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Shedding light on triple negative breast cancer

Trials are under way for new drugs aimed at treating this aggressive type of the disease, which disproportionally strikes younger and African-American women

October 02, 2010|By Meredith Cohn, The Baltimore Sun

Another nationwide study in which breast cancer patients at Maryland are participating is for Avastin, which has sparked some controversy because it has not been shown to extend life for those with advanced breast cancer and has serious side effects. The drug, which may no longer be used on those kinds of patients, works by blocking blood vessel production in cancerous tumors. Cancer cells need the oxygenated blood to survive.

This study, however, is for early-stage cancer patients such as Bittinger. For a year and a half, Bittinger, who lives in Barton in Western Maryland, came to the university center three weeks a month to participate in the trial. She had hoped she'd get both the normal standard of care and the trial drug, which she did. She finished about two months ago.

After a cocktail of chemotherapy drugs and Avastin, surgery, radiation and another course of chemo drugs and Avastin, her scans show no cancer. She once had a tumor approximately 6-9 centimeters that shrank to less than a half a millimeter before it was surgically removed.

"The tumor shrank pretty dramatically," Bittinger said. "A local doctor I had seen said if she'd not examined me beforehand herself she'd not have known there was ever anything there."

Now, the teacher's aide and mother of two boys, 12 and 14, is hopeful. Triple negative breast cancer frequently recurs in the first few years after treatment. But the longer she survives, the lower the odds that will happen.

The doctors at Maryland are optimistic, too, that new therapies will keep more women cancer-free for longer. It's not clear, however, when any of the new drugs will gain government approval. Drug trials can be lengthy, Tkaczuk said.

"There's no telling how soon some of the new drugs can make it to market," she said. "It could take a long time. But we've had favorable results here."

Researchers will soon launch a trial of a hormone therapy not thought to be effective in triple negative patients because the cancers have no hormone receptors. Researchers at Maryland have been working to "reprogram" the cancer to make the treatment more effective.

Hopkins and Franklin Square are participating in trials involving chemotherapy drugs and targeted therapies for triple negative patients. And Hopkins is also leading or participating in several trials for other types of breast cancer and is including triple negative patients.

Not everyone can and will participate in trials, however. Doctors say they often require extra tests and time in treatment for uncertain results and possible side effects. The trials also aren't always local.

Dr. Marisa Weiss, an oncologist near Philadelphia who is president and founder of breastcancer.org an information clearinghouse, said only 5 percent of breast cancer patients participate in trials. Most, she said, just don't know trials are an option.

She said the trials are needed to develop new drugs for all kinds of cancer, but since there are no targeted drugs for triple negative breast cancer, it's especially important for women to participate.

"If anyone should be part of clinical trials it would be triple negative breast cancer patients," said Weiss, who provides trial information on her website. "But most are not treated in trials. A significant reason is they are not told and they don't ask about them. It's important to ask."

For Sharon Stewart, the treatment wasn't the problem. It was the diagnosis.

She received traditional care for her breast cancer: chemotherapy, surgery and radiation. A year after finishing the treatment, her golf-ball-sized tumor is gone, as is the cancer that had spread to a lymph node under her arm.

Stewart said she didn't even miss much work at her job scheduling appointments in a University of Maryland center that provides care for people living with viral and infectious diseases.

But she said, initially, her doctor insisted she had a cyst. When the lump she found kept growing, Stewart, then 46, decided to go early for her annual mammogram. Sure enough, it was cancer — triple negative.

"At the time, I didn't even know there were kinds of breast cancer, or stages," she said. "But in my heart I knew something was wrong."

So, her advice is to trust your instincts and seek out a second opinion.

Now she's focused on the reconstruction of her breast and on taking care of herself. She's taking medication to help repair some damage to her bones caused by chemotherapy.

"I feel good," said Stewart. "They told me the cancer could come back, but I don't believe it will."

Her example shows that triple negative breast cancer patients can have good outcomes, even without a trial drug, said Dr. Eric Winer, chief of the division of women's cancers at the Dana Farber Cancer Institute and a professor of medicine at Harvard Medical School.

Winer, a board member for the Triple Negative Breast Cancer Foundation, said traditional therapy can cure such cancer if it hasn't spread beyond the breast and lymph nodes under the arm.

For now, no breast cancer that leaves the breast and the nodes for other organs appears to be curable, Winer said. The spread can happen more quickly for triple negative patients, and that's where the trial drugs may be able to help most. He was optimistic that potential new therapies such as the PARP inhibitors could improving the quality and quantity of life for many more patients.

"But we don't assume chemotherapy can't be effective for triple negative patients," said Winer. "Many women do exceedingly well."



Triple negative breast cancer resources

tnbcfoundation.org the latest on triple negative breast cancer, including forums for survivors

breastcancer.org a clearing house of information on breast cancer, including trials

komen.org information on breast cancer, including research

Coming next Sunday

Special section on breast cancer, its survivors and those still fighting it.

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