December 30, 2015 | by By Veronique de Turenne
The evolution of breast cancer treatment has become a revolution thanks to precision medicine, improved screening, and a move to more refined surgical techniques. This momentum will continue in 2016 as advances such as immunotherapy, nipple-sparing surgery, and gene therapy continue to transform the field.
To learn more, we spoke with two of City of Hope’s breast cancer specialists, Laura Kruper, M.D., head of breast surgery service, and Joanne Mortimer, M.D., director of the Women's Cancers Program. They answered five questions about new directions in breast cancer treatment and research in the coming year.
Kruper, an assistant professor in the Department of Surgery, is director of the Women’s Center. A vocal advocate for breast cancer awareness, Kruper led a study that showed how race, income and insurance status can prevent breast cancer patients from getting the reconstructive surgery to which they are legally entitled.
Mortimer, who has been named numerous times as one of America’s Top Doctors by Castle Connolly, serves as vice chair and professor in the Department of Medical Oncology & Therapeutics Research. As part of her research, Mortimer is working on a new way to match breast cancer patients to specific treatments.
1. What treatment advances do you expect for breast cancer patients in 2016?
“We’re seeing very promising advances in several directions, such as in systemic therapies where the focus is moving to drugs that target abnormalities in the cancer cell that are unique to each patient,” Mortimer said. “We’re also looking to provide individualized treatment for breast cancer patients, which means less chemotherapy, less surgery and less radiation.”
In the area of surgery, Kruper sees a new emphasis on procedures that remove tumors while preserving as much of the breast as possible.
“One of the innovative surgeries that we can offer patients here at City of Hope are nipple-sparing mastectomies with direct implant-based reconstruction,” Kruper said. “This means that we preserve the whole envelope of the breast, and the plastic surgeons then place implants during the same surgery.”
Unlike at many other medical centers, plastic surgeons at City of Hope do not use tissue expanders, Kruper said.
“With expanders, patients undergo expansion with saline over a period of three months and then have the tissue expanders exchanged for implants as a separate surgery,” she said. “By eliminating the need for tissue expansion, patients are spared many office trips as well as an additional surgery.”
Also, two new therapies to destroy early-stage breast cancers are showing great promise in clinical trials, Kruper said. One uses lasers; the other uses freezing, also known as cryoablation. In fact, she said, a cryoablation trial called FROST will open soon at City of Hope.
2. How significant is that?
The move to precision medicine in breast cancer means being able to match a patient with the most effective treatment for her specific cancer, Mortimer said.
“When you identify which drugs are best for individual patients, you are likely to find more effective treatments for each individual,” she said. “That means less chemotherapy, less surgery and less radiation, which means fewer side effects. This will also help prevent resistance to existing therapies.”
The surgical innovations offer breast cancer patients a better quality of life during and after treatment, Kruper said. Cryoablation and laser therapy are less invasive than traditional surgery, so patients recover more quickly and with less pain.
3. How will this improve the patient experience or patient outcomes?
Growing precision in the area of drug therapy means matching a type of cancer to a specific treatment, Mortimer said.
“Patients will be more comfortable that they are getting the appropriate therapy that is unique and individual to them,” she said. “And as a result they will experience fewer of the side effects that make cancer treatment difficult.”
As for nipple-sparing surgery without the use of tissue expanders, that preserves the natural look of a patient’s breast and eliminates the need for additional surgery, Kruper said.
“By eliminating the need for tissue expansion, patients are spared many office trips as well as an additional surgery,” Kruper said. “Patients also wake up after surgery with intact nipples and the original appearance of their breasts.”
4. What research progress do you expect in 2016?
The focus on the genetic and molecular makeup of breast cancer will continue to reveal how the disease works and how the body can be mobilized to fight it. Breast cancer is made up of many types and sub-types and each patient is different, Kruper said.
“For example, there are at least six different subtypes of ‘triple-negative’ breast cancer,” she said. “We will see increasing use of molecular profiling tools that result in more personalized treatment regimens.”
Research into checkpoint inhibitors, which unleash the power of a patient’s own immune system, will significantly advance the cancer fight, Mortimer said.
“We will improve quality of life for patients because treatment will no longer be one-size-fits-all,” she said.
5. Overall, where is the field of breast cancer treatment and research moving?
“The shift is toward a greater and more thorough understanding the biology of each subtype of cancer,” Mortimer said. “The more we understand about the genetics of cancer, the more we will be able to identify therapies that will be more effective than the drugs we have had up until now, many of which simply kill all cells that divide, rather than just breast cancer cells.”
Kruper foresees continued and rapid change.
“The field is constantly changing, which is exciting,” Kruper said. “We learn more each year about the (diversity) of breast cancer and how important individualized patient treatments are so important.”
Learn more about City of Hope's Breast Cancer Program and research. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.