceedings of the IEEE, (Volume:102 ,  Issue: 10 ), Bioinspired Polarization Imaging Sensors: From Circuits and Optics to Signal Processing Algorithms and Biomedical Applications

6.  Green tea nanocomplex improves performance of Herceptin

http://www.nhs.uk/news/2014/10October/Pages/Green-tea-compound-may-improve-cancer-drugs.aspx

• http://www.dailymail.co.uk/health/article-2781366/Green-tea-helps-scientists-develop-new-cancer-fighting-drugs.html
• A compound in green tea – Epigallocatechin-3-O-gallate (EGCG) – may help improve the effectiveness of anti-cancer drugs such as Herceptin, used in the treatment of breast and stomach cancer.
• The research involved developing a new biological compound to carry cancer drugs based on derivatives (by-products) of one of the main ingredients in green tea, called Epigallocatechin-3-O-gallate (EGCG).
• The research team joined EGCG derivatives with various anti-cancer proteins to form what are known as nanocomplexes – intricately engineered combinations of proteins.
• One of the nanocomplexes comprised the anti-cancer protein Herceptin bundled with an EGCG derivative, forming a core, and a separate EGCG-derived shell around the outside.
• They injected this into mice with cancer to see if the Herceptin-EGCG carrier nanocomplex was more or less effective at fighting tumour cells than “free” Herceptin alone.
• The researchers also coupled ECGC derivatives with another protein called interferon α-2a, which is used in combination with chemotherapy and radiation as a cancer treatment. This nanocomplex was better at limiting cancer cell growth than free interferon α-2a.

For more information:  Nature Nanotechnology. Published online October 5 2014,  Self-assembled micellar nanocomplexes comprising green tea catechin derivatives and protein drugs for cancer therapy

7.  Breast Cancer Patients Most Likely to Struggle with Depression and Anxiety

http://www.ibtimes.co.uk/breast-cancer-patients-most-likely-struggle-depression-anxiety-1468908

• Breast cancer patients are most likely to develop psychological disorders such as depression and anxiety over those with prostate, stomach or pancreatic cancers.
• Researchers at the University of Leipzig in German found one in three cancer patients develop mental illness. The rate is significantly higher than the rate of the general population developing psychological conditions, which is around 20%.
• Around 42% of breast cancer patients and 41% of neck and head cancer patients suffered from mental illness.
• The findings also showed that 39% of malignant melanoma patients, 22% of prostate and 21% of stomach cancer patients also experienced psychological disorders. Around 20% of pancreatic cancer patients suffered depression or anxiety.
• It is hoped that the research will shed light on the type of cancer patients vulnerable to mental illness who need support.
• The research has been published as part of Mental Illness Awareness Week in the United States.
• Dr Anja Mehnert, a professor of psychosocial oncology who led the study, said it was surprising that patients with a more treatable cancer, such as breast cancer, experienced more distress than people with cancers more challenging to beat, such as stomach and pancreatic cancers.

For more information:  Journal of Clinical Oncology, October 6, 2014JCO.2014.56.0086, Four-Week Prevalence of Mental Disorders in Patients With Cancer Across Major Tumor Entities

8.  Use of biphosphonates for osteoporosis shield bones from breast cancer metastasis

http://www.futurity.org/osteoporosis-drug-breast-cancer-776812/

• Skeletal metastases develop in up to 70 percent of women who die from breast cancer.
• Researchers analysed data from more than 21,000 women diagnosed with breast cancer in two groups of women: those with early stage, localized, cancer and those whose cancer had spread to lymph nodes
• They evaluated the relationship between use of oral bisphosphonates, a common osteoporosis medication, and development of bone metastases.
• The study is novel in that it mainly involved women who were post-menopausal and in whom bone-turnover is high due to osteoporosis.  This process results in an environment that is favorable for tumor cell growth and consequent metastasis.
• Bisphosphonates work by slowing down this bone-turnover. This will, in turn, make it harder for tumor cells to establish in the bone and may explain why there was such a decline in metastasis.
• The association between the medication and improved survival merits further investigation. “Ours was an epidemiological study, involving a large number of women strengthening the importance of the findings.
• “However, clinical interventional studies are needed before the results can be translated into standard clinical practice and guidelines.”

For more information:  JNCI J Natl Cancer Inst(2014) 106 (11): dju264doi: 10.1093/jnci/ dju264, Effect of Oral Bisphosphonates for Osteoporosis on Development of Skeletal Metastases in Women With Breast Cancer: Results From a Pharmaco-epidemiological Study