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Welcome to The Breastcancer.org Podcast, the podcast that brings you the latest information on breast cancer research, treatments, side effects, and survivorship issues through expert interviews, as well as personal stories from people affected by breast cancer. Here’s your host, Breastcancer.org Senior Editor, Jamie DePolo.
Jamie DePolo: Hello. I'm Jamie DePolo, senior editor at Breastcancer.org. I'm podcasting live from the 2024 San Antonio Breast Cancer Symposium. I'm thrilled to be joined by Dr. Marisa Weiss, a radiation oncologist who is the founder and chief medical officer of Breastcancer.org. She has been here at the conference all week and we are going to discuss some of the most interesting, in her opinion, and also most immediately applicable research when she goes back to the clinic on Monday.
So, Dr. Weiss, what caught your eye at this conference?
Dr. Marisa Weiss: Well, first of all, I think there’s some major trends that are building that people need to know about. One is that we are no longer in a one-size-fits-all or one-size-fits-most situation here. Everyone’s situation is unique to them and since breast cancer is the most common cancer to affect women, each person’s situation is like a rare disease. It’s so unique to you. And so, you need to work with your team of doctors and other types of medical professionals to make sure that you get the best treatment for you, that’s going to give you the greatest benefits and the least side effects. So, personalization of medical care to your unique situation is a major theme.
Another major theme is de-escalation. Basically, I'm only giving you what you need and making sure that in each area of your care, if it’s surgery, you know, radiology, pathology, medical oncology, radiation oncology, that you only get what you need. And you know, I tell my patients, you know, if people were thinking like, oh no, I don’t want chemotherapy. I say, well, if you need it, you want it, but if you don’t need it, you don’t want it.
And so, a lot of the conference is focused on how can we, you know, not throw the whole kitchen sink at everybody and only do what is going to be helpful to your unique situations.
Such…so, for example, if you were at elevated risk for breast cancer, maybe you have a strong family history, maybe you had a personal history of breast cancer and you have dense breasts, like heterogeneously dense or extremely dense, those are like 47% of people with breast cancer have dense breasts like or maybe you have a known inherited breast cancer gene that elevates your risk somewhat, like a CHEK2, or a lot like a BRCA genetic abnormality, then you need to be followed extra for that extra risk. And what is that going to be? Is it going to be 3D tomography, type of mammography, in alternation with MRI? Or is it going to be 3D mammography that combines contrast enhancement? These are things you should talk to your doctor about.
But definitely if you’re at elevated risk for one of those reasons and also include in there strong family history, even if you don’t have dense breasts or you don’t have an inherited gene, like any of those categories, or you know you’ve had breast cancer before and you have one of those things like dense breasts, an inherited genetic abnormality, a strong family history, or maybe you’ve had radiation exposure as an adolescent girl. Then that’s extra breast cancer risk and you want to get extra imaging under those circumstances to give you the benefit of early detection.
We also heard an important study about the role of prophylactic surgeries in young women diagnosed with breast cancer who also have a BRCA genetic abnormality, that’s BRCA1 or BRCA2. And in that study, the women had prophylactic removal of the breast. They had a therapeutic mastectomy on the side that was affected, and the other side was removed prophylactically. And some of those women also had prophylactic removal of the ovaries and fallopian tubes.
And what they found was that there was a definite survival benefit with either of those two approaches and probably…they didn’t show the data, but we’ll learn soon…maybe an even bigger benefit when you do both in terms of protecting you against, not just breast cancer, but some of the other cancers that can go along with a BRCA1 or BRCA2 inherited genetic abnormality, like a cancer of the ovary or fallopian tubes or some of the others cancers that can occur in women who are at elevated risks because of something that they inherited.
And that’s good news for those young women who are diagnosed. I take care of a lot of those people, and they want to know what can I do that’s going to make a meaningful difference that’s going to help me live a long life full of wonderful things where I get to do what I want to do when I want to do it, and remain the independent woman that I am.
Another important theme that is being really explored at this San Antonio Breast Cancer Symposium is the fact that breast cancers are very what we call heterogeneous. They’re made of many, many cells. Even a cancer that’s a centimeter round has, you know, millions of cells in there and they’re not all the same, they’re different from each other. It’s like being at a family reunion, you look around the room and they’re all related to you, but they’re different from each other. And in order to get rid of the different kinds of breast cancer cells that are in one cancer you often need different forms of treatments that work in different ways to get rid of the different kinds of things that might be in there.
And there was a study called the PATINA study – P-A-T-I-N-A study – for women who have hormone receptor-positive, HER2-positive metastatic breast cancer. And they looked at those women and said, okay, so you’re already on anti-HER2 therapy, like Herceptin, Perjeta maybe, and an aromatase inhibitor or Faslodex or something like that. And they said, well, what if we add in there another medicine to the mix, to the cocktail of medicines, that works in a different way that may in combination give you a better outcome.
And what they found was that in those women, again they were women with metastatic disease, that were hormone receptor-positive, HER2-positive. When they added in Ibrance, which is a CKD4/6 inhibitor, and they combined that together with an aromatase inhibitor or a SERD and anti-HER2 therapy, that women live longer and better, freer of breast cancer. And they were able to tolerate it relatively well and get that benefit with fewer side effects than if they had to move on to a chemotherapy, because the cancer grew despite just those, the endocrine therapy and the anti-HER2 therapy.
So, it’s an example of combining another form of treatment that works in a different way to give you a greater benefit and with fewer side effects over time, which is obviously going to be the most important goal to get the best care possible.
Jamie DePolo: Dr. Weiss, thank you so much for joining us. Thank you for those explanations and we appreciate all your insights.
Dr. Marisa Weiss: It’s great to have you here with us, Jamie. You are the queen of podcasts, and we love having you here. And the whole Breastcancer.org team is here to capture all these important discoveries so that anyone who’s out there who is part of our Breastcancer.org community can benefit sooner than later, because we know what’s at stake. It’s your life and it’s your future. And you know, even though I'm chief medical officer and founder of Breastcancer.org, I'm also a survivor myself. So, I've been in the hot seat, and I know how important these discoveries are. So, we hope that they’re helpful to you as well.
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