Five Advances Transforming Breast Cancer Care and Prevention
Article Summary
- Breast cancer is the most common cause of cancer in the U.S.
- Sylvester Comprehensive Cancer Center offers a number of innovative treatments for breast cancer patients.
- Sylvester researchers are basing treatments on mutations presumed to be driving tumor growth and spread, not the cancer’s site of origin, in their work for the ASCO TAPUR study.
Breast cancer is the most common cancer in U.S. women and accounts for about 30% of all new cancers diagnosed in women each year.
Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine and South Florida’s only National Cancer Institute (NCI)-designated cancer center, is at the forefront of breast cancer care and innovation.
Here are five advances that Sylvester is spearheading to transform breast cancer care and prevention.
Prevention in a Pill
According to Elisa Krill-Jackson, M.D., a Sylvester hematologist and oncologist and associate director of Community Outreach for Women’s Health at UHealth in Aventura, Fla., medical management is a powerful and underused tool in breast cancer prevention.
“Many women who are at higher breast cancer risk because of family history, an abnormal breast biopsy or extremely dense breast tissue could prevent breast cancer by taking a pill,” Dr. Krill-Jackson said, adding that some pill-based treatments have shown to prevent 50% of breast cancers in high-risk women. “We have a number of different options, including tamoxifen.”
Dr. Krill-Jackson explained that studies have found that taking one-fourth of the tamoxifen dose used to treat breast cancer appears to be as effective as the full dose for the prevention of new breast cancer, with few side effects.
Other pill options that have been approved in the U.S. for preventing new breast cancers include anti-estrogen aromatase inhibitors and raloxifene, which is used to improve bone density for osteoporosis.
Precision Medicine Evolves in TAPUR Trial
As a regional provider for the American Society of Clinical Oncology (ASCO)-sponsored Targeted Agent and Profiling Utilization Registry (TAPUR) study, Sylvester’s researchers have learned more about genomics and breast cancer for precision care, said TAPUR principal investigator Carmen Calfa, M.D., medical co-director of Sylvester’s Cancer Survivorship and Supportive Care Program, leader of the Genetic Predisposition Syndrome (GPS) Initiative at Sylvester and a breast medical oncologist and physician.
The TAPUR study looks at all tumor types. Investigational treatments are based on mutations presumed to be driving tumor growth and spread, not the cancer’s site of origin.
“Many breast cancer patients were able to participate in TAPUR, nationally and at our institution,” said Dr. Calfa, a member of the ASCO TAPUR steering committee and molecular tumor board. “The beauty of this trial is that it is pragmatic, mimics real-life practice, is scientifically sound and offers the opportunity to try single agents or combination of drugs and learn quickly if there is a positive or a negative signal for a response.”
TAPUR has bolstered evidence for the use of immunotherapy and other targeted therapies in selected breast cancer patients.
“In our six years participating in TAPUR, we have witnessed amazing, life-changing and durable responses, which keeps our hopes high and our commitment to finding a cure even higher,” Dr. Calfa said.
Can Circadian Alignment Reduce Treatment-related Fatigue?
Sylvester and Dana Farber Cancer Institute researchers are collaborating on the FastER trial to study the impact of circadian alignment in breast cancer patients who recently started cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor therapy.
Circadian alignment entails prolonged, overnight fasting with or without exercise for study participants. The NCI-funded study looks at how to reduce treatment-related fatigue in advanced or metastatic breast cancer, one of the treatment’s most problematic side effects.
“Two years ago, we conducted a pivotal trial that demonstrated if we can align people’s circadian rhythms based upon when they are eating their meals and their exercise during the day, we could improve levels of fatigue and sleep,” said Tracy Crane, Ph.D., RDN, director of lifestyle medicine, prevention and digital health at Sylvester and the contact principal investigator on the study.
SLYMPHA Surgical Procedure
Lymphedema is a serious complication from cancer surgery and radiation treatment that impacts as many as 30% of breast cancer patients To help these patients, Sylvester breast cancer surgeon Eli Avisar, M.D., pioneered a relatively simple surgical procedure that has been shown to reduce the rate of lymphedema by about two-thirds.
Dr. Avisar has completed about 500 Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) procedures, reconnecting the lymph channels to vessels of the veins.
“This procedure is something any surgeon can learn and is taught annually at the American Society of Breast Surgeons meetings. Today, surgeons are performing it worldwide,” he said. “Unfortunately, too many patients don’t know this is an option, and they still get all the side effects, including swelling, pain and more.”
Lymphedema Treatment
For cancer patients who struggle with lymphedema, Sylvester offers the Comprehensive Lymphatic Center, the only South Florida Center of Excellence in lymphedema care designed by the Lymphatic Education and Research Network.
While there are many options for patients, treatment is catered to the patient’s diagnosis.
“We use an interdisciplinary and multidisciplinary team approach, with certified lymphatic massage therapists, certified lymphedema physical and occupational therapists, cancer rehabilitation medicine, and microsurgery and vascular surgery specialists, to create individualized treatment plans to meet the needs of breast cancer patients and the many other patients who suffer from this condition,” said Diana Molinares, M.D., assistant professor of clinical physical medicine and rehabilitation and director of Oncology Rehabilitation Medicine at Sylvester.
Tags: breast cancer, cancer research, Dr. Carmen Calfa, Dr. Diana Molinares, Dr. Eli Avisar, Dr. Elisa Krill-Jackson, Dr. Tracy Crane, lymphedema, Sylvester Comprehensive Cancer Center