City of Hope Testing Novel Freezing Technique on Early-Stage Breast Cancer
August 24, 2017
| by Samantha Bonar
Lusi Tumyan, M.D.
City of Hope is among just a handful of facilities in the country — and one of only two in California — participating in a clinical trial of an exciting new way to treat breast cancer by freezing the tumor.
This minimally invasive technique, called FROST (Freezing Instead of Resection of Small Tumors), can be done on an outpatient basis using local anesthesia.
“It’s less than an hour and they’re done and they go home,” said Lusi Tumyan, M.D., a diagnostic radiologist and assistant clinical professor in the Department of Diagnostic Radiology at City of Hope. Tumyan is the only physician at City of Hope who performs this procedure and one of just two physicians in Southern California to do so.
Freezing, also called cryoablation, has been used successfully for decades to treat several types of cancer, most commonly liver, lung and prostate. The process uses liquid nitrogen to freeze tumors and damage the adjacent blood vessels that fuel their growth. “We know that it works in other cancers,” Tumyan said. “Now we just have to prove that it works in breast cancer.”
The technology uses a probe that channels liquid nitrogen to flow within a precise area of the needle so that it creates a freeze zone. This creates what Tumyan calls an “iceball” around the tumor that freezes and kills it.
Tumyan said FROST offers a safe, effective option for women with early-stage breast cancer (typically with a tumor size of 1.5 cm. or smaller), especially when they are not good candidates for standard treatments (for example, if they have other medical conditions that would make surgery risky). It is also less likely to disfigure the breast and the aftereffects are “minimal.” Patients receive imaging every six months after the treatment as follow-up.
Currently, the standard of care for early-stage breast cancer is surgery (lumpectomy or mastectomy) followed by radiation and/or chemotherapy. A major drawback of surgery is cosmetic and functional impairment of the breast.
An important added bonus of the FROST treatment is that it may stimulate an immune response in the body that will keep it on the lookout for any stray cancer cells, even after the tumor is destroyed.
“The thinking is that once we freeze the tumor cells and the dead cells enter the blood to be eliminated, the body will perceive them as abnormal and begin creating antibodies to them,” Tumyan said. “So not only do you get this freezing effect, you also get this immunological effect. It’s exciting and we should be looking at that effect also.” She said City of Hope is considering adding blood tests to their FROST clinical trial so that staff immunologists can measure this response.
An initial five-year, multicenter study of cryoablation to treat early-stage breast cancer sponsored by the National Cancer Institute found it to be 92 percent effective for complete ablation of invasive breast tumors smaller than 2 centimeters and 100 percent effective for complete ablation of invasive ductal breast cancer tumors smaller than 1 centimeter.
Results from this study led to the current FROST trial, for which Tumyan is actively recruiting patients. The FROST Clinical Study is currently enrolling women age 50 and older with core needle biopsy proven clinical stage I, T1, (≤1.5 cm.) clinically node negative (N0), unifocal, hormone receptor positive and HER2/neu-negative invasive ductal carcinoma. For more information, please go here.
“These are patients with less aggressive cancers,” Tumyan explained. “At some point, if we get favorable results, we could apply it to other kinds of tumors. At this point, we’re trying to see if we can treat the smallest and the most favorable tumors. This is all new. As soon as the results are in on this trial, we can tell you exactly how effective it is. Further studies will explore how much of the tumor can we really treat and can we really treat the aggressive tumors.
“It’s going to be a great option, I think,” she added. “This is the future. It offers a noninvasive treatment of breast cancer. The patient comes in and they go home the same day. It would be like having a small biopsy.”