Non-Small Cell Lung Cancer (NSCLC) Treatment & Management

Answers To 10 Frequently Asked Questions About Metastatic Breast Cancer

ConferenceEducated Patient® Breast Cancer Summit

Here are answers to 10 questions patients asked at the CURE® Educated Patient® Metastatic Breast Cancer Summit about scans, treatment and clinical trials.

Questions about CT scans were answered during the CURE® Educated Patient® Metastatic Breast Cancer Summit.

Receiving a diagnosis of metastatic breast cancer or knowing someone who has can be overwhelming, especially when there's a lot to learn. So, during the CURE® Educated Patient Metastatic Breast Cancer Summit, two experts answered frequently asked questions about metastatic breast cancer.

From questions about scans, treatment advances to clinical trials, Dr. Jennifer M. Matro and Dr. Rebecca A. Shatsky, medical oncologists at the University of California San Diego Health, provided responses to patients at the summit.

Here are 10 answers to frequently asked questions about metastatic breast cancer.

1. How would the test Signatera (a type of circulating tumor DNA blood test) be used in monitoring metastatic breast cancer?

Matro and Shatsky: Currently, Signatera is not used in monitoring metastatic breast cancer. We use scans and labs/tumor markets to monitor. This is an area of research, though.

2. What about frequent nuclear bone scans?

Bone scans are done in combination with CT scans (imaging procedure to take detailed, two-dimensional pictures of the entire body) of the chest, abdomen and pelvis. It typically would be done approximately every three months or even more frequently if needed for suspected disease progression (worsening or spreading) or aggressive disease.

3. Since we are surviving metastatic breast cancer for longer periods, is there updated information about the frequency (especially for CT scans) regarding the risk of radiological scans? What should we do to reduce or monitor for issues?

There is no data whatsoever that suggests that frequent CT scans have any negative effects on patients with active metastatic breast cancer. CT scans are very necessary for disease monitoring and the benefits of monitoring metastatic breast cancer far outweigh any theoretical risks of radiation from CT scans.

4. Is it reasonable to request scans during monitoring and follow-up appointments? Surveillance of cancer for me is a physical exam and periodic blood tests. My monitoring feels inadequate because my original tumor was not palpable. I would feel confident about my health status if I was undergoing diagnostic testing as part of my appointments.

Scans are not used in stage 1 to 3 breast cancer for almost any patient. Insurance does not pay for them, as they have not been shown to improve outcomes.

5. If the first-line treatment is Kisqali (ribociclib)/Femara (letrozole), with the new data, what CDK inhibitor could patients switch to? Would hormone therapy chance as well?

Data from the phase 3 postMONARCH trial, presented at ASCO this year, suggested that changing the hormone therapy and changing the CDK inhibitor to Verzenio (abemaciclib) provides greater benefit than a new hormone therapy on its own. So, in the absence of other mutations, this may be an option for some patients.

6. Does Enhertu (trastuzumab deruxtecan) work for leptomeningeal disease?

Yes, there are emerging data that Enhertu is very beneficial in leptomeningeal disease and brain metastases.

7. Many patients with metastatic breast cancer die of brain metastases or leptomeningeal disease. Should a baseline brain MRI (a scan that takes pictures of the body's anatomy and physiological processes) be done when a person's disease becomes metastatic?

The development of leptomeningeal disease and the risk of brain metastases or leptomeningeal disease depends on the specific subtype of breast cancer patients have. The highest risk or rates are for HER2-positive and triple-negative breast cancer. Brain metastases are rarer in estrogen-positive HER2-negative breast cancer, but the rates are increasing as patients live longer. The rates of leptomeningeal disease are higher also in patients with lobular breast cancer. There is no data that suggests that routine brain MRIs in asymptomatic patients improve outcomes.

READ MORE: Oncologist Debunks Clinical Trial Myths

8. How often does hormone receptor (HR)-positive cancer mutate into a triple-positive cancer when it becomes metastatic?

This happens approximately 10% to 15% of the time, where the cancer recurs (comes back) in a different form than the initial presentation. That's why we always do a biopsy and receptor testing on newly diagnosed metastatic breast cancer.

LEARN MORE: Biomarker Testing Is Essential in HR-Positive Metastatic Breast Cancer

9. If a person does not live near a National Cancer Institute-designated cancer center, must they travel to the trial center? Does it make a difference if a person is in the state of the ongoing trial, such as California?

A patient must travel to wherever the trial they want to enroll in is being run. If they are in the state where the trial is being run and they want to hear more about it, they may be able to ask for a telemedicine visit to hear more about it. But to enroll, they will need to go there physically. If they want to get an opinion from a clinical trialist and don't live nearby, it's a great idea to ask for a telemedicine visit with a specific doctor at a big center that runs clinical trials.

10. If patients are reluctant to receive the standard of care and aren't eligible for a trial, do doctors ever offer label treatments or try to get a trial drug on compassionate use (receiving promising but not-yet-approved drugs when no other treatment options are available)?

Unfortunately, doctors are not able to prescribe therapies that are not FDA-approved through compassionate use, unless the respective drug company allows doctors to, which is incredibly rare.

I only prescribe "off-label therapy" when there is a good clinical rationale for using that therapy and a good chance it might work based on pre-clinical data (this is for drugs that are already FDA-approved in other cancer types. We cannot do this with drugs that are not yet approved).

It would be against the oncology code of ethics to prescribe a therapy that does not have good data for its use and that may benefit the patient.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

How Primary Bone Cancer Starts And How It Differs From Secondary Bone Cancer

Bone cancer, as the name suggests, is a type of cancer that affects the bones. This form of cancer is rare and, reportedly, makes up less than 1% of all cancer cases. However, although bone cancer is uncommon, doctors urge regular screening to detect the disease early and avoid complications associated with bone metastases, which are cancers that have spread to the bones.

July is Sarcoma and Bone Cancer Awareness Month and to mark the event, we at OnlyMyHealth interacted with Dr Vibhor Sharma, Senior Consultant and Head - BMT and Medical Oncology (Unit II), Asian Hospital, Faridabad, who shared invaluable insights around bone cancer, how it starts, what happens if and when it spreads to other body parts, and how to approach the disease.

Also Read: Bone Cancer: Symptoms, Risk Factors, Diagnosis, and Treatment

How Primary Bone Cancer Starts

When it comes to bone cancer, it usually has no known causes, Dr Sharma said. However, the doctor shares the process by which primary bone cancer typically starts.

He explained, "When cells inside or close to a bone experience DNA alteration, bone cancer begins. The instructions for growth and multiplication in healthy cells are encoded in their DNA. The instructions specify when the cells must die. The altered DNA in cancer cells provides alternative instructions. The alterations instruct the cancer cells to divide rapidly into many more cells. While healthy cells would die, cancer cells can continue to exist."

As a result, there is an overproduction of cells, which results in a mass known as a tumour. This tumour has the potential to spread and affect other healthy bodies, leading to metastatic or advanced cancer.

Common Symptoms Of Bone Cancer

According to Dr Sharma, bone cancer often starts in the thigh bone near the knee, the shin bone near the knee, and the upper arm bone near the shoulder. He noted that these spots are more likely to develop cancer because they grow quickly and have many cells that can change into cancer cells.

Some of the common symptoms associated with bone cancer include:

Difficulties with pain and swelling, pacing around

Experiencing fatigue

Having a fever

Increased instances of fractures or cracks in the bone

Losing weight without any known cause

However, it is important to note that these symptoms do not necessarily indicate bone cancer, which is why getting yourself examined by a doctor can help confirm your diagnosis.

Also Read: What Do We Need To Know About Our Bone Health During This Pandemic

Understanding Secondary Bone Cancer Or Bone Metastases

When the cancer starts in the bone, it is known as primary bone cancer. However, when cancer cells in any other part of the body break away and spread to the bones through the bloodstream or lymphatic system, it is called secondary bone cancer or bone metastases.

For instance, if your cancer started in the lungs but has spread to your bones, it is called a secondary cancer.

According to the American Cancer Society (ACS), almost all cancers can spread to the bone, but cancers that often spread to the bones include breast, lung, prostate, kidney, melanoma, ovarian, and thyroid.

The spine is the most common site for bone metastases, which the health body shares, adding other common areas such as hip bone (pelvis), upper leg bone (femur), upper arm bone (humerus), ribs, and the skull.

Early Diagnosis Is Key

According to Dr Sharma, many bone tumours can be detected early through their symptoms and other indications.

He said, "For those with an average risk of bone cancer, there are no recommended screening tests. The majority of bone malignancies are nevertheless discovered early on, before they have obviously migrated to other bodily areas. Doctor visits are frequently prompted by symptoms like oedema or bone discomfort."

"Doctors may advise close monitoring for patients with certain bone disorders that put them at higher risk for developing bone cancer. Sometimes early detection and effective treatment of bone cancer can be achieved by keeping an eye out for early signs and symptoms," he concluded.

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Recent Study Reveals Key Immune Cells As Critical Factors In Lung Cancer Prognosis

An extensive analytical study performed at the Terasaki Institute and published in Frontiers in Immunology highlights the crucial role of tissue-resident memory T cells and how they influence the immune environment of patients with non-small cell lung cancer and their overall prognosis.

Non-small cell lung cancer accounts for ~85% of lung tumors and is a leading cause of death in adults. Tissue-resident memory T cells, a specialized subset of immune cells residing in peripheral tissues, have been suspected of impacting cancer progression. However, it's still not fully understood how tissue-resident memory T cells affect the tumor immune microenvironment and tumor progression in various non-small cell lung cancer patient populations.

In this comprehensive study, multiple independent datasets from lung cancer patient samples were analyzed. In addition, a machine learning model was developed and validated to predict patient survival, refining an 18-gene risk score that effectively categorizes lung cancer patients into low-risk and high-risk groups. In cancer research, the 18-gene risk score is used to predict disease progression or recurrence chances, which helps create personalized treatment plans. The scores are usually divided into low and high risk, with specific thresholds setting these categories.

In this study, patients with high-risk scores exhibited significantly lower overall survival rates than their low-risk counterparts. Distinct Tissue Resident Memory T cell biomarkers were identified that correlate positively with other immune cells within the tumor environment. Moreover, these biomarkers were strongly associated with immune checkpoint and stimulatory genes, directly influencing patient prognosis.

"The study's findings highlight the critical impact of Tissue Resident Memory T cell abundance on immune responses and patient outcomes in lung cancer," said Dr. Xiling Shen, Chief Scientific Officer at Terasaki Institute for Biomedical Innovation. "Our findings not only validate these cells as a prognostic marker but also underscore their potential in guiding personalized treatment strategies, particularly in immunotherapy."

This research, independently validated by the Cancer Genome Atlas Program and multiple lung cancer patient datasets, provides a deeper understanding of the complex interplay between Tissue Resident Memory T cells and the tumor. It represents a significant step towards advancing precision medicine in lung cancer treatment.

More information: Aidan Shen et al, A comprehensive meta-analysis of tissue resident memory T cells and their roles in shaping immune microenvironment and patient prognosis in non-small cell lung cancer, Frontiers in Immunology (2024). DOI: 10.3389/fimmu.2024.1416751

Provided by Terasaki Institute for Biomedical Innovation

Citation: Recent study reveals key immune cells as critical factors in lung cancer prognosis (2024, July 30) retrieved 30 July 2024 from https://medicalxpress.Com/news/2024-07-reveals-key-immune-cells-critical.Html

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