South Florida Sun-Sentinel (Sunday)
Treatment innovations advancing fast in Florida
South Florida researchers are trying out several vaccine strategies to prevent or cure breast cancer. So far, early trials are holding out some promise for a breast cancer prevention vaccine, a curative vaccine for aggressive late stage breast cancer, or even a vaccine aimed at survivors to keep breast cancer from recurring.
Most of the trials are centered on training cells to recognize tumors as foreign. Until now, researchers have found it difficult to identify the abnormalities that breast cancer cells pick up because they often are intermingled with features of normal cells. But through trials, researchers are doing more sophisticated analyses of tumor cells’ genetic makeup to learn how to target the foreign cancer markers.
At the University of Miami’s
Sylvester Comprehensive Cancer Center in Plantation, where Jill Biden recently visited to spread breast cancer awareness, a breast cancer vaccine trial is underway and another trial has just finished with results pending.
“Vaccines are interesting because they are a form of immunotherapy which is changing the way we treat cancer,” said Dr. Alejandra T. Perez, medical director of the Braman Family Breast Cancer Institute at Sylvester at Plantation.
Researchers say vaccines could be a better way to treat advanced breast cancer than radiation and chemotherapy by killing cancer cells without harming healthy ones — and without the side effects.
A one-year vaccine trial that UM’s Sylvester participated in with Mayo Clinic had focused on preventing the recurrence of the triple-negative breast cancer, the most aggressive and deadly form of the disease, after women had completed chemotherapy and other treatment. The trial just closed and Perez said early results are promising. “With clinical trials it’s hard to know, but our patients did well.”
Fort Lauderdale attorney Karen Amlong participated in the trial and is hopeful. Amlong, 75, learned she had stage four breast cancer in August 2021.
“It was a small lump and I caught it early, but it was triple negative, which is aggressive,” she said. After undergoing chemotherapy treatment and radiation, Amlong received an injection that could be a placebo or a breast cancer vaccine.
“So far I am clean and that’s good news,” she said. “If the vaccine is effective, I am protected and it will keep the cancer away, but either way it’s a chance to do something to help others in the same situation.”
Dr. Carmen Calfa, breast medical oncologist and medical co-director of the Cancer Survivorship Program at Sylvester Comprehensive
Cancer, said she now is enrolling patients in another vaccine trial. This one is known as the BriaCell vaccine trial for advanced breast cancer that has spread.
“We are using the vaccine in combination with immunotherapy to treat stage four cancer and prevent it from further spreading,” Calfa explained. “We are trying to find new treatments that are focused on people living with advanced breast cancer to give them new hope.”
Perez said Sylvester also wants to participate in preventive vaccine trials in the near future.
Meanwhile, a preventive vaccine trial is in progress at Cleveland Clinic. Researchers at the health system are hosting a small, early-stage trial for a vaccine aimed at preventing triple-negative breast cancer. The trial is expected to conclude in spring 2023. If proven to work, the vaccine could be given to women at high risk.
“Long term, we are hoping that this can be a true preventive vaccine that would be administered to healthy women to prevent them from developing triple-negative breast cancer, the form of breast cancer for which we have the least-effective treatments.” G. Thomas Budd, M.D., of Cleveland Clinic’s Taussig Cancer Institute and principal investigator of the study, said when the trial
was announced.
A future larger trial at Cleveland Clinic with women who have the
BRCA1 or BRCA2 gene that puts them at risk of developing triple-negative breast cancer could begin in late
2023, but the multi-phased studies and FDA review could take several years.
A lot is riding on the outcomes of vaccine trials, but Perez and Calfa at UM are cautiously optimistic that breast cancer care will look different in the near future and that vaccines will play a role.
The need for innovation is intensifying
For millions of women, advances can’t come fast enough. Breast cancer accounts for 1 in 3 of all new cancers diagnosed annually in women in the U.S., according to the American Cancer Society. It’s estimated that more than 43,000 women in the U.S. will die from breast cancer this year. While treatments have improved and the mortality rate has declined, the number of women being diagnosed with the disease each year has risen.
Along with vaccine trials, South Florida breast cancer doctors are using innovative screening tools, medications and radiation options to improve how the disease is detected and treated.
A big innovation in breast cancer detection is how and when woman are screened in South Florida. The focus has shifted from mammograms beginning at a certain age, to recommendations for more varied screenings based on breast cancer risk.
At Baptist Health Lynn Cancer Institute in Boca Raton, Dr. Kathy Schilling said risk factors she uses include breast density, age, family history and exposure to hormones.
“We recommend every woman get a formal risk assessment to determine what her level of risk is,” Schilling said. “Those who may have genetic susceptibility who are at higher risk need to start screening earlier and more intensely.”
Screening tools now include 3D mammography, ultrasound and MRIs. Shilling said Lynn also offers contrast-enhanced mammography “We are finding many more cancers earlier than we would not have,” she said.
At Lynn, with the move to digital 3D mammography, Shilling said artificial intelligence scans every image at no additional cost to the patient. This advancement, she said, will save lives.
“Computers don’t fatigue and can see things that the human brain and eye can not perceive, and we have noticed that we are increasing our cancer detection rate by using this tool. We are finding cancers that are 3, 4, 5 milliliters, so very tiny cancers, years before we would have found them if were we not using this technology,” Shilling said.
As a bonus, the technology also is picking up potential heart disease, she said.
More options to traditional treatment
Many women undergo surgery for breast cancer and may also receive additional treatment after surgery, such as chemotherapy, hormone therapy or radiation.
Florida oncologists say treatment is becoming more personalized as medical knowledge advances.
“With genomic testing, we’ve gotten a lot better in selecting people who need chemotherapy, narrowing it to those who will benefit from it,” said Calfa at Sylvester.
At Cleveland Clinic in Weston, Dr. Cassann Blake, a surgical oncologist, says women with tumors now have more options and surgery can be less invasive .
“More and more are candidates for chemotherapy before surgery,” she said. “By giving it first to women who have nodal involvement, they can have less aggressive lymph node surgery. If we find no cancer left in the lymph node at the time of the surgery, we don’t have to be as aggressive to have equivalent outcomes.”
Blake said because screenings are finding masses earlier and they are smaller, some women now have the option to get the tumor removed at the same time as they have plastic surgery to reduce and lift both breasts.
At Lynn, Shilling said a trial is launching that provides an option to surgery altogether. Doctors will use laser therapy to treat small, invasive breast tumors of less than 1.5 centimeters. “There’s a lot of innovation going on and a lot of progress.”
Radiation is another area where changes are improving breast cancer treatment.
At Baptist Health South Florida’s Miami Cancer Institute, Dr. Marcio Fagundes, a radiation oncologist, says pencil beam proton therapy used for other types of cancers now is being applied for breast cancer. The therapy can precisely target and deliver high radiation doses to a tumor.
“The advantage is it doesn’t deposit radiation where you don’t need it,” Fagundes said. “The heart, lungs and certain lymph node regions can be spared exposure without sacrificing the radiation targeting the tumor, he said. The goal is to minimize lung scarring, future heart issues or damage to the lymph nodes.
“We are all going in the direction of making radiation more selective and safer whenever possible,” he said.
Old medications, new uses
In the battle against breast cancer, South Florida’s oncologists are trying at least a dozen experimental drug therapies to slow down or cure the disease.
In some cases, the drugs already have been used successfully for other types of cancer.
Calfa at Sylvester is the principal investigator of the TAPUR trial, a national study for late-stage cancer patients that uses FDA-approved drugs for other types of cancer in an off-label way to fight breast cancer based on the characteristics of a patient’s tumor.
“We have seen some amazing responses in patients that otherwise lost hope and had no other intervention that they were eligible for,” Calfa said.
In another trial, Calfa is using Taxol already used for breast cancer, in combination with radium, which is used for prostate cancer. “We are looking at whether the patient has a better outcome if Taxol is used in combination.”
Sylvester cancer patient Trish Gainer Gaddis is a trial participant.
Gaddis was diagnosed with breast cancer in 2011 when she was only 51. After a lumpectomy, Gainer thought she was in the clear. Now at 62 she is fighting stage 4 breast cancer. Gainer says she is in the clinical trial for two reasons. “I am hoping the medication will work to extend my life,” she said. “And I want to help others like me.”
Calfa said most people don’t realize that breast cancer is an umbrella under which there are multiple types and subtypes.
“Finding one treatment will not be a home run.,” she said. “We need to study multiple treatments to address the many types, and research is the only way to find them.”