Copper depletion therapy keeps high-risk triple-negative breast cancer at bay
New Weill Cornell study shows anti-copper drug might prevent the spread of cancer to organs
NEW YORK (February 13, 2013) -- An anti-copper drug compound that
disables the ability of bone marrow cells from setting up a "home" in
organs to receive and nurture migrating cancer tumor cells has shown
surprising benefit in one of the most difficult-to-treat forms of cancer
-- high-risk triple-negative breast cancer.
The median survival for metastatic triple-negative breast cancer
patients is historically nine months. However, results of a new phase II
clinical trial conducted by researchers at Weill Cornell Medical
College and reported in the Annals of Oncology shows if patients
at high-risk of relapse with no current visible breast cancer are copper
depleted, it results in a prolonged period of time with no cancer
recurrence. In fact, only two of 11 study participants with a history of
advanced triple-negative breast cancer relapsed within 10 months after
using the anti-copper drug, tetrathiomolybdate (TM).
"These study findings are very promising and potentially a very
exciting advance in our efforts to help women who are at the highest
risk of recurrence," says the study's senior investigator, Dr. Linda
Vahdat, director of the Breast Cancer Research Program, chief of the
Solid Tumor Service and professor of medicine at Weill Cornell Medical
College.
Dr. Vahdat says four of the study participants with a history of
metastatic triple-negative breast cancer have had long-term benefit
remaining disease free for between three and five and a half years.
"The anti-copper compound appears to be keeping tumors that want to
spread in a dormant state," reports Dr. Vahdat, who is also medical
oncologist at the Iris Cantor Women's Health Center at
NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "We believe
one of the important ways it works is by affecting the tumor
microenvironment, specifically the bone marrow-derived cells that are
critical for metastasis progression."
In addition, study participants with other forms of high-risk for
relapse breast cancers -- either stage 3 or stage 4 -- without evidence
of disease after treatment have also fared well. The progression-free
survival rate among these 29 patients in the study has been 85 percent,
to date.
"As good as these interim findings look to us, we cannot talk about
significant benefit until we compare TM treatment to other therapies,"
she says. Dr. Vahdat expects to launch a phase III randomized clinical
trial in the near future.
This research is a report of the first 40 patients. The clinical
trial, which began in 2007, has been expanded many times and now
includes 60 patients, more than half of who have triple-negative breast
cancer.
Deplete Copper to Prevent Cancer Spread
New discoveries in the science of metastasis and examination of the
body's utilization of copper to promote cancer spread led to this
clinical trial.
Investigators at Weill Cornell, including some of this study's
co-authors, have contributed to the recent understanding of the role
bone marrow cells play in promoting metastasis. They previously found
that a collection of bone marrow-derived cells, which include VEGFR1+
hematopoietic progenitor cells (HPCs), prepare a site in distant organs
to accept cancer cells. HPCs also recruit endothelial progenitor cells
(EPCs), among others, to activate an "angiogenic switch" that establish
blood vessels at the site to feed newly migrated cancer cells.
Breast cancer research studies conducted at Weill Cornell have also
found that immediately prior to cancer relapse, levels of EPCs and HPCs
rise significantly further, suggesting that the EPC target of the copper
depletion approach is one that makes sense.
"Breast tumors want to move to specific organs, and these EPCs and
HPCs cells leave a 'popcorn trail' for cancer cells to follow, as well
as provide the building blocks for blood vessels to greet them as they
arrive," Dr. Vahdat says.
Copper is critical to mobilizing these cells. Copper is essential to
the metastatic process. It is a key component of enzymes that help turn
on angiogenesis in the tumor microenvironment, and it also appears to
play a role in directing cancer cell migration and invasion, according
to researchers.
TM is a copper chelation compound used to treat Wilson's disease, a
hereditary copper metabolism disorder, and has been studied in phase I
and phase II clinical trials for a number of disorders. Animal studies
have demonstrated that depleting copper decreases proliferation of EPCs,
as well as blood vessel formation and tumor growth.
Dr. Vahdat's study is the first human clinical trial to utilize a
copper depletion strategy to modulate EPCs in breast cancer patients
with an extraordinarily high risk of relapse from hidden residual
disease. Most of the studies in other solid tumors with visible advanced
disease have been disappointing, say researchers.
Despite improvements in breast cancer therapy, there is significant
risk of relapse in a high-risk subset of patients. The risk of relapse
in stage 3 patients is 50-75 percent over five years, and patients with
stage 4 breast cancer always recur. Triple-negative breast cancer
patients have a poorer prognosis even when diagnosed in early disease
stages.
"These triple-negative patients represent a substantial proportion
of metastatic breast cancer patients," says Dr. Vahdat. "These are the
patients that need the most attention, which is why we have focused most
of the resources of our Metastases Research Program on this problem."
In the study, researchers found that 75 percent of patients achieved
the copper depletion target using TM after one month of therapy, and
that copper depletion was most efficient (91 percent) in patients with
triple-negative tumors, compared to other tumor types (41 percent). In
copper-depleted patients only, there was a significant reduction in
EPCs, and the 10-month relapse-free survival was 85 percent. In
addition, TM was found to be safe and well-tolerated in patients.
The study shows copper depletion appears to inhibit the production,
release, and mobilization of EPCs from the bone marrow, leading to a
suppressed angiogenic switch and tumor dormancy.
"There are a lot of cancer experts at Weill Cornell working very
hard to understand this precise mechanism, define the clinical benefit
in this ongoing copper depletion drug clinical trial, and determine its
future study," says Dr. Vahdat. "Keeping cancer dormant is what we all
want for our patients -- especially triple-negative breast cancer
patients at highest risk of recurrence."
###
Study co-authors include Dr. Sarika Jain, Maureen M. Ward, Naomi
Kornhauser, Dr. Ellen Chuang, Dr. Tessa Cigler, Dr. Anne Moore, Diana
Donovan, Christina Lam, Marta V. Cobham, Sarah Schneider, Sandra M. Dr.
Hurtado Rúa, Celine Mathijsen Greenwood, Dr. Richard Zelkowitz, Dr. J.
David Warren, Dr. Maureen E. Lane, Dr. Vivek Mittal and Dr. Shahin Rafii
from Weill Cornell; Dr. Jules Cohen from Stony Brook University Cancer
Center, Stony Brook, N.Y.; and Steven Benkert from NewYork-Presbyterian
Hospital.
The study was funded by the grants from the Anne Moore Breast Cancer
Research Fund, Stephen and Madeline Anbinder Foundation, Rozaliya
Kosmandel Research Fund, Susan G Komen for the Cure, New York Community
Trust, Cancer Research and Treatment Fund, Manhasset Women's Coalition
Against Breast Cancer and Berman Fund.
Question: I take a multivitamin that contains copper. I had heard before that copper wasn't really so advisable. Do you think I should stop? Hmmm...definitely something to thing about.
Copper is an essential trace element for us vertebrates and is required for the function of a number of enzymes. Copper deficiency leads to a number of disorders. Like everything else, I think is a balance. The study cited above is just a phase 2 with a small # of patients and adverse reactions were encountered including hematological, GI and neurological. In answer to your question, personally I don't think is an issue but you might want to check w/ your doc. According to WebMD, people eating a normal diet doesn't require copper supplementation. It might be hard to find a multivitamin w/o copper.
Web address: http://www.sciencedaily.com/releases/2013/04/ 130401074911.htm
Surgical Removal of Lung Metastases in Breast Cancer Patients May Improve Overall Survival
Apr. 1, 2013 — Patients with
primary breast cancer that has spread to the lungs may live longer if
the lung metastases are surgically removed, according to a study
published in the April 2013 issue of The Annals of Thoracic Surgery.
Georgios Meimarakis, MD, Hauke Winter, MD, PhD, and colleagues from
Ludwig-Maximilians-University in Munich, Germany, examined factors that
influenced the long-term survival of patients with isolated pulmonary
metastases of primary breast cancer following surgical removal of the
metastases (pulmonary metastasectomy).
Metastatic breast cancer (mBC) is a stage identified when the disease
has spread to distant, non-adjacent organs or areas. The median
survival of patients with mBC treated with conventional chemotherapeutic
regimens ranges from 12 months to 24 months, and it previously had been
assumed that these patients would not benefit from surgical
intervention.
The researchers found that, with metastasectomy, the median overall survival increased to as much as 103.4 months.
"Before this study, no randomized trial had examined prospectively
the impact of metastasectomy on survival compared to conservative
therapeutic strategies," said Dr. Meimarakis.
Between 1982 and 2007, 81 patients with a median age of 58.2 years (range 28.3 to 76.3 years) were recruited for the study.
In 81.5% of patients (66), complete removal of all tumors was
observed, with microscopic examinations showing no remaining tumor cells
(R0 resection). In 7.4% of patients (6), some tumors cells were still
visible microscopically (R1 resection) and 11.1% of patients (9) showed
portions of remaining tumors visible to the naked eye (R2 resection).
R0 resection was associated with significantly longer median overall
survival than R1 or R2 resection (103.4 months, 23.6 months, and 20.2
months, respectively). Additional analysis revealed that R0 resection,
and number and size of metastases were factors that affected long-term
survival.
Dr. Meimarakis noted: "Too often patients with mBC are not considered
for surgical treatment, as it is assumed that these patients would not
benefit from surgical interventions for various reasons. Based on our
findings we highly recommend surgeons consider patients with isolated
pulmonary metastases for surgical resection."
Cancer treatment teams need to consider metastasectomy
In an invited commentary appearing in the same issue, Hans Hoffmann,
MD, from The University of Heidelberg in Germany, noted that this study
adds meaningful data to the available body of evidence that breast
cancer patients with a suspected first recurrence are most likely to
gain substantial benefit from an intensified multidisciplinary
therapeutic approach.
"As the morbidity and mortality of pulmonary resection has decreased
substantially over the last decades, this potentially beneficial
procedure should be discussed and considered more often than not in an
intensified multidisciplinary therapeutic approach," said Dr. Hoffmann.
Your article brings up a good topic about treating mets. My friend was diagnosed almost 3 years ago with Stage 4 Peritonneal Cancer (similar to Ovarian). Besides chemo, she's had 3 de-bulking surgeries (one that resected part of the liver) that I believe have helped her have a good quality of life and live longer than the original prognosis. Her oncologist didn't want her to have the last surgery and just wanted to do more chemo. She consulted with a top liver surgeon who agreed to perform the surgery. I think it's something patients should investigate further with a good, qualified surgeon.
Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
I thought the article was interesting and therefore posted it. The study cohort is highly selected though, patients with only lung mets -- how common is that? Also the patients who do best are the ones with solitary lung mets < 3 cm. It is something to keep in mind. With TN, it seems like when metastasis is detected, there are mets in multiple organs. Maybe it argues for closer surveillance.
By George W. Sledge Jr., MD, Fatima Cardoso, MD, Eric P. Winer, MD, and Martine J. Piccart, MD
Article Summary:
Overview: Metastatic breast cancer (MBC), a usually
incurable disease, continues to vex physicians and patients. Recent
decades have seen great improvements in the treatment of MBC, based on
the availability of novel targeted therapeutics and more standard
chemotherapeutic agents. This article describes the goals of therapy for
MBC, the progress made against MBC in recent decades, the current
standard of care, and the ongoing efforts of basic and translational
researchers to transfer the fruits of modern scientific discovery to
patients in the clinic.
Full Article - go to this link, then click on the "View Full Educational Article" to download pdf.
Division
of Hematology/Oncology, Sylvester Comprehensive Cancer Center, Miller
School of Medicine, University of Miami, 1475 NW 12th Avenue, D8-4,
Miami, FL, 33136, USA, jhurley@miami.edu.
Abstract
Triple-negative
breast cancers comprise about 20 % of breast cancers. They have poor
prognosis and have no standard therapy. The aim of this study was to
evaluate pathologic complete response (pCR), progression-free survival
(PFS), and overall survival (OS) in patients with TNBC treated with
neoadjuvant platinum-based chemotherapy. This is a retrospective study
of one hundred and forty-four women with TNBC treated with neoadjuvant
platinum-containing chemotherapy for locally advanced breast cancer at
the University of Miami between January 1, 1999, and January 1, 2011.
The medical record was reviewed to obtain data on clinical
characteristics, including ethnicity, race, age, clinical stage,
treatment regimen, and vital status. This study was approved by the
University of Miami IRB. All patients had locally advanced breast cancer
with at least one of the following features at presentation: T3, T4,
N2, and N3. The mean tumor size by palpation was 9.4 cm. The clinical
T-stage at presentation was 1.4 % T1, 8.3 % T2, 52.8 % T3, and 37.5 % T4
(19.4 % T4d). The nodal status by physical exam at presentation was
23 % N0, 37.5 % N1, 34 % N2, and 5.5 % N3. pCR in breast and axilla was
seen in 31 %. PFS and OS were 55 and 59 %, respectively, at 7 years.
Cisplatin offered a survival advantage over carboplatin in both PFS
(P = 0.007) and OS (P = 0.018). Node positivity was the most important
predictor of survival. Cisplatin/docetaxel neoadjuvant therapy was well
tolerated and an effective therapy in locally advanced TNB.
Breast-Conserving Therapy Achieves Locoregional Outcomes Comparable
to Mastectomy in Women with T1-2N0 Triple-Negative Breast Cancer.
Ann Surg Oncol Epub May 19, 2013
Abstract
BACKGROUND:
Conflicting
data exist regarding optimum local therapy for early-stage
triple-negative breast cancer (TNBC). We examined outcomes according to
local treatment type in a large cohort of node-negative TNBC patients.
METHODS:
A
total of 1,242 consecutive patients with TNBC treated at a single
institution from 1999 to 2008 were identified. Of these, 646 with
pathologic stage T1-2N0 TNBC underwent breast-conserving therapy (BCT)
(N = 448) or total mastectomy (TM) without postmastectomy radiation
(N = 198) and comprised the study population. Locoregional recurrence
(LRR), distant metastasis (DM), and overall recurrence were investigated
with a competing risk analysis using Gray's test and multivariable Fine
and Gray competing risk regression. Overall survival was assessed using
standard Kaplan-Meier methods and a Cox proportional hazards analysis.
RESULTS:
Median
follow-up was 78.3 months (range 1-156). Eight-one percent of patients
received adjuvant chemotherapy. TM patients were younger, were more
likely to have lymphovascular invasion, and had larger tumors than
patients undergoing BCT (all P ≤ 0.05). The 5-year cumulative incidence
of LRR was 4.2 and 5.4 % for patients undergoing BCT and TM,
respectively. There was no significant difference in LRR, DM, overall
recurrence, disease free survival, or overall survival between groups on
univariate analysis, or after adjusting for other variables in
multivariate models. Lack of chemotherapy and high tumor stage
independently predicted for decreased overall survival (both
P < 0.001).
CONCLUSIONS:
A low, 5-year risk of LRR
(4.7 %) was achieved in a large group of women with T1-2N0 TNBC treated
with multimodality therapy. BCT was as equally effective as TM for local
and distant control.
S0221: Comparison of two schedules of paclitaxel as adjuvant therapy for breast cancer.
Subcategory:
Cytotoxic Chemotherapy
Session Type and Session Title:
Oral Abstract Session, Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy
Abstract Number:
CRA1008
Citation:
J Clin Oncol 31, 2013 (suppl; abstr CRA1008)
Author(s):
G.
Thomas Budd, William E. Barlow, Halle C. F. Moore, Timothy J. Hobday,
James A. Stewart, Claudine Isaacs, Muhammad Salim, Jonathan K. Cho,
Kristine Rinn, Kathy S. Albain, Helen K. Chew, Gary Von Burton, Timothy
David Moore, Gordan Srkalovic, Bradley Alexander McGregor, Lawrence E.
Flaherty, Robert B. Livingston, Danika Lew, Julie Gralow, Gabriel N.
Hortobagyi; Cleveland Clinic, Cleveland, OH; Cancer Research and
Biostatistics, Seattle, WA; Mayo Clinic, Rochester, MN; Baystate Medical
Center, Springfield, MA; Lombardi Comprehensive Cancer Center,
Washington, DC; Allan Blair Cancer Center, Saskatoon, SK, Canada; Oncare
Hawaii, Honolulu, HI; Swedish Cancer Institute, Seattle, WA; Loyola
University Medical Center, Maywood, IL; University of California, Davis
Cancer Center, Sacramento, CA; LSU Health Sciences Center, Shreveport,
LA; Mid Ohio Oncology Hematology, Inc., Columbus, OH; Sparrow Regional
Cancer Center, Lansing, MI; Willford Hall Medical Center, Lackland, TX;
Wayne State University School of Medicine, Detroit, MI; Arizona Cancer
Center, Tucson, AZ; Southwest Oncology Group Statistical Center,
Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; The University
of Texas MD Anderson Cancer Center, Houston, TX
Background: S0221 is a SWOG-coordinated phase III adjuvant
chemotherapy intergroup trial in node-positive and high-risk
node-negative operable breast cancer which hypothesized that 1) the
weekly AC+G regimen is superior to ddAC x 6 and 2) 12 weeks of weekly
paclitaxel (wP) is superior to q 2 week paclitaxel x 6 (ddP). Methods:
Between December 2003 and November 2010, 2,716 patients were randomized
in a 2 x 2 factorial design to 1) AC+G vs ddAC and 2) P 80 mg/m2/week x 12 vs P 175 mg/m2
q 2 weeks x 6. If there was no significant interaction between the
factors, the trial was powered to find a disease-free survival hazard
ratio (HR) ≤ 0.82 for weekly vs q 2 week for each factor. At the first
interim analysis, the AC randomization was halted for futility, and
S0221 was closed to accrual 10 November 2010. S0221 reopened 15
December 2010, after which time all patients received 4 cycles of ddAC
and randomization to P weekly x 12 and ddP x 6 continued. Accrual
halted at a total of 3,294 in January 2012. Results: By
September 7, 2012, 487 events and 340 deaths had occurred, prompting the
third planned interim analysis. The Data Safety and Monitoring
Committee recommended reporting the results since the futility boundary
was crossed. A Cox model adjusting for the AC arms had a HR = 1.08 (95%
CI 0.90-1.28; p=0.42), with the 99.5% CI excluding the original
alternative hypothesis that the HR=0.82. There was no significant
interaction of the two factors. Estimated 5-year progression-free
survivals were 82% for weekly P and 81% for ddP. Toxicity data were
available for 1,385 patients treated with ddP and 1,367 treated with
weekly P. Grade 5 toxicity occurred in 4 patients on ddP and 2 on
weekly P. Percent grade 3-4 toxicity per arm are shown in the Table. Conclusions:
Either ddPx6 or weekly P x 12 are acceptable schedules of P
administration. The differences in leukopenia likely reflect
ascertainment bias against weekly P. If this is accepted, weekly P x 12
produces less overall toxicity than 6 cycles of ddP. Support: NCI
grants CA32102, CA38926, CA21115, CA21076, CA77597, CA25224, CA77202,
CCSRI15469, and Amgen, Inc. Clinical trial information: NCT00070564.
Affiliations of authors:
Centre for Cancer Genetic Epidemiology, Department of Public Health and
Primary Care (NM, SP, DF, SE, RP, EF, ACA, DFE);
Genetic Medicine, Manchester Academic Health
Sciences Centre, Central Manchester University Hospitals NHS Foundation
Trust,
Manchester,
UK (DGE); South East Thames Regional Genetics Service, Guy’s Hospital, London, UK (LI); Oncogenetics Team, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK (RAE); Yorkshire
Regional Genetics Service, Leeds, UK (JA); Ferguson-Smith Centre for Clinical Genetics, Yorkhill Hospitals, Glasgow,
UK (RD); Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK (DE); West Midlands Regional Genetics Service, Birmingham Women’s Hospital Healthcare NHS Trust, Edgbaston, Birmingham, UK (TC); Sheffield Clinical Genetics Service, Sheffield Children’s Hospital, Sheffield, UK (JC); Department of Clinical Genetics, Royal Devon & Exeter Hospital, Exeter, UK (CB); Department of Clinical Genetics, East Anglian Regional Genetics Service, Addenbrookes Hospital, Cambridge, UK (MT);
Institute of Genetic Medicine, Centre for Life, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK (FD); Clinical Genetics Department, St.Georges University of London, Tooting, London, UK (SH); Oxford Regional Genetics Service, Churchill Hospital, Oxford, UK (LW); South East of Scotland Regional Genetics Service, Western General Hospital, Edinburgh, UK (MEP); Northern Ireland Regional Genetics Centre, Belfast City Hospital, Belfast, UK (PJM); North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Trust, London, UK (LES); Academic Unit of Clinical and Molecular Oncology, Trinity College Dublin and St James’s Hospital, Dublin, Ireland (MJK); Cheshire & Merseyside Clinical Genetics Service, Liverpool Women’s NHS Foundation Trust, Liverpool, UK (CH); South West Regional Genetics Service, Bristol, UK (AD); All Wales Medical Genetics Services, University Hospital of Wales, Cardiff, UK (MTR); North West Thames Regional Genetics Service, Kennedy-Galton Centre, Harrow, UK (HD); North of Scotland Regional Genetics Service, NHS Grampian & University of Aberdeen, Foresterhill, Aberdeen, UK (ZM, HG); Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, UK (JE); Leicestershire Clinical
Genetics Service, University Hospitals of Leicester NHS Trust, Leicester, UK (JB); All Wales Medical Genetics Service, Glan Clwyd Hospital, Rhyl, UK (EM, AM).
Correspondence to: Nasim Mavaddat, MBBS, PhD, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK (e-mail:
nasim@srl.cam.ac.uk).
Received July 24, 2012.
Revision received March 20, 2013.
Accepted March 22, 2013.
Abstract
Background Reliable estimates of cancer risk are critical for guiding management of BRCA1 and BRCA2
mutation carriers. The aims of this study were to derive penetrance
estimates for breast cancer, ovarian cancer, and contralateral
breast cancer in a prospective series of
mutation carriers and to assess how these risks are modified by common
breast cancer
susceptibility alleles.
Methods Prospective cancer risks were estimated using a cohort of 978 BRCA1 and 909 BRCA2
carriers from the United Kingdom. Nine hundred eighty-eight women had
no breast or ovarian cancer diagnosis at baseline,
1509 women were unaffected by ovarian cancer,
and 651 had been diagnosed with unilateral breast cancer. Cumulative
risks were
obtained using Kaplan–Meier estimates.
Associations between cancer risk and covariables of interest were
evaluated using Cox
regression. All statistical tests were
two-sided.
Results The average cumulative risks by age 70 years for BRCA1 carriers were estimated to be 60% (95% confidence interval [CI] = 44% to 75%) for breast cancer, 59% (95% CI = 43% to 76%)
for ovarian cancer, and 83% (95% CI = 69% to 94%) for contralateral breast cancer. For BRCA2 carriers, the corresponding risks were 55% (95% CI = 41% to 70%) for breast cancer, 16.5% (95% CI = 7.5% to 34%) for ovarian
cancer, and 62% (95% CI = 44% to 79.5%) for contralateral breast cancer. BRCA2
carriers in the highest tertile of risk, defined by the joint genotype
distribution of seven single nucleotide polymorphisms
associated with breast cancer risk, were at
statistically significantly higher risk of developing breast cancer than
those
in the lowest tertile (hazard ratio = 4.1, 95%
CI = 1.2 to 14.5; P = .02).
Conclusions Prospective risk estimates confirm that BRCA1 and BRCA2
carriers are at high risk of developing breast, ovarian, and
contralateral breast cancer. Our results confirm findings from
retrospective studies that common breast cancer
susceptibility alleles in combination are predictive of breast cancer
risk
for BRCA2 carriers.
JNCI J Natl Cancer Inst
(2013)
105
(11):
812-822.
doi:
10.1093/jnci/djt095
First published online:
April 29, 2013
Relating Neuropsychological Test Performance To Cognitive Complaints After Breast Cancer
Approximately one out of five breast cancer
patients treated for breast cancer had elevated memory and/or executive
function
complaints that were statistically significantly
associated with domain-specific neuropsychological (NP) test
performances
and depressive symptoms. Combined chemotherapy and
radiation treatment in these patients was also associated with memory
complaints
according to a study published April 18 in the Journal of the National Cancer Institute.
Cognitive complaints have been
frequently reported following breast cancer treatments, however, their
connection with neuropsychological
(NP) test performance has not been well established.
In order to determine the
relationship between cognitive complaints and neurocognitive testing,
Patricia A. Ganz, M.D., at
the Division of Cancer Prevention and Control
Research, UCLA Jonsson Comprehensive Cancer Center and colleagues,
looked at
early-stage post treatment breast cancer patients who
were enrolled in a prospective, longitudinal, cohort study before they
started receiving endocrine therapy and evaluated them
using an NP test battery and questionnaires that were self-reported,
which gauged their symptoms, including cognitive
complaints.
The researchers found that of
the 189-breast cancer patients evaluated, 23.3% had higher memory
complaints and 19% reported
higher executive function complaints than found in
age-matched healthy women without breast cancer. They also found that
higher
memory complaints were statistically significantly
associated with combined chemotherapy and radiation treatments, and not
chemotherapy alone. “Our findings add further support
for the value of patient-reported outcomes as a central measurement
in evaluation of cancer treatment-related
morbidities,” the authors write.
In an accompanying editorial,
Christina A. Meyers, Ph.D., M.D. Anderson Cancer Center, writes that the
studies that use subject
data can obscure individual differences and may
underestimate the true incidences of cognitive symptoms in breast cancer
patients
and feels that, “many cancer survivors can enjoy
improved levels of functioning if properly diagnosed and provided with
the
right support.”
JNCI J Natl Cancer Inst
(2013)
105
(11):
1.
doi:
10.1093/jnci/djt112
First published online:
April 18, 2013
TNBC Foundation just posted on their Facebook page:
"Aggressive breast cancer genes found. Scientists at A*STAR’s Genome Institute of Singapore (GIS) led a study that has identified genes that are potential targets for therapeutic drugs against aggressive breast cancer. These findings were reported in the July 2013 issue of PNAS........They also showed that patients with TNBC tumours that have high levels of UBASH3B tend to be more likely to have early recurrence and metastasis......The scientists discovered that a protein tyrosine phosphatase, called UBASH3B, is overexpressed in one third of TNBC patients. UBASH3B controls the activity of an important breast cancer gene." Article at: http://www.sciencealert.com.au/news/20132807-24630.html with source of http://www.a-star.edu.sg/Media/News/PressReleases/tabid/828/articleType/ArticleView/articleId/1855/Default.aspx
Grateful for today.............Judy
Edited by Grateful for today - Jul 29 2013 at 12:51pm
In addition to getting copies of the imaging tests one has, one can consider keeping a self made history list with the date, name of test, (amount of radiation if known).
Grateful for today...........Judy
-------------------------------
Added to page 4:
GENES
Gene Reviews. Expert-authored summaries about diagnosis, management and genetic counseling for specific inherited conditions, University of Washington. http://www.ncbi.nlm.nih.gov/books/NBK1116/
First published online in THE ONCOLOGIST Express on June 5, 2013.
Abstract
Metastasis to the central nervous system
(CNS) is a devastating neurological complication of systemic cancer.
Brain metastases
from breast cancer have been documented to occur in
approximately 10%–16% of cases over the natural course of the disease
with leptomeningeal metastases occurring in
approximately 2%–5% of cases of breast cancer. CNS metastases among
women with
breast cancer tend to occur among those who are
younger, have larger tumors, and have a more aggressive histological
subtype
such as the triple negative and HER2-positive
subtypes. Treatment of CNS metastases involves various combinations of
whole
brain radiation therapy, surgery, stereotactic
radiosurgery, and chemotherapy. We will discuss the progress made in the
treatment
and prevention of breast cancer-associated CNS
metastases and will delve into the biological underpinnings of CNS
metastases
including evaluating the role of breast tumor
subtype on the incidence, natural history, prognostic outcome, and
impact of
therapeutic efficacy.
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