What is the new breast cancer breakthrough?

Breast cancer treatment saw several big changes in the past year.

First, we have two targeted therapies that are newly approved for early-stage treatment of one type of breast cancer known as “triple negative.”

Triple negative breast cancer is considered a more aggressive (likely to spread) form of cancer. It is often found in a later stage, with a poorer prognosis.

Triple negative breast cancer accounts for about 10 to 20 percent of cases. This type of breast cancer is not “fueled” by hormones (estrogen, progesterone) or HER2, so it does not respond to typical hormone or targeted treatments used for other types of breast cancer. This year, however, we have seen data that adding immunotherapy improves how the triple negative breast cancer responds to treatment and improves survival.

Also, a new type of drug has been shown to help people with hereditary breast and ovarian cancer syndrome (BRCA1 or BRCA2 genetic mutations), which also commonly presents as triple negative breast cancer. Adding what is known as a PARP inhibitor prevents cancer cells from repairing themselves and targets cancer cells, minimizing damage to  healthy cells. These findings are directly impacting how we can care for patients with breast cancer.

What breast cancer research is currently underway at Lifespan?

I partner with collaborators around the country as well as here at the Lifespan Cancer Institute and the Cancer Center at Brown University on a variety of research. Our studies range from exploring the microbiome of the breast to the genomics of breast cancer, as well as improving healthcare disparities.

I am also passionate about clinical research for drug development. This means taking drugs and testing them against a person's cancer to introduce new treatments into oncology. The goal is to improve cure rates or prolong survival for persons with cancer.

For me, the joy of seeing a patient's cancer respond to a new drug, the partnership with patient volunteers participating in clinical trials, and the hope of making cancer treatment better is a powerful and rewarding part of being an oncologist.

Other exciting cancer research

I am always excited about research that is underway! In particular, we have several phase one trials in the pipeline looking at new drugs. The targets of the drugs are either inflammation and its role in cancer, or on the cancer cells themselves in order to destroy just those cells.

We also have ongoing trials designed to answer questions we have about whether certain treatments should continue after cancer has progressed. For example, in hormone receptor positive breast cancer, we often use several different medicines together to block the hormone cascade, like an anti-hormone therapy and a CDK4/6 inhibitor. If cancer grows on a combination, should we stop all the medicines in the combination or swap out some medications for others? Or would it be best to add a third drug?

Still other trials we are working on involve whether to increase or reduce treatment based on a tumor's response or risk profile. One of the patient advocates I collaborate with has coined this approach "right-sizing" treatment.

The future of breast cancer

I hope we will continue to better understand the mechanisms of cancer biology. This could help us to diagnose cancer more consistently at the earliest stages, or ideally at a pre-cancerous state when the disease can be fully stopped or prevented. Advances in blood-based testing and imaging are bringing us closer to this goal.

I am also hopeful that the momentum and collaboration we witnessed across the scientific community during COVID will help us increase the pace of oncology research and drug development.

What breast cancer patients should know

There are so many things I want patients to know! I want persons with cancer to be fearless asking questions about their diagnosis and treatment--they deserve a thorough understanding of their unique cancer. The patient and physician should be partners in communication and treatment planning.

I want everyone to know that clinical trials are not a "last hope" but rather represent a safe, effective treatment option for cancer (or any health condition) at any time in the management of your cancer.

Lastly, the coronavirus pandemic changed the focus on our health to COVID-19 -- social distancing, masking, and thankfully now, getting vaccinated. But that means many Americans fell behind on cancer screenings.

Our health system is here for you! We have mastered strategies to deliver the high-quality care you expect safely, with enhanced workflows to keep you and our colleagues safe. If you are due for a screening mammogram, screening colonoscopy, even just a routine checkup with your primary care physician--today is the day to take action!

Get involved in or support breast cancer research

There are so many ways you can get involved with breast cancer research, even if you have not been diagnosed with breast cancer. You can support cancer research right here at the Lifespan Cancer Institute in Rhode Island.

You can also get involved with events like The Miriam Hospital Gala or the Tour de Rhody.

I also work as the medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research, which offers the Love Research Army. The Army is essentially an email list that shares evolving research opportunities for everyone from those at risk for developing breast cancer to those with advanced or metastatic disease. You can join here.

Visit our website for more information on the Lifespan Cancer Institute and our research studies.

Stephanie Graff, MD

Stephanie L. Graff, MD

Dr. Stephanie Graff is the director of breast oncology at the Lifespan Cancer Institute.