Author Interviews, Breast Cancer, JAMA, USPSTF / 01.05.2024

MedicalResearch.com Interview with: Wanda K. Nicholson, M.D., M.P.H., M.B.A. Senior Associate Dean for Diversity, Equity, and Inclusion Professor of Prevention and Community Health Milken Institute School of Public Health George Washington University Dr. Nicholson was appointed chair of the U.S. Preventive Services Task Force in March 2024. She served as vice chair from March 2022 to March 2024 and as a member of the Task Force from January 2009 through December 2013. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Breast cancer is the second most common cancer and the second most common cause of cancer deaths for women in the U.S. After reviewing the latest science, the Task Force recommends screening all women for breast cancer every other year starting at age 40 and continuing through age 74. This new approach has the potential to save nearly 20 percent more lives from breast cancer and has even greater potential benefit for Black women, who are much more likely to die from breast cancer. (more…)
AACR, Author Interviews, Biomarkers, Breast Cancer, Cancer Research / 11.04.2024

MedicalResearch.com Interview with: RJ Tesi M.D. CEO and Founder of INmune Bio MedicalResearch.com: What is the background for this study? What are the main findings?
  • MUC4 expression by high-risk breast cancer (HER2+ or TNBC) is a biomarker that predicts resistance to therapy and an increased risk a metastasis. MUC4 expression can be determined at time of biopsy and therapeutic decisions should be adjusted to optimize the chance of response to first line therapy.
This biomarker is easily determined using immunohistochemistry in the diagnostic breast biopsy tissue similar to testing for HER2 expression. Testing for MUC4 can be easily added to the current panel of routine stains obtained at the time of the diagnostic biopsy. Knowing MUC4 status in women with high-risk breast cancer will improve results.
  • Soluble TNF causes the up regulation of immune checkpoint proteins of cells of the TME. This includes CD47 and SIRPa on tumor based macrophages and CTLA4, PD1, LAG3 and TIGIT on T cells in the TME. INB03 is a pan immune checkpoint modulator. Treatment with INB03 downregulates all immune checkpoint proteins on the cells. Downmodulation of all immune checkpoint proteins improves response to immunotherapy.
Currently, monoclonal antibodies targeting immune checkpoint proteins are a mainstay of cancer therapy and cancer drug development. These strategies target one immune checkpoint protein at a time. To date, combination therapy targeting two immune checkpoint proteins has been tried (e.g.: anti-PD1 and anti-CTLA4 combination therapy) with mixed results. Combination immune checkpoint strategies may increase therapeutic response but increase toxicity. INB03 downregulates all immune checkpoint proteins. This is equivalent to giving a patient a 6 antibody cocktail – something that cannot be done in man. As expected, decreased immune checkpoint expression improves response to therapy by converting immunotherapy resistant tumors to immunotherapy sensitive tumors.
  • In TNBC, MUC4 expression predicts both resistance to anti-PD1 therapy and increased risk of distant metastasis. Treatment with INB03 decreases expression of proteins associated with tumor metastasis, decreases the number of metastasis and improves response to anti-PD1 therapy. Early use of INB03 may prevent distal disease and improve tumor control.
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Author Interviews, Breast Cancer, Radiology / 28.03.2024

MedicalResearch.com Interview with: Yolanda Bryce, MD Director, Interventional Radiology Residency Program Memorial Sloan Kettering Cancer Center New York   MedicalResearch.com: What is the background for this study? For whom would this treatment be indicated? Response: The standard of care for local breast cancer includes surgery, however many patients are poor surgical candidates or refuse surgery. I use cryoablation to treat this population. (more…)
Author Interviews, Breast Cancer, Cancer Research / 04.02.2024

MedicalResearch.com Interview with: Takemi Tanaka, Ph. D. Professor, Stephenson Cancer Center Department of Pathology, School of Medicine University of Oklahoma Health Science Center MedicalResearch.com: What is the background for this study? Response: Our previous cohort study has shown that breast cancer progresses 60 days after diagnostic biopsy in early-stage ER+ breast cancer. Others have also reported increased breast cancer mortality due to surgery delay. These observations raised the question of how slow-growing ER+ breast cancer progresses so quickly in just 60 days following diagnosis, prompting us to hypothesize whether needle biopsy of breast tumors accelerates pro-metastatic changes. (more…)
Breast Cancer, Technology / 22.10.2023

Breast cancer accounts for 12.5% of new annual cases in the world, making it the most common of all cancers. Early detection is vital, since when breast cancer is localized, it boasts a 99% survival rate. Despite this fact, only 64% of breast cancer cases are detected at a localized stage in the US, according to data obtained from the National Breast Cancer Foundation. The good news is that scientists at MIT have developed a new device that can simply be incorporated into a bra. Doing so would allow more frequent monitoring of people with a high risk for breast cancer and it would enable women to detect very early stage tumors.
A Patch In Time
The device is a flexible patch that can be attached to any bra. It has an ultrasound tracker that can analyze breast tissue from various angles—and the images obtained are as high in quality as those obtained from ultrasound probes used in medical imaging clinics The device provides real-time information that is easy to access and interpret. The development of the device resulted from the personal experience of MIT associate professor. Canan Dagdeviren. The latter’s aunt was diagnosed with late-stage breast cancer at the age of 49, passing away six months later. While sitting by her aunt’s bedside, the researchers created a rough schematic of a diagnostic patch that could be incorporated into a brassiere. The aim was to enable women to obtain more frequent information instead of depending on a once-yearly (or less frequent) checkup. Dagdeviren’s device is essentially a miniature 3D-printed ultrasound scanner that has tiny openings. It can be rotated to obtain images from a plethora of angles, and does not require medical expertise to use. The device leverages the very latest technology, including AI algorithms, biomedical systems, and low-power circuits
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Author Interviews, Breast Cancer, JAMA, OBGYNE, Surgical Research / 04.10.2023

MedicalResearch.com Interview with: Gabriele Martelli, MD Breast Unit, Surgery Fondazione IRCCS Istituto Nazionale dei Tumori Milan, Italy MedicalResearch.com: What is the background for this study? Response: Approximately 8% of breast cancer cases are associated with pathogenic germline variants of the BRCA1 or BRCA2 genes. Women with a pathogenic BRCA1 variant have lifetime risks of breast or ovarian cancer of 45% to 80% and 30% to 60%, respectively. Women with a pathogenic BRCA2 variant have lifetime risks of breast or ovarian cancer of 35% to 60% and 10% to 25%, respectively. BRCA1 breast cancer is often more aggressive than sporadic disease, while BRCA2 breast cancer is often of similar aggressivity to sporadic disease. However, few studies have investigated outcomes of breast-conserving surgery, prophylactic mastectomy, or prophylactic salpingo-oophorectomy in patients with BRCA1/2 breast cancer. We conducted a cohort study to assess outcomes of breast-conserving surgery vs mastectomy, prophylactic mastectomy vs no prophylactic mastectomy, and prophylactic salpingo-oophorectomy vs no prophylactic salpingo-oophorectomy in patients with BRCA1/2 breast cancer. (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, MRSA, Radiation Therapy / 06.05.2023

MedicalResearch.com Interview with: Beth McLellan, M.D. Chief, Division of Dermatology Montefiore Medical Center Albert Einstein College of Medicine MedicalResearch.com: What is the background for this study? How is the decolonization initiated and maintained? Response: We were interested in exploring whether bacteria on the skin plays a role in radiation dermatitis like it does in other skin diseases that cause a breakdown in the skin barrier. We used a bacterial decolonization regimen that includes chlorhexidine 2% cleanser for the body and mupirocin 2% ointment to the inside of the nose for 5 consecutive days before starting radiation therapy and repeated for an additional 5 days every other week for the duration of radiation. (more…)
Author Interviews, Breast Cancer, JAMA, Race/Ethnic Diversity / 25.04.2023

MedicalResearch.com Interview with: Mahdi Fallah, MD, PhD Study and Group Leader Risk Adapted Prevention (RAD) Group Division of Preventive Oncology National Center for Tumor Diseases (NCT) German Cancer Research Center (DKFZ) Heidelberg, Germany   MedicalResearch.com: What is the background for this study? Response: Breast cancer is a significant public health problem, being the most commonly diagnosed cancer and the second leading cause of cancer death in women in the US. Breast cancer screening from age 50 has been associated with a reduction in mortality and is recommended by the US Preventive Services Task Force. However, there is a significant disparity in mortality rates between Black and White individuals, with Black women having a higher death rate, especially before age 50. The current one-size-fits-all policy for breast cancer screening may not be equitable or optimal, and risk-adapted starting ages of screening based on known risk factors, such as race and ethnicity, may be recommended to optimize the benefit of screening. Our study aimed to provide evidence for a risk-adapted starting age of screening by race and ethnicity. (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, Race/Ethnic Diversity / 09.03.2023

MedicalResearch.com Interview with:
Hyuna Sung, PHDHyuna Sung, PHD Senior Principal Scientist, Cancer Surveillance Research American Cancer Society Kennesaw, GA 30144
  MedicalResearch.com: What is the background for this study? Response: Triple-negative breast cancer (TNBC) accounts for 10% to 20% of all breast cancer diagnoses in the US. This subtype of breast cancer tends to spread faster and has fewer treatment options. In the US, Black women are about two-fold more likely than White women to develop TNBC. (more…)
Author Interviews, Breast Cancer, Mammograms / 07.12.2022

MedicalResearch.com Interview with: Wendie Berg, MD, PhD, FACR Professor of Radiology University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Mammography misses many cancers in women with a personal history of breast cancer (PHBC). MRI improves early detection of cancer in women with PHBC and the American College of Radiology recommends adding MRI every year for women with PHBC and dense breasts or diagnosis by age 50 but not every woman can tolerate MRI. Contrast-enhanced mammography (CEM) appears to be a good alternative to MRI.  Our study examined performance of CEM after tomosynthesis in women with PHBC.  We first trained our radiologists in CEM (Berg WA et al JBI 2021) and two radiologists interpreted both tomosynthesis and CEM on every participant. (more…)
Author Interviews, Breast Cancer, JAMA, Mammograms, Medical Imaging, UCSF / 15.06.2022

MedicalResearch.com Interview with: Karla Kerlikowske, MD. Professor, Departments of Medicine and Epidemiology/Biostatistics, Cancer Center Program Membership. Breast Oncology UCSF MedicalResearch.com:  What is the background for this study?  Response: Digital breast tomosynthesis (DBT) was developed with the expectation it would improve detection of breast cancer in women with dense breasts and decrease false-positive results. DBT is now available at most breast screening centers. (more…)
ASCO, Author Interviews, Breast Cancer, Cancer Research, Race/Ethnic Diversity / 09.06.2022

MedicalResearch.com Interview with: Sachi Singhal, MD Department of Medicine Crozer Chester Medical Center Upland, PA MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: This study focuses on analysing the National Inpatient Sample for patients with breast cancer, their breakdown by race, gender and US regions, and their mortality per sub-group. The main findings are that African Americans, especially AA women are at significantly increased odds of dying from metastatic breast cancer in the United States. (more…)
Author Interviews, Breast Cancer, JACC, Weight Research / 18.05.2022

MedicalResearch.com Interview with: Dr. Amy Kirkham, PhD Assistant Professor of Clinical Cardiovascular Health Faculty of Kinesiology & Physical Education University of Toronto Affiliate Scientist at Toronto Rehabilitation Institute MedicalResearch.com:  What is the background for this study?  Response: Women who have had a breast cancer diagnosis are at least two-fold and often higher risk of cardiovascular or heart disease compared to women without a history of breast cancer. Older age, higher body mass index, and receipt of chemotherapy treatment that can injure the heart are risk factors for cardiovascular death after a breast cancer diagnosis. Time-restricted eating is a type of intermittent fasting that appears to be easy to follow and to improve some measures of metabolic health but has not been studied in populations with a cancer history. Time-restricted eating simply involves consuming all calorie intake within a specific time window, commonly 8 hours, like between 12 and 8 pm, and then only consuming water or black coffee outside of those hours. We enrolled breast cancer survivors who were aged 60 or older, had an overweight or obese mass index, and were finished chemotherapy treatment in a single-arm trial of time-restricted eating for 8 weeks. We asked participants to restrict their calorie intake between 12 and 8 pm from Monday to Friday with no restrictions on weekend and no further instructions on what to eat. (more…)
Author Interviews, Breast Cancer, Cancer Research, Race/Ethnic Diversity, Vitamin D / 26.04.2022

MedicalResearch.com Interview with: Katie M. O’Brien PhD Chronic Disease Epidemiology Group National Institute of Environmental Health Sciences MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: Vitamin D may protect against breast cancer. Although women of color have lower average vitamin D levels than non-Hispanic White women, few studies have considered the role of race/ethnicity. In a sample of self-identified Black/African American and Hispanic/Latina women, we observed that vitamin D concentrations measured in blood were inversely associated with breast cancer, particularly among Latinas. These findings indicate that vitamin D may protect against breast cancer, including among racial/ethnic groups with low average circulating levels. (more…)
ASCO, Author Interviews, Biomarkers, Breast Cancer / 18.06.2021

MedicalResearch.com Interview with: Dr. Frank Vicini, MD, FACR, FASTRO Principal Investigator Radiation Oncologist at GenesisCare Member of NRG Oncology MedicalResearch.com: Would you briefly explain what is meant by DCIS? Response: DCIS stands for ductal carcinoma in situ and indicates the presence of abnormal cells inside a milk duct in one or both breasts. Sometimes referred to as Stage 0 (zero), it is considered the earliest form of breast cancer and is noninvasive. The tumor has not yet left the duct-- a passageway that transports milk from the breast lobules to the nipple-- and begun to invade the healthy tissue surrounding it. Standard treatment options for DCIS include surgery, radiation therapy and hormonal therapy. (more…)
ASCO, Author Interviews, Breast Cancer, Cancer Research, Journal Clinical Oncology, Metabolic Syndrome, Race/Ethnic Diversity, Social Issues / 08.06.2021

MedicalResearch.com Interview with: Giampaolo Greco PhD MPH Assistant Professor Department of Population Health Science and Policy Icahn School of Medicine  at Mount Sinai MedicalResearch.com: What is the background for this study? Response: The motivation for our study was to understand why mortality rate from breast cancer is much higher in African American women than in White women, despite the fact that these groups have similar incidence rate of breast cancer. Metabolic syndrome, a cluster of metabolic abnormalities that includes abdominal obesity, hypertension, hyperglycemia and dyslipidemia, is more prevalent among African American women and may be a risk factor for breast cancer. Subjective social status (SSS) is the perception of individuals of their own ranking in the social hierarchy and complements other parameters of socioeconomic status, such as income and education, that are considered more objective. Socioeconomic status is associated with cardiovascular and mental health. Although objective measures of social status are associated with worse breast cancer outcomes, the relationship of SSS to breast cancer is uncertain. (more…)
Author Interviews, Breast Cancer, Cancer Research, Radiation Therapy / 03.06.2021

  Professor Jayant S Vaidya MBBS MS DNB FRCS PhD Professor of Surgery and Oncology University College London MedicalResearch.com: What is the background for this study? What type of single dose radiation is used? Response: The new paper published in the British Journal of Cancer (go.nature.com/3yN0mzu) expands on the previously published results of the large international randomised trial (TARGIT-A trial)(BMJ 2020;370:m2836), that confirmed the long-term effectiveness of Targeted Intraoperative Radiotherapy (TARGIT-IORT): a breast cancer treatment which is increasingly available throughout the world. The TARGIT-A trial found that a single dose of targeted radiotherapy during surgery (TARGIT-IORT) is just as effective as conventional radiotherapy, which requires several visits to hospital after surgery. From the perspective of patients, it is so much better for them and also allows prompt completion of cancer treatment during the COVID pandemic. Conventional external beam radiotherapy (EBRT) is delivered from outside the body via a radiotherapy machine (linear accelerator), and consists of a daily treatment session (known as fractions) to the whole breast, over a period between three to six weeks. Each of these treatments is given over a few minutes, but requires up to 30 hospital visits, which could be a significant distance from where the patient lives. TARGIT-IORT is delivered immediately after lumpectomy (tumour removal), via a small ball-shaped device placed inside the breast, directly where the cancer had been. The single-dose treatment lasts for around 20 to 30 minutes and replaces the need for extra hospital visits, benefiting both patient safety and well-being. The device used is called INTRABEAM. The new results are described on the Nature.com and UCL webpages https://go.nature.com/3ymrplc blog https://www.ucl.ac.uk/news/2021/may/pioneering-single-dose-radiotherapy-breast-cancer-treatment and explained in a short video https://youtu.be/w0OMjVfJ5pY  (more…)
Author Interviews, Breast Cancer, JAMA, Race/Ethnic Diversity / 17.05.2021

MedicalResearch.com Interview with: Ying Liu, MD, PhD Assistant Professor Washington University School of Medicine Department of Surgery, Division of Public Health Sciences St. Louis, MO MedicalResearch.com: What is the background for this study? Response: Non-Hispanic African American women experience a disproportional burden of poor breast cancer outcomes than non-Hispanic White women, which is associated with a higher incidence of triple-negative breast cancer (TNBC), more advanced stages at diagnosis, and lower treatment adherence. However, the differences in clinical treatment and outcomes between African American women with TNBC and their White counterparts have not been well defined. (more…)
Author Interviews, Breast Cancer, Cancer Research, Personalized Medicine / 09.05.2021

MedicalResearch.com Interview with: Kelly de Ligt, PhD Postdoctoral researcher | Project lead ‘PRO implementation in clinical care’ Psycho Social Research and Epidemiology (PSOE) Netherlands Cancer Institute – Antoni van Leeuwenhoek MedicalResearch.com: What is the background for this study? Response: Health-related Quality of Life (HRQoL) and survivorship has become increasingly important within breast cancer care, as the majority of women survives at least 10 years after breast cancer diagnosis. Breast cancer survivors may experience multiple co-existing symptoms that affect their health-related quality of life (HRQoL). Previous studies have mainly studied these symptoms as separate, independent items. However in reality, survivors usually experience multiple symptoms that can add up. We therefore studied the overall symptom burden in breast cancer survivors and tried to identify patterns in this. We believe this may be more relevant, as currently the needs of breast cancer survivors are not fully met and there is a growing demand for personalized follow-up care. We selected breast cancer survivors from the Netherlands Cancer Registry, which contains comprehensive information about diagnosis and treatment for all cancer patients in the Netherlands. Women who had been surgically treated with or without adjuvant treatment for breast cancer stages I to III and between one and five years after diagnosis were invited to participate in our survey. A total of 404 participating survivors were questioned about their experienced burden for fatigue, nausea, pain, shortness of breath, insomnia, appetite, constipation, diarrhoea, as well as emotional and cognitive symptoms  (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, NEJM / 22.04.2021

MedicalResearch.com Interview with: Aditya Bardia MD, MPH Director, Breast Cancer Research Program, Attending Physician, Massachusetts General Hospital Harvard Medical School  MedicalResearch.com: What is the background for this study? Response: Triple negative breast cancer (TNBC) represents an aggressive subtype of breast cancer associated with guarded prognosis. For patients with pre-treated metastatic TNBC, standard chemotherapy is associated with low response rate (5-10%) and poor progression-free survival (2-3 months), highlighting need for better therapies. Sacituzumab govitecan is an antibody drug conjugate (ADC) which  combines SN-38, an active metabolite of irinotecan, with an antibody against Trop-2, an antigen overexpressed in majority of triple negative breast cancer. (more…)
Author Interviews, Breast Cancer, Cancer Research, Sugar / 14.03.2021

MedicalResearch.com Interview with: Nadia Koyratty PhD student Department of Epidemiology and Environmental Health University at Buffalo State University of New York MedicalResearch.com: What is the background for this study? Response: The literature suggests that sugars contribute to the incidence of breast cancer, but few exists on the prognosis after a breast cancer diagnosis. MedicalResearch.com: What are the main findings? Response: Compared to breast cancer patients who never or rarely drank non-diet soda, those who reported drinking non-diet soda five times or more per week had a 62% higher likelihood of dying from any causes, and were 85% more likely to die from breast cancer specifically. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Stem Cells / 05.03.2021

MedicalResearch.com Interview with: Khalid Shah, MS, PhD Vice Chair of Research, Department of Neurosurgery Director, Center for Stem Cell Therapeutics and Imaging Director, Center for Excellence in Biomedicine Brigham and Women's Hospital Associate Professor, Harvard Medical School Principal Faculty, Harvard Stem Cell Institute  MedicalResearch.com: What is the background for this study? Response: Approximately 15-to-30 percent of patients with metastatic breast cancer have brain metastasis (BM), with basal-like breast cancer (BLBC) metastasizing to the brain most frequently. The prognosis for BLBC-BM patients is poor, as the blood-brain barrier prevents most therapeutics from reaching the brain. Testing candidate therapies in clinical trials is also challenging because animal models that mimic BM are limited. In this study we engineered a bimodal tumor-suppressing and killing molecule that can be delivered to the brain by stem cells and tested them in mouse models of brain metastases that mimic clinical setting. (more…)
Author Interviews, Breast Cancer, Genetic Research, JAMA, Race/Ethnic Diversity / 22.01.2021

MedicalResearch.com Interview with: Kent Hoskins, MD Eileen Lindsay Heidrick Professor in Oncology Division of Hematology/Oncology University of Illinois at Chicago Director of Cancer Genetics Co-Leader, Breast Cancer Research Group University of Illinois Cancer Center MedicalResearch.com: What is the background for this study? Response: The racial disparity in breast cancer mortality emerged in the US in the late 1980s in the wake of widespread implementation of mammography screening and the development of successful systemic adjuvant therapies for early breast cancer. Unfortunately, more than three decades later, Black women in the US still have a 40% higher mortality rate from breast cancer compared with non-Hispanic White women despite similar disease incidence. Health disparities research has primarily focused on the fact that Black women have a higher incidence of the aggressive triple-negative subtype, and that they are more likely to present with more advanced stages of disease. As important as those factors are, in recent years our group and others reported that Black women with hormone receptor-positive breast cancer have worse survival than non-Hispanic white women even after adjustment for stage at diagnosis and treatment. Since nearly 2/3 of breast cancers in Black women are hormone receptor-positive, this is a significant contributor to the overall mortality disparity. Importantly, these studies also suggested that Black women disproportionately develop biologically aggressive forms of hormone-dependent breast cancer, which is typically considered a more favorable disease subtype. Using data on more than 70,000 patients from the SEER registry that is linked to data from Genomic Health Laboratory, which provides the Oncotype DX recurrence score (the most commonly ordered prognostic/predictive multi-gene expression assay for early breast cancer), we set out to address three questions: 1) is there evidence of disproportionately aggressive tumor biology among Black women with hormone receptor (HR)-positive breast cancer, as reflected in the Oncotype DX recurrence score? 2) Is there a racial survival disparity even among patients with early stage, axillary node-negative tumors with comparable recurrence scores on the Oncotype assay? and 3) Is there is a difference in the prognostic accuracy of the Oncotype assay between Black and non-Hispanic white patients, since there was limited representation of Black women in the development and validation of the Oncotype assay and other prognostic/predictive assays?  (more…)
Author Interviews, Breast Cancer, Cancer Research, COVID -19 Coronavirus / 10.12.2020

MedicalResearch.com Interview with: Joanne L. Blum, MD, PhD, FACP Texas Oncology and Director Hereditary Cancer Risk Program Baylor University Medical Center MedicalResearch.com: What is the background for this study? Would you briefly describe the POLARIS study? Response: POLARIS is an ongoing prospective, real-world, non-interventional study in patients with HR+/HER2-ABC receiving palboiclib plus endocrine therapy with a targeted enrollment of 1500 patients at 110 sites in the United States and Canada.  MedicalResearch.com: What are the main findings?
  • Because of the COVID-19 pandemic, approximately one third of the study sites experienced an impact on their responsiveness to correspondence, timely data entry, and subject management.
  • The geographic location or type (e.g., academic or community) of study site appears associated with whether the site was impacted by COVID-19.
  • Other study site characteristics were generally similar between sites that reported an impact of COVID-19 and those that were not impacted.
  • Because of inherent limitations of survey studies, these findings must be interpreted with caution.
(more…)
Author Interviews, BMC, Breast Cancer, Brigham & Women's - Harvard, Cancer Research, Diabetes, Nutrition / 10.12.2020

MedicalResearch.com Interview with: Tengteng Wang, PhD, MSPH, MBBS Postdoctoral Research Fellow Department of Epidemiology Harvard T.H. Chan School of Public Health Channing Division of Network Medicine Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Type 2 diabetes (T2D) has been associated with poor progression of breast cancer. Moreover, having a breast cancer diagnosis may also increase the risk of developing T2D. Therefore, identifying strategies for T2D prevention among breast cancer survivors may play a key role in improving their survival outcomes. One approach may be through a diabetes risk reduction diet (DRRD), a dietary pattern comprised of 9 components that has been associated with 40% lower T2D risk in a previous Nurses’ Health Study publication.1 However, no studies to date have evaluated the association between adherence to the DRRD (as measured by the DRRD score) and survival outcomes following breast cancer. In this prospective cohort study among 8,320 breast cancer survivors, we found that greater adherence to the diabetes risk reduction diet after diagnosis was associated with a statistically significant 31% lower risk of overall mortality. Reduced breast cancer-specific mortality was also observed, which was more pronounced (20% lower risk) among those who improved adherence after diagnosis compared to women with consistently low DRRD adherence before and after diagnosis. (more…)
Author Interviews, Breast Cancer, Cancer Research, Chemotherapy, JAMA, Yale / 26.11.2020

MedicalResearch.com Interview with: Lajos Pusztai, M.D, D.Phil. Professor of Medicine Director, Breast Cancer Translational Research Co-Director, Yale Cancer Center Genetics and Genomics Program Yale Cancer Center Yale School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: In HER2-positive early stage (stage I-II) breast cancer, several different preoperative (also called neoadjuvant) chemotherapy options exist, each of these is associated with a different rate of complete eradication of cancer from the breast and lymph nodes (called pathologic complete response or pCR). Patients who experience pCR have excellent long term survival. The complete response rates range from 20% to 80%, the rates are higher with regimens that include several different chemotherapy drugs and dual HER2 blockade. Unfortunately, these highly effective multi-drug treatment regimens are also more toxic and more expensive.  We also learned that patients who do not achieve pCR after preoperative therapy, have high rates of recurrence, but the recurrence rate can be improved by administering postoperative adjuvant therapy. These two observations together, (1) different regimens with different toxicities and costs resulting in different pCR rates, and (2) existence of effective postoperative therapies for patients with residual cancer after preoperative therapy, sets the stage for combining various pre- and post-operative treatment strategies. Starting with a shorter, less toxic and less expensive neoadjuvant regimen would allow a substantial minority (20-45%) of patients who archive pCR to be spared of longer and more toxic regimens, whereas those with residual disease could receive the remaining part of the currently most effective regimens post-operatively as adjuvant therapy. In this study we examined the cost effectiveness of different neoadjuvant followed by adjuvant treatment strategies from a healthcare payer perspective. (more…)
Author Interviews, BMJ, Breast Cancer, Cancer Research, Radiation Therapy / 10.11.2020

MedicalResearch.com Interview with: Professor Jayant S Vaidya MBBS MS DNB FRCS PhD Professor of Surgery and Oncology University College London MedicalResearch.com: What is the background for this study? What type of single dose radiation is used?  Response: The findings of the large international randomised trial (TARGIT-A trial), published in the British Medical Journal (BMJ 2020;370:m2836), confirm the long-term effectiveness of Targeted Intraoperative Radiotherapy (TARGIT-IORT): a breast cancer treatment which is increasingly available throughout the world. For most women with early breast cancer, a single dose of targeted radiotherapy during surgery is just as effective as conventional radiotherapy, which requires several visits to hospital after surgery. Conventional external beam radiotherapy (EBRT) is delivered from outside the body via a radiotherapy machine (linear accelerator), and consists of a daily treatment session (known as fractions) to the whole breast, over a period between three to six weeks. Each of these treatments is given over a few minutes, but requires 15 to 30 hospital visits, which could be a significant distance from where the patient lives. TARGIT-IORT is delivered immediately after lumpectomy (tumour removal), via a small ball-shaped device placed inside the breast, directly where the cancer had been. The single-dose treatment lasts for around 20 to 30 minutes and replaces the need for extra hospital visits, benefiting both patient safety and well-being. The device used is called INTRABEAM. More details are described on the BMJ and UCL webpages: https://www.bmj.com/company/newsroom/single-dose-radiotherapy-as-good-as-conventional-radiotherapy-for-most-women-with-early-breast-cancer/ https://www.ucl.ac.uk/news/2020/aug/single-dose-radiotherapy-effective-treating-breast-cancer https://blogs.bmj.com/bmj/2020/08/20/targeted-intraoperative-radiotherapy-for-early-breast-cancer-new-evidence/ (more…)
Author Interviews, Breast Cancer, Cancer Research, Genetic Research, Ovarian Cancer / 22.07.2020

MedicalResearch.com Interview with: Prof Ranjit Manchanda MD, MRCOG, PhD Professor of Gynaecological Oncology & Consultant Gynaecological Oncologist NHS Innovation Accelerator (NIA) Fellow Integrated Academic Training Programme Director London Specialty School of Obstetrics & Gynaecology, Health Education England Specialty Research Lead for Gynaecological Cancer, NIHR, North Thames Clinical Research Network Cancer Research UK, Barts Centre | Queen Mary University of London Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine | Charterhouse Square | London Department of Gynaecological Oncology | Barts Health NHS Trust, Royal London Hospital MedicalResearch.com: What is the background for this study? Response: Around 10–20% of ovarian cancers and 6% breast cancers overall are caused by inheritable BRCA1/BRCA2 mutations. Women carrying BRCA1/BRCA2 mutations have a 17–44% risk of ovarian cancer and 69–72% risk of breast cancer until age 80 years. Most of these cancers can be prevented in unaffected BRCA1/BRCA2 women carriers. Women can opt for a range of options including screening, preventive, and reproductive choices to minimise their risk. The current approach uses established clinical-criteria/family-history (FH) based a priori BRCA probability thresholds to identify high-risk individuals eligible for BRCA testing. However, this requires individuals and health practitioners to recognise and act on a significant FH. BRCA carriers, who are unaware of their FH, unappreciative of its risk/significance, not proactive in seeking advice, or lack a strong FH (small families/paternal inheritance/chance) get excluded. Over 50% BRCA carriers do not fulfil clinical criteria and are missed. Despite >25 years of BRCA testing and effective mechanisms for prevention, current guidelines and access to testing pathways remain complex and associated with a massive under-utilisation of genetic testing. Only 20% of eligible women have accessed/undergone genetic testing and our earlier analysis showed that 97% of BRCA carriers in the population remain unidentified. Current detection rates are inadequate to identify all BRCA carriers and even doubling detection rates will not work. Why should we wait for decades for people to develop cancer before identifying BRCA carriers and unaffected at-risk family members to offer prevention?. This highlights substantial missed opportunities for early detection and prevention. A new population testing approach can change this. Jewish population studies show this is feasible, acceptable, has high satisfaction (91–95%), significantly reduces anxiety, doesn’t harm psychological well-being or quality of life, and is extremely cost-effective. However, this has not been evaluated in the general population and in particular across different  countries or health systems. The potential applicability and scope for this approach transcends continents and countries. Additionally, for interventions to be sustainable, they need to be cost-effective and affordable. We have undertaken a cost-effectiveness analysis of population based BRCA testing compared with current standard clinical testing of women designated as high risk, across high income countries (UK/USA/Netherlands), upper-middle income countries (China/Brazil), and low-middle income country (India). (more…)
Author Interviews, Breast Cancer, Mammograms / 30.06.2020

MedicalResearch.com Interview with: Rachel Farber, MPH School of Public Health Faculty of Medicine and Health University of Sydney New South Wales, Australia MedicalResearch.com: What is the background for this study? Response: Most breast screening programs worldwide have replaced the use of film mammography with digital mammography. While digital mammography provides significant technical and practical advantages over film mammography in the provision of population screening programs, the effect of this move on health outcomes remained unclear. An increase in screen detected cancer rates is only beneficial if the additional cancers detected would have otherwise presented at a later stage and caused morbidity and premature mortality. An indirect measure of this is an observed decrease in interval cancer rates. Interval cancers are cancers that are diagnosed after a woman has a negative screening result and before her subsequent scheduled screening. (more…)
ASCO, AstraZeneca, Author Interviews, Breast Cancer, Cancer Research / 02.06.2020

MedicalResearch.com Interview with: Josefa Briceno, MD Medical Head, DDR/ADC Franchise AstraZenca  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In January 2018, the US FDA expanded the approved use of LYNPARZA to treat patients with HER2- negative metastatic breast cancer with germline BRCA mutations based on positive results from the Phase III OlympiAD trial, which demonstrated the benefit of LYNPARZA over standard of care in physician’s choice chemotherapy in this patient population. LUCY is a Phase IIIb interim analysis aimed to evaluate the clinical effectiveness and safety of LYNPARZA in a real-world setting and has been expanded to include a group of patients with somatic BRCA mutations. A total of 252 patients with HER2-negative metastatic breast cancer with germline BRCA mutations were enrolled in the open-label, single-arm, Phase IIIb study. Patients received a taxane and/or anthracycline in the (neo)adjuvant/metastatic setting, and ≤2 lines of chemotherapy. The primary end point of the study was investigator-defined progression-free survival (PFS), and secondary end points included overall survival, time to first subsequent therapy or death, and investigator-assessed clinical response rate. The interim analysis was planned to take place after 160 progression-free survival events. Overall, treatment lasted for a median of 7.9 months, and the median progression-free survival was 8.1 months (95% confidence interval of 6.9-8.7; 166 progression-free survival events). In addition, the median time to first subsequent therapy or death was 9.7 months (95% confidence interval of 8.7-11.1) and the investigator-assessed clinical response rate was 48.6% (95% confidence interval of 42.2-55.0). Adverse events of all grades were reported in >20% of patients were nausea, anemia, asthenia, vomiting, and fatigue. Grade ≥3 adverse events were reported in 24.6% of patients, and 4.4% of patients had an adverse event that led to treatment discontinuation. (more…)