Best of Breast: news for week ending 12 September 2014

The latest medical news in Breast Cancer and Cancer from Google Alerts, for the week ending 12 September 2014.

Wahey, it’s the week of the American Society of Oncology Symposium!  As usual it’s yielded the results of new trials or new research into cancer treatments.  Yet I’ve chosen to lead with another article on cancer-sniffing dogs.  Why is this?

While I appreciate what modern science is doing to prolong life and achieve remission, these treatments or diagnoses come with side-effects and long-term issues.  The research is also very technical and full of stats – nothing to touch the heart there.

So whenever I see a new method of detection that is simplicity in itself and with minimal side-effects, I cheer!  In previous posts I’ve covered how dogs have miraculously detected cancer in their owners.  There are also organisations that are now investigating how dogs detect cancer.  If you do not have cancer and would like to volunteer to provide a breath sample, please contact the number in the article.

As a layman, I’m interested in prevention, and things that I can do to help prevent or keep the cancer in remission, for example, diet – hence the article which implies that soy is dangerous for women with breast cancer, and another on how a probiotic, lactobacillus plantarum may help prevent cancer.

Another subject that is close to my heart is oncolytic virotherapthy, harnessing the body’s own immune system to fight the cancer.  In May this year, I posted about a woman with Stage 4 multiple myeloma who was went into remission thanks to a specially-engineered  measles vaccine.  She now has a blog, Let’s Go Viral.  Please note that this is not a cure-all – there was another patient who had the vaccine at the same time and did not go into remission.  Interestingly, the side-effects from the measles vaccine resembled those of Removab (a tri-functional antibody) – fever, shivering, headaches – but possibly more severe.

04/09/14 Medical Detection Dogs feature - Great Horwood

Daisy the Dog, awaiting for instruction at the testing centre

1.  Medical Detection Dogs need volunteers (without breast cancer) for the first ever canine breast cancer detection trail

http://www.mkweb.co.uk/Medical-Detection-Dogs-need-volunteers-canine/story-22878610-detail/story.html

  • A MILTON Keynes charity is looking for volunteers without breast cancer to provide breath samples for the world’s first ever canine breast cancer detection trial.
  • Medical Detection Dogs (MDD), based in Great Horwood, is calling for female residents aged 18 to 30 to provide five breath samples to help investigate the ability and accuracy of its specially trained cancer detection dogs, like Daisy (pictured).
  • With these samples, dogs can learn to distinguish between breath samples donated by individuals with cancerous, non-cancerous lumps and other conditions.
  • This will provide valuable information to assist in the development of new ways to detect and diagnose breast cancer.
  • “It doesn’t seem necessarily logical that breast cancer should lead to volatile substances to be present in breath samples, but we have seen sufficient anecdotal and minor trial evidence to feel confident this is an avenue well worth pursuing.  “If it works, it will revolutionise the way we think about breast cancer.
  • “In the long term, we hope to assist scientists to develop E-noses, that is to say electronic systems that are able to detect the odour of cancer through cheap, quick, non-invasive tests. If we can prove the principle that breast cancer is detectable on a person’s breath, machines could eventually detect that odour.”
  • “Volunteers can book an appointment at our centre and the whole process will take about 15 minutes and will not require you to be in contact with a dog.”
  • To book call 01296 655888 or email operations@medicaldetectiondogs.org.uk

2.  Soy consumption may promote overexpression of breast cancer genes in some women

http://www.mskcc.org/blog/soy-consumption-may-promote-overexpression-breast-genes-some-women

  • Researchers at the Memorial Sloan Kettering Cancer Centre in New York studied 140 women diagnosed with invasive breast cancer.
  • Half took soy protein powder containing genistein while the other half took a placebo for between seven and 30 days before they had surgery to remove their cancer.
  • Only 20 per cent of those patients who took the soy had really high levels of the genistein metabolite.
  • The reasons behind the disparity are unclear, adding that there is no way to predict who would have this reaction after consuming soy.
  • The scientists compared tumour tissues from before and after the operation and found changes in the expressions of certain genes, that are known to promote cell growth, in those women taking the soy supplement.
  • Of the women with high genistein levels, a few of them experienced changes in a specified set of genes that are known to affect breast cancer cell growth, death, or some aspect of breast cancer pathology.
  • The findings led them to conclude the soy protein could potentially accelerate the progression of the disease.
  • The changes were seen in women who consumed around 51.6 grams of soy – the equivalent of about four cups of soy milk a day.

For more information:  JNCI J Natl Cancer Inst(2014) 106 (9): dju189doi: 10.1093/jnci/ dju189, The Effects of Soy Supplementation on Gene Expression in Breast Cancer: A Randomized Placebo-Controlled Study

LPlantarum

3.  Study suggests that lactobacillus plantarum can be protective against the development of breast cancer

http://www.foodconsumer.org/newsite/Nutrition/Biotics/probiotic_helps_prevent_breast_cancer_0911140505.html

  • A study found supplementation with a new probiotic bacterial strain, Lactobacillus plantarum LS/07 (PRO) along with or without prebiotic oligofructose-enriched inulin prevented breast cancer in rats who were exposed to a carcinogen called 7,12-dimethylbenz[a]anthracene (DMBA).
  • The probiotic was used in a dose of 8.4×10(8) cfu per day in rats and the insulin in a dose of 20 grams per kg.  The supplementation started two weeks prior to the exposure to the cancer causing agent and lasted until the end of the 16-week intervention.
  • The study showed that administration of the probiotic, the prebiotic and the combination of the two significantly suppressed the tumor frequency, increased CD4+ T-cells in tumor tissue and lowered serum tumor necrosis factor-&alpha.
  • In rats treated with the probiotic and the probiotic-prebiotic combo, CD8+ T-cells decreased in blood and increased in tumor tissue.

For more information:  Anticancer ResearchSeptember 2014, vol. 34 no. 9 4969-4975,  Preventive Effects of Probiotic Bacteria Lactobacillus plantarum and Dietary Fiber in Chemically-induced Mammary Carcinogenesis

4.  Minnesota cancer survivor wants others to get experimental measles treatment that cured her

http://www.nydailynews.com/life-style/health/minn-cancer-survivor-measles-treatment-article-1.1936146

  • A woman cured of her cancer thanks to an experimental version of a measles virus is now fighting for others to receive the life-saving treatment that she did.
  • Stacy Erholtz of Minnesota had tumors on her forehead, collarbone, sternum and spine from multiple myeloma, a type of blood cancer.
  • When chemotherapy and stem cell transplants didn’t work on her, she was accepted into a trial that would use the engineered measles virus to damage her cancer cells but leave the healthy ones untouched.
  • Researchers were able to pinpoint that the treatment works optimally in a body with critically low antibodies. However, not long after the transfusion, you could see the virus taking hold of her body. Her body temperature rose to 105 degrees within four hours and she began vomiting, shaking and experienced a headache that still brings a shudder to Erholtz to this day.
  • Within 36 hours, a giant tumor on her forehead — so big her three children nicknamed it “Evan” — disappeared. Her energy quadrupled in weeks, and all of her tumors were gone within months.
  • For more information:  Stacy’s Blog, Let’s Go Viral

5.  Cryoablation plus ipilimumab induced immune responses in early-stage breast cancer

http://www.healio.com/hematology-oncology/breast-cancer/news/online/%7B05978238-c0e8-40a1-8f54-6a4fb2355941%7D/cryoablation-plus-ipilimumab-induced-immune-responses-in-early-stage-breast-cancer?sc_trk=internalsearch

  • The combination of preoperative cryoablation plus ipilimumab conferred higher rates of systemic immune activation compared with either therapy alone in women with early stage breast cancer.
  • 18 patients with early-stage breast cancer were evaluated. Thirteen of the patients had ER-positive, two had HER-2+, and three patients had triple-negative breast cancer.
  • Most patients assigned the combination achieved systemic immune response 30 days after treatment.
  • However, only two patients assigned ipilimumab alone achieved elevated levels of either marker. No patients assigned cryoablation alone demonstrated systemic immune response.

For more information:  American Society of Oncology 2104 Breast Cancer Symposium (BCS), Abstract 64, Tumor and systemic immune responses to preoperative (pre-op) cryoablation (cryo) plus immune therapy with ipilimumab (ipi) in early-stage breast cancer (ESBC).

6.  Women with breast cancer who respond well to neoadjuvant chemotherapy could be spared radiotherapy after surgery

http://www.medscape.com/viewarticle/831208

  • Women with breast cancer who respond well to neoadjuvant chemotherapy could be spared radiotherapy after surgery, and might also need less extensive surgery.
  • The investigators found that in women with breast cancer treated with neoadjuvant chemotherapy, pathologic complete response (pCR) and tumor subtype are “strong predictors” of local and regional breast cancer recurrence.
  • The advantage of neoadjuvant chemotherapy is that if clinicians can use information specific to that approach, such as pCR, they can identify patients who can safely proceed without radiation.

For more information:  American Society of Oncology 2104 Breast Cancer Symposium (BCS): Abstract 61. Presented September 4, 2014

7.  New approach to radiotherapy using image-guided, high-dose brachytherapy

http://augustafreepress.com/battling-breast-cancer-uva-pioneers-image-guided-high-dose-approach/

  • An experimental approach to treating breast cancer allows doctors to administer significantly higher doses of cancer-killing radiation where it’s needed at the same time as tumor removal while sparing healthy tissue.
  • The approach, known as image-guided, high-dose-rate brachytherapy, aims to overcome many of the limitations of other forms of intraoperative radiation therapy [IORT] by using powerful imaging technology to visualize what’s occurring inside the breast during treatment.
  • The team delivers image-guided high-dose rate brachytherapy IORT with the use of a CT-on-rails device – a CT scanner that slides across the floor to image the patient during the procedure.
  • The use of image-guided brachytherapy allows the researchers to sculpt the radiation to whatever shape is most effective, unlike other forms of IORT, which simply deliver radiation in a spherical shape.
  • “Shaping and targeting the dose lets us deliver a higher radiation dose to the area that’s at the highest risk of reoccurrence, and it also reduces the amount of dose we’re giving to the skin and chest wall, which we believe will reduce the rates of negative cosmetic outcomes or skin changes, such as skin darkening or scar tissue formation.
  • That ability to shape the dose would allow doctors to customize treatment to each person, targeting cancerous cells more effectively while sparing healthy tissue. “Because of the properties of high-dose brachytherapy and all the flexibility we have with shaping the dose, we can delivery a much higher prescription dose, or tumorcidal or cancer-killing dose, to the high-risk target line, the area that’s at risk for cancer.”

For more information:  Brachytherapy journal, DOI: http://dx.doi.org/10.1016/ j.brachy.2014.04.005Dosimetric comparison of 192Ir high-dose-rate brachytherapy vs. 50 kV x-rays as techniques for breast intraoperative radiation therapy: Conceptual development of image-guided intraoperative brachytherapy using a multilumen balloon applicator and in-room CT imaging

8.  Novel immunotherapy vaccine, GP2, decreases recurrence in HER2 positive breast cancer patients

http://medicalxpress.com/news/2014-09-immunotherapy-vaccine-decreases-recurrence-her2.html

  • A new breast cancer vaccine candidate, (GP2), provides further evidence of the potential of immunotherapy in preventing disease recurrence. This is especially the case for high-risk patients when it is combined with a powerful immunotherapy drug.
  • One of only a few vaccines of its kind in development, GP2 has been shown to be safe and effective for breast cancer patients, reducing recurrence rates by 57%.
  • Further, women with the highest overexpression of HER2 (known as HER2 +3) had no cancer recurrences when they were administered the vaccine after completing trastuzumab (Herceptin), a type of immunotherapy drug known as a monoclonal antibody.
  • HER2 is an oncoprotein that promotes tumor growth and is expressed to some extent in 75-80% of breast cancers.
  • The findings are the result of a phase II randomized trial that paired the GP2 vaccine, designed to stimulate the CD8+ cells, commonly known as “killer” or “toxic” T cells, with an immune stimulant known as granulocyte/macrophage colony stimulating factor (GM-CSF).
  • The trial included 190 patients with varying levels of HER2; 89 women received the GP2 vaccine with a GM-CSF adjuvant and a control group of 91 patients received GM-CSF alone.
  • Eight patients experienced early recurrence or developed a second malignancy and did not complete the vaccine trial.
  • The vaccine is injected subcutaneously and the initial series consisted of monthly inoculations for six months, followed by four cycles of booster shots administered every six months thereafter. The patients were monitored for nearly three years.
  • Women with HER2 who were administered trastuzumab as part of the standard of care prior to receiving the vaccine experienced no cases of cancer recurrence.
  • Trastuzumab may act like a primer for the vaccine.  Trastuzumab stimulates CD4+ T cells to release substances that fight cancer cells and initiates an antibody response.
  • Thus, it may prepare the immune system, making the vaccine even more effective. MD Anderson is now testing this combination of immunotherapies in other clinical trials.

For more information:  American Society of Oncology 2104 Breast Cancer Symposium, J Clin Oncol 32, 2014 (suppl 26; abstr 134), Primary analysis of the prospective, randomized, phase II trial of GP2+GM-CSF vaccine versus GM-CSF alone administered in the adjuvant setting to high-risk breast cancer patients

9.  First clinical trial on HER-2-negative breast cancer with nintedanib

http://medicalxpress.com/news/2014-09-team-successfully-fisrt-clinical-trial.html

  • The experimental drug nintedanib, combined with standard chemotherapy with paclitaxel, causes a total remission of tumours in 50% of patients suffering from early HER-2- negative breast cancer, the most common type of breast cancer.
  • Recent theories suggest that a possible solution to cancer might be to ‘suffocate the tumour’ by blocking the formation of new blood vessels that surround it.
  • The mechanism of action of the experimental drugs nintedanib (Boehringer Ingelheim) and dovitinib (Novartis) precisely consists on blocking the formation of new blood vessels, so-called angiogenesis, which can lead to retardation in tumour growth rates and limit its viability.
  • “Nintedanib [a drug that there is more experimental data on] is an improved antiangiogenic drug compared to previous angiogenesis inhibitors, given that it prevents angiogenesis in a more efficient way and with lower toxicity than its predecessors.”
  • Nintedanib, in addition to blocking vascular endothelial growth factor receptors (VEGFR) and platelet derived growth factor receptors (PDGFR), also acts on fibroblast growth factor receptors (FGFR), which makes it different to classical angiogenesis inhibitors.
  • FGFRs work in an aberrant manner in 10-15% of HER-2 negative breast cancers, which could explain a greater the compound’s greater anti- tumour activity compared to other compounds.

For more information: British Journal of Cancer (2014) 111, 1060–1064. doi:10.1038/ bjc.2014.397, Phase I clinical trial of nintedanib plus paclitaxel in early HER-2-negative breast cancer (CNIO-BR-01-2010/GEICAM-2010-10 study)

10.  Researchers Predict Atypical Ductal Hyperplasia Patients at Low Risk for Breast Cancer

http://www.cancernetwork.com/asco-2014-breast-cancer-symposium/researchers-predict-adh-patients-low-risk-breast-cancer

  • Researchers have identified a group of women with atypical ductal hyperplasia found on core needle biopsy who should be considered to be at low risk for disease upgrade.
  • These women should be considered for prevention therapy and surveillance rather than undergoing surgical excision

For more information:  American Society of Oncology 2104 Breast Cancer Symposium, J Clin Oncol 32, 2014 (suppl 26; abstr 3), A multivariate model to predict cancer upgrade from atypical ductal hyperplasia by core needle biopsy.

11.  ‘Electronic skin’ could improve early breast cancer detection

http://www.eurekalert.org/pub_releases/2014-09/acs-s091014.php

  • Small masses of cancer cells are not always easy to catch. Current testing methods, including MRI and ultrasounds, are sensitive but expensive.
  • Mammography is imperfect, especially when it comes to testing young women or women with dense breast tissue.
  • Clinical breast exams performed by medical professionals as an initial screening step are inexpensive, but typically don’t find lumps until they’re 21 millimeters in length, which is about four-fifths of an inch.
  • Detecting lumps and determining their shape when they’re less than half that size improves a patient’s survival rate by more than 94 percent.
  • Some devices already mimic a manual exam, but their image quality is poor, and they cannot determine a lump’s shape, which helps doctors figure out whether a tumor is cancerous.
  • Scientists are now developing an “electronic skin” that “feels” and images small lumps that fingers can miss. Knowing the size and shape of a lump could allow for earlier identification of breast cancer, which could save lives.
  • The electronic skin is made out of nanoparticles and polymers that can detect, “feel” and image small objects.
  • To test how it might work on a human patient, they embedded lump-like objects in a piece of silicone mimicking a breast and pressed the device against this model with the same pressure a clinician would use in a manual exam.
  • They were able to image the lump stand-ins, which were as little as 5 mm and as deep as 20 mm.
  • The device could also be used to screen patients for early signs of melanoma and other cancers.

For more information:  ACS Applied Materials & Interfaces, 2014, 6 (18), pp 16368–16374, DOI: 10.1021/am5046789, Tactile Imaging of an Imbedded Palpable Structure for Breast Cancer Screening

12.  Ramucirumab fails in HER2-negative advanced breast cancer

http://www.2minutemedicine.com/ramucirumab-fails-in-her2-negative-advanced-breast-cancer/

  • The addition of ramucirumab, a VEGF-2 receptor blocker, to docetaxel did not significantly increase progression free or overall survival in HER-2 negative advanced breast cancer.

For more information, American Society of Oncology 2104 Breast Cancer Symposium, September 2, 2014, doi:10.1200/JCO.2014.57.1513, Primary Results of ROSE/TRIO-12, a Randomized Placebo-Controlled Phase III Trial Evaluating the Addition of Ramucirumab to First-Line Docetaxel Chemotherapy in Metastatic Breast Cancer

13.  Mixed Results for Saving Ovaries in Breast Cancer

http://www.medpagetoday.com/MeetingCoverage/MBCS/47534

  • Women who received a luteinizing hormone-releasing hormone (LHRH) analog during chemotherapy had a nonsignificant increase in pregnancies and resumption of menstruation, a randomized trial showed.
  • The addition of triptorelin to breast cancer chemotherapy did not adversely affect disease control or survival compared with chemotherapy alone.
  • Earlier this year, investigators in a different trial reported a significant reduction in ovarian failure, a significant increase in pregnancies, and significant improvement in DFS among breast cancer patients treated with the LHRH agonist goserelin during chemotherapy.
  • That trial was limited to patients who had hormone receptor-negative breast cancer, whereas 80% of the Italian study’s patient population had hormone-sensitive disease, Lambertini noted.
  • A large study conducted by the National Surgical Adjuvant Breast and Bowel Project showed that treatment-induced amenorrhea for 6 months or longer predicted better overall survival and DFS in women with hormone receptor-positive disease.

For more information: American Society of Oncology 2104 Breast Cancer Symposium, Abstract 105, “Long-term outcome results of the phase III PROMISE-GIM6 study evaluating the role of LHRH analog during chemotherapy as a strategy to reduce ovarian failure in early breast cancer patients

14.  Radiation may replace axillary lymph node dissection after sentinel lymph node biopsy-detected N1 disease

  • Radiation and axillary lymph node dissection conferred similar OS and RFS among patients with pathological N1 breast cancer detected by sentinel lymph node biopsy after mastectomy.
  • However, radiation was associated with less side-effects, results showed.
  • Recent research suggested that axillary lymph node dissection (ALND) was unnecessary after lumpectomy in patients with one to two positive nodes detected by sentinel lymph node biopsy (SLNB), according to background information provided by researchers.
  • “Radiation was as effective as complete axillary lymph node dissection in patients with mastectomy and N1 disease detected by SLNB for OS and RFS rates, yet radiation after SLNB had fewer side effects than axillary lymph node dissection,” Fu and colleagues wrote. “SLNB followed by radiation could replace axillary lymph node dissection in patients with mastectomy and pathological N1 breast cancer identified by SLNB.”

For more information:  American Society of Oncology 2104 Breast Cancer Symposium, J Clin Oncol 32, 2014 (suppl 26; abstr 101), Is axillary lymph node dissection necessary after sentinel lymph node biopsy in patients with mastectomy and pathological N1 breast cancer?

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3 responses

  1. I’ve been recently reading a lot about BET inhibition in combatting metastasis. As I’ve developed the paraneoplastic syndrome called dermatomyositis, stimulating the immune system to fight breast cancer increases the autoimmune attack on my body as well. BET inhibition is an intriguing therapy because it involves gene therapy rather than immuno stimulation therapy. It’s called an epigenetic type of therapy and Phase 2 trials are popping up. very exciting stuff.

  2. An interesting question would be; is soy consumption in its largely “native’ form (eg as tofu, soy milk, natto or even plain boiled soybean) the same as consuming its extracted form ie soy protein or soy protein isolate?

    Anyway, the MSK researchers used:
    Soy Protein isolate that also contained maltodextrin, sucrose, fructose, artificial flavour, calcium phosphate, magnesium phosphate, riboflavin, vitamin A palmitate, folic acid, vitamin D3, and vitamin B12. Isoflavone content of the soy protein: 1.2 mg genistein/g protein, and 0.8mg daidzein/g protein.

    The Placebo is made of isolated milk protein and the same other components as above for soy, but no isoflavones.

    As for 100g of boiled soybean, it contains:
    Calories 173
    Total Fat 9 g
    Saturated fat 1.3 g
    Polyunsaturated fat 5 g
    Monounsaturated fat 2 g
    Sodium 1 mg
    Potassium 515 mg
    Total Carbohydrate 10 g
    Dietary fiber 6 g
    Sugar 3 g
    Protein 17 g
    and Vitamin C, Calcium, Iron, Vitamin B-6, Magnesium

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