Breast cancer could soon be beaten in a week

Breast cancer treatment has so often been a cruel tradeoff. On the one hand, the priority is doing whatever it takes to obliterate tumours – be it with potent drugs or painful operations that leave the anatomy scarred and, sometimes, misshapen.

It’s thanks to these sometimes aggressive methods that 90% of women with earliest-stage cancers are still alive and well five years after diagnosis.

But on the other hand, this comes at a mammoth personal cost. Women face months on end of hospital visits, sacrificing successful careers, family life and intimacy. There’s an onslaught of gruelling side effects, from unbearable nausea and exhaustion to painful skin sores and loss of sensation.

More than 3,000 Irish women are diagnosed with breast cancer every year – and numbers are growing. It’s not simply because more people are developing the disease, but also due to the fact we are now far better at spotting it.

Today, doctors are focusing more than ever on ways to beat the disease, without destroying women’s lives in the process.

Last week, at the world’s biggest breast cancer conference in San Antonio, Texas, experts unveiled a raft of discoveries that, they hope, will do just that.

From powerful radiotherapy that clears cancer cells with pinpoint accuracy within days – sparing patients from many weeks of daily hospital sessions – to tumour

DNA tests that may help spare women with advanced breast cancer from chemotherapy, there was much to celebrate.

The new goal is clear: find ways to give the minimum therapy, with maximum results.

University of Cambridge cancer expert Professor Charlotte Coles said: ‘There’s a misconception with breast cancer that you’ve got to throw everything at it, treatment-wise – the more the better.

‘But that’s not necessarily the case.’

Dr Hendrik-Tobias Arkenau, oncologist and Medical director of the Sarah Cannon Research Institute in London, welcomed the advances: ‘The focus of breast cancer treatment is no longer just about controlling tumour growth, or keeping patients alive. It’s not enough – these women are young, have families and careers, so the emphasis more recently is about limiting the disruption to their lives.

‘Mastectomies, and even lumpectomies, can be traumatic and completely change women’s lives for ever. Chemotherapy and radiotherapy often make patients sick, exhausted and may cause painful skin infections.

‘There’s little point successfully treating a cancer if a woman has to spend every minute in hospital, or is in agonising pain. Now, the focus is on striking the right balance between destroying the disease and inflicting the least side effects possible to maintain a good quality of life.’

Here, we outline the major announcements made at the conference – and explain how they will be affecting the lives of breast cancer patients from now on.

A BREAKTHROUGH TEN-DAY TREATMENT

Many breast cancer patients could be spared weeks of radiotherapy treatment – thanks to a new targeted approach that means treatment can be given in just ten days, a new study suggests. The method involves targeting just part, rather than the whole breast, with tumour-blasting X-rays. ‘Small breast cancers tend to recur in the same area,’ explained oncologist Dr Simona Shaitelman, from the University of Texas MD Anderson Cancer Center.

‘For this reason, it makes sense just to treat that part, rather than the entire breast.’

By limiting the treatment area, the risk of problems such as skin burns and scarring, and the already small possibility of damage to surrounding organs including the heart, are reduced.

For the trial, researchers in Italy recruited 520 women over the age of 40 with breast cancer.

They all had small to mediumsize tumours that had not yet spread beyond the breast or surrounding lymph nodes – known as stage one or stage two breast cancers. Half were offered accelerated partial breast radiotherapy, the new targeted treatment, carried out every other day over the course of ten days.

The other half were treated with traditional whole breast therapy – the current standard of care for Irish breast cancer patients. In this study, it involved 30 daily hospital visits over six weeks. After ten years, the study found similar rates of local recurrence, suggesting both treatment methods may be equally effective.

Overall survival was also similar, with more than 90% of both groups still alive at the end of the study.

‘Patients undergoing standard radiotherapy may have to come in for four, five or even six weeks, every day,’ said researcher Dr Icro Meattini, a clinical oncologist from the University of Florence.

‘It can be incredibly stressful.’ Dr Shaitelman adds: ‘For most people working full-time, this part of treatment is hard. A radiotherapy session itself only lasts five minutes, but from the time a patient checks in to when they leave, it’s an hour – not including time spent travelling. Making the whole process easier is a huge win.’

MINIMAL RADIATION …OR NONE AT ALL

The new study adds to a growing body of evidence that suggests ‘less is more’ when it comes to radiotherapy for some patients. Last year, a major trial led by The Institute of Cancer Research and University of Cambridge found that partial radiotherapy after surgery could significantly reduce side effects including breast pain and sensitivity, compared to whole breast radiation.

Radiotherapy was given in 15 treatments over five weeks.

The study found almost all the women had no signs of breast cancer after five years, regardless of which treatment they had received. But women who received partial radiotherapy reported fewer longterm changes to the appearance and feel of their breast – with less buildup of hard, lumpy scar tissue.

In different studies in which radiotherapy was given twice a day, for five days, similar numbers of women were cured – but the

appearance of the breast changed.

Giving the breast tissue ‘time to recover’ could be key, says University of Cambridge oncologist Professor Charlotte Coles. A separate trial is investigating whether just five sessions of whole breast radiotherapy, given over five days, is similarly effective. This could pave the way for fiveday treatment for partial breast radiotherapy, too.

Professor Coles added: ‘Partial breast radiotherapy is an easy technique and can be done with existing machines.’

In some cases, patients may not need radiotherapy at all. Prof Coles and her Cambridge University team are now trialling a test that, they hope, will be able to flag up whether breast cancer is so low-risk that simply having the tumour removed will be enough.

It means treatment could, in specific cases, be over in a week or less. Professor Judith Bliss, of the Institute of Cancer Research in the UK, who is partly running the trial said: ‘We know radiotherapy works. But for some women, the absolute risk of their cancer coming back is so low that having the treatment does not actually give any meaningful benefit.’

The study, which will follow patients for ten years, is ongoing.

BLOOD DNA TEST COULD MEAN NO CHEMO

While the majority of patients are cured of breast cancer, in some cases, the disease is harder to treat. There are many Irish women living with cancer that has spread, with tumours elsewhere in the body.

Many of these women might soon be spared from chemotherapy, thanks to new targeted drugs – and a pioneering genetic test that can help doctors provide personalised treatment.

Tumours have their own genetic code – and hundreds of genetic sub-types of breast cancer have now been identified. A targeted drug may work well on one subtype, but not on others, so the challenge, for doctors, is matching the right drug with the right patient.

Researchers at the UK’s Institute of Cancer Research and The Royal Marsden NHS Foundation Trust have developed a new ‘liquid biopsy’ that can accurately detect genetic mutations in tumours – from a blood sample drawn from the arm.

The test results can be used to pair patients with tailored treatments to slow cancer growth.

Currently, doctors must test physical samples in order to do this – and results can take up to six weeks. The new test gives doctors a detailed picture of what is driving the tumour’s growth in just ten days.

Cancer specialist Professor Nicholas Turner, who led the research, said: ‘For women with advanced cancer, chemotherapy is the only option open to them. But simple tests can match treatments to a patients’ specific type of cancer – of which there are many. This makes them potentially more effective, with fewer side effects than chemotherapy.’

The study included 1,000 women whose disease had returned after treatment, or which had spread to another part of the body.

The blood test was used to check for three specific DNA mutations. Each of these was matched with a new targeted drug. Thanks to the test, a total of 142 women were given targeted treatments.

Prof Turner said versions of the test might be in use by next year, subject to approval.

THE PEN THAT SPOTS TUMOUR CELLS

When removing a breast tumour, both the lump and a margin of tissue surrounding it must be cut away – to make sure no cancerous cells remain.

But working out where this boundary lies can be tricky.

If any tumour cells are left behind, it could cause the disease to return. Now a high-tech ‘pen’ is being used to help surgeons differentiate between healthy and potentially harmful tissue.

The hand-held device, developed by scientists at the University of Texas, can be used during surgery to ‘scan’ the removed tissue.

Once the gadget gives the all clear, surgeons know they don’t need to cut away any more.

Kyana Garza, one of the researchers involved in the development of the MasSpec Pen says: ‘With breast cancer, patients want a cosmetically pleasing outcome.

‘But the more tissue you take away, the more the appearance of the breast changes. On the other hand, if you don’t get all the cancer out, it could spread.

‘It’s a balancing act, and the MasSpec takes away some of the guesswork surgeons have to do in order to work out where the safe margins lie.’

The gadget has now been tried out in 20 breast cancer operations. Data from tests on tissue samples in the laboratory, presented thismonth, show that it can accurately identify healthy and cancerous cells more than 90% of the time. During surgery, the pen is placed on areas suspected of being cancerous during surgery.

The device issues a tiny water droplet, which is then sucked back in, bringing with it tiny molecules which cannot be seen by the naked eye.

This is then analysed in a special machine in the operating theatre, which shows if it is likely to be cancerous.

The whole process takes up to 30 seconds. How well the device performs during surgery will be the subject of future trials. But Mr Garza says: ‘It’s really promising.’

It is hoped the device, which is also being tested in pancreatic and thyroid cancers, could be available within the next five to ten years.