The big chill: New breast cancer treatment freezes tumors

August 16, 2018 | by Michael Easterling

FROST Trial | City of Hope Patient Josephine Lambert (left) with her daughter, Susan
With a family history of cancer — ovarian, lung, breast and bladder among them — Josephine Lambert said she is lucky to have “dodged the cancer bullet” to make it to age 87.
But, in February of this year, Lambert found that her luck faded. Constant pain and tenderness in her right breast sent her to her physician who, upon examination, found a small lump in her left breast as it turned out. She found out she had breast cancer on Valentine’s Day, specifically ER+, PR+, HER2- with no lymph node activity.
Already enrolled in a clinical trial elsewhere for glaucoma, Lambert sought treatment for her cancer there originally. Her physician recommended surgical removal of the mass, as well as one of or more lymph nodes, with no chemotherapy or aromatase inhibitors to follow.

The Surgical Option

“Because of my advanced age, my daughter was very concerned about how I would fare through surgery,” Lambert said. “And because of my elevated levels of homocysteine, the procedure could have had deleterious effects on my vision and cognition.”
Lambert’s daughter Susan began looking for clinical trials, and it was a City of Hope Facebook post that prompted her to call and ask to speak to someone on the clinical trials team. She was connected to Tiffini Gosha, R.N., a clinical trials nurse navigator, whom Lambert said “was a godsend.”
“Susan contacted me and was very concerned about her mother having surgery, largely because of methylation difficulties and her historically high homocysteine, which would complicate traditional surgery done with anesthesia,” said Gosha. “When I came across Dr. Tumyan’s FROST clinical trial, I immediately contacted her and Dr. Laura Kruper to let them know I had found a patient who was potentially a good candidate for it. With the help of New Patient Services we got her consult scheduled. I feel blessed and fortunate to have helped Josephine and I look forward to helping others in the future.”
“Tiffini listened to my daughter very intently and compassionately, and before the conversation ended, she had found a few potential trials,” Lambert said. “The FROST study looked to be the best match and together they secured an appointment for me with Dr. Tumyan.”

An Ideal Candidate

Lusine Tumyan, M.D., is a diagnostic radiologist and assistant clinical professor in City of Hope’s Department of Diagnostic Radiology. Laura Kruper, M.D., M.S., is the director of City of Hope's Women’s Center and head of breast surgery service. For the past year, they have been conducting a clinical trial that freezes breast tumors as a treatment for cancer, a minimally invasive technique called FROST, or Freezing Instead Of Resection of Small Breast Cancers, also known as cryoblation. The procedure takes less than an hour and is less likely to disfigure the breast than a traditional lumpectomy. Lambert, accompanied by her daughter, was able to go back to her San Diego home the same day.
“Josephine was an ideal candidate for the clinical trial,” Tumyan said. “She met the criteria: She was over 50, her ductal carcinoma was less than 1.5 centimeters, and she was strong enough physically and emotionally to undergo baseline and follow-up breast MRIs and reconstruction. It was a great option for her.”
Other criteria to participate in the study are that the cancer has not spread and the patient has received no prior treatment for the current cancer in the breast. Patients in the trial must also agree to a five-year minimum course of endocrine therapy following the cryoblation. City of Hope is one of only two institutions in Southern California with cryoblation clinical trials.

Our First Patient in New Clinical Trial

Lambert was City of Hope’s first patient to have the FROST procedure. She said she was impressed and grateful for the speed in which she was enrolled into the clinical trial to receive the treatment.
“I had my first appointment at City of Hope just 40 days from my original diagnosis, and nine days after that I met with Dr. Tumyan and Dr. Kruper, and they explained how the procedure would be handled, and what to expect.”
The process uses liquid nitrogen to freeze tumors and damage the blood vessels that are feeding the tumor growth, which creates what Dr. Tumyan calls an “ice ball” that encases the tumor and freezes it for removal.

In Good Hands

Lambert responded well to the procedure and required no pain medication after. She is currently taking the aromatase inhibitor Femara to complete her cancer treatment.
“She’s doing great,” Tumyan said. “We were hopeful she’d do well with the cryoblation, and her response exceeded even our expectations. We’re very pleased with Josephine’s outcome and have already enrolled other patients. I want people to know that they can be treated for cancer when surgery is too risky for them because of other diseases.”
Lambert continues her follow-up appointments at City of Hope. She calls her experience at City of Hope and with the clinical trial “remarkable.”
“I am indeed lucky to have been able to participate in the FROST clinical trial,” she said. “It was much easier than I expected. I would recommend it to others if they meet the criteria, and I hope it’s something that can expand to other forms of cancer. And Dr. Tumyan’s calm and professional demeanor was therapy in itself. I remember throughout the procedure thinking, ‘I am in good hands.’ I still am.”
For more information on the FROST clinical trial, click here. You may also call City of Hope New Patient Services at 877-482-HOPE (4673).

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