Promising Breast Cancer Research at UAB

 October, National Breast Cancer Awareness Month, reminds us that one in eight women will be diagnosed with breast cancer during her lifetime. The UAB Comprehensive Cancer Center is in the forefront of work to provide better outcomes and quality of life for all breast cancer patients. The center uses a multidisciplinary team approach to evaluate cancer treatments from various perspectives, including medical oncology, radiation oncology and surgical oncology.

Because UAB is one of the premier clinical research institutions in the nation, many people with cancer are able to participate in clinical trials that offer the latest treatments. Trials typically target one or more types of breast cancer in early to late stages.

“Our Comprehensive Cancer Center researchers have received two especially large grants that in combination will provide more than $12 million over the next five years for the development of better breast cancer therapies,” says medical oncologist Andres Forero, M.D., who serves as medical director of clinical studies at the Cancer Center.

One of the two grants is through the National Cancer Institute’s Specialized Programs of Research Excellence (SPORE), which has been funding UAB breast cancer studies for the past 10 years. The other is from the Susan G. Komen for the Cure® foundation with co-funding from the Triple Negative Breast Cancer Foundation.

Breast Cancer Clinical Drug Trials

The Komen grant targets drug therapies for triple negative breast cancer, which accounts for an estimated 15 to 25 percent of all breast cancer. This type of cancer often occurs in young, Hispanic, and African-American women. “Triple negative breast cancer is more aggressive than other types. It quickly spreads and often goes to the brain,” says Dr. Forero.

He and other investigators are leading a study of tigatuzumab, a monoclonal antibody developed at UAB that kills cancer cells, in combination with standard chemotherapies for treating triple negative breast cancer. The national trial also will be held at 14 other Translational Breast Cancer Research Consortium medical centers. “In a previous SPORE study at UAB we found tigatuzumab was extremely effective for this type of cancer,” Dr. Forero says.

In addition, UAB researchers recently finished a study using BSI-201, an inhibitor of the PARP enzyme, to treat triple negative breast cancer. (PARP is used by cancer cells to repair damage done by chemotherapy drugs.) An expanded-access clinical trial using BSI-201 in combination with chemotherapy will be offered at UAB in the near future.

“BSI-201 eventually could become the first drug approved by the FDA specifically for treating triple negative breast cancer,” Dr. Forero says.

UAB is leading a national clinical drug trial that will test a combination of the monoclonal antibody bevacizumab (Avastin), which blocks the growth of blood vessels to tumors, and letrozole, which reduces the production of estrogen. Letrozole slows the growth of luminal breast cancer, a type of breast cancer fed by the hormone.

“Our pilot study showed that a combination of those agents is much more effective than the use of the current standard treatment [letrozole] alone,” Dr. Forero says.

Radiation Oncology Studies

In the area of radiation oncology, UAB is taking part in a randomized national trial comparing partial to whole breast radiation treatment for women in early stages of breast cancer. If radiating the portion of the breast where the cancer was located is found as effective as radiating the entire breast, the course of treatment could be significantly shortened, says radiation oncologist Jennifer De Los Santos, M.D.

Standard radiation treatment following breast-conserving surgery typically involves a 6 to 7 week course of therapy delivered once daily, Monday through Friday. The partial breast irradiation (PBI) regimen calls for treatments twice a day (separated by six hours) over only five days. Some low-risk breast cancer patients at UAB now may be eligible for the shorter course.

“Having cancer is stressful in and of itself, and the therapy can be disruptive to daily routines. People find the shorter treatment schedule easier to cope with and less disruptive to their lives,” Dr. De Los Santos says. “It’s especially helpful for our patients who must travel from more distant areas of Alabama or surrounding states.”

Dr. De Los Santos is the principal investigator in a large multicenter study conducted through the Translational Breast Cancer Research Consortium. This study will look at whether magnetic resonance imaging (MRI) can accurately predict the course of the disease following chemotherapy given prior to surgery or radiation therapy. Data from the study will help support a future national trial through the Radiation Therapy Oncology Group. That study will look at treating the breast with radiotherapy alone, eliminating the need for surgery, in women whose tumors respond completely to chemotherapy as determined by a post-treatment MRI.

“This approach may help patients avoid an invasive procedure requiring anesthesia, which always carries risks, and may also result in a better cosmetic result,” De Los Santos says. “Additionally, not everybody is an appropriate candidate for surgery.”

Surgery for Stage IV Cancer Patients

Cancer that begins in the breast is diagnosed as stage IV if it has spread to other parts of the body such as the brain, liver, or bones. There are no clear-cut national standards for surgical treatment of breast tumors at that stage because doctors aren’t sure if surgery is helpful. Breast surgeon Helen Krontiras, MD , is spearheading UAB’s participation in a national study to look at the question.

“A preliminary study showed that surgery to remove the primary tumor does lengthen life,” Dr. Krontiras says. “This national study through The Translational Breast Cancer Research Consortium will help demonstrate whether surgery truly is valuable for stage IV breast cancer patients.”

The study will look at how patients and doctors make treatment decisions. Blood and tissue samples will be collected for laboratory studies to learn more about tumors that have spread to other parts of the body.

“Research continues to help reduce mortality for all types of breast cancer,” says Dr. Krontiras, who is co-director of the UAB Breast Health Center. “Each type of breast cancer responds differently to various therapies. That’s one of the many reasons it’s important to try to determine the best treatment options for the individual patient.”