November 2014 Research Highlights

Jamie DePolo: Hello, everyone, this is Jamie DePolo. I’m the senior editor here at Breastcancer.org, welcome to the latest edition of our podcast. We’re going to be covering some Research News stories today, and our guest, as always, for our Research News podcast is Dr. Brian Wojciechowski, who is the Breastcancer.org medical adviser.

Welcome, Dr. Brian, how are you today?

Dr. Brian Wojciechowski: I’m very well, Jamie, how are you?

Jamie DePolo: I’m doing well, thank you. So, we’ve got a couple, well, actually, four studies we’re going to talk about today. I think they’re all very interesting, and they also have some pretty practical applications.

The first one was a study that came out in November, just towards the end of November, and it was on calcium channel blockers, which are a high blood pressure medicine. And the researchers found that these medicines do not increase breast cancer risk. I’m going to let you explain, Brian, what happened, why there was a study that came out in August of 2013, last year, that said that calcium channel blockers did increase breast cancer risk. So, apparently, it seems like these researchers wanted to duplicate that or figure out what was going on?

Dr. Brian Wojciechowski: Yeah. This was a bigger and more reliable study then the prior study that you were talking about and, you know, there’s always confounding factors when you’re looking at association kind of studies like this. If you look at one group of women who are on the blood pressure medicine versus the other group who are not on the blood pressure medicine, they might find that the women on the blood pressure medicine have a higher risk of breast cancer. But women who have high blood pressure are probably more likely to be overweight or diabetic, all of which can contribute to breast cancer risk. So, you don’t know what’s contributing there, and it might skew your results. It might make you think that there’s an increased risk from the drug, when the increased risk is actually from other factors.

Jamie DePolo: Okay. So, do we feel good about these results?

Dr. Brian Wojciechowski: I definitely feel reassured about these results. I mean, there’s no mechanism of action by which I can think of that these drugs should cause an increased breast cancer risk, and with a bigger study, it’s certainly more reassuring and more reliable that your results are true and not just coincidence.

Jamie DePolo: Okay. So if anybody is a postmenopausal woman who is taking a calcium channel blocker to control high blood pressure, I think you could feel pretty reassured that that medicine is not going to increase your breast cancer risk. But also, keep in mind, as Dr. Brian said, the risk factors for high blood pressure, which include being overweight, not getting enough exercise, smoking cigarettes, and drinking alcohol are also all risk factors for breast cancer. So, if you’re doing lifestyle changes to help control your high blood pressure, you’re probably also helping to keep your risk of breast cancer as low as it can be. So, that’s always a good thing.

Dr. Brian Wojciechowski: Exercise is good medicine.

Jamie DePolo: Yes. Absolutely. Our second study, I thought this was very interesting. There is a group called the Society for Integrative Oncology, and that group looks at how to make complementary medicine techniques part of the whole treatment plan and ways to integrate these complementary therapies, like acupuncture or yoga or massage, in with more traditional Western medicine. This group looked at, I think it was 90, more than 90, types of complementary therapies and issued recommendations on which ones were helpful, or the most helpful, for people who had been diagnosed with breast cancer. And they actually gave each complementary therapy a letter grade, almost like you would get in school, from A to D and then, there was an H and that meant […] that the therapy does more harm than good, so you should definitely not do those. And I meant that it was incomplete, that there wasn’t enough research. Were there any surprises in here for you, Dr. Brian? I know it showed that meditation and yoga and relaxation have the strongest evidence showing that they were helpful.

Dr. Brian Wojciechowski: Yeah, I think that’s consistent with many of the studies we have reviewed in Research News. I was not surprised to see that soy extracts and soy foods get a grade D. There has been some concern about the plant estrogens in soy, although the research has been mixed, but I think it is still wise to avoid those things. Other than that, I think these are good guidelines that provide clinicians with an excellent resource, just looking for other ways to help cancer patients cope with their diagnosis and their side effects.

I’ve seen patients benefit from meditation techniques and acupuncture and yoga, so I try to encourage it for my patients. Not everyone is interested in it and that’s fine, but I do support it with the following caveat. Patients tend to get into trouble when they’re using complementary and alternative medicine in place of traditional Western medicine -- that I’m not in favor off. I think the two will go well together, but I don’t want to see patients abandoning things like chemotherapy, radiation, hormone therapy for these alternative therapies because I don’t think they’ll do well.

Jamie DePolo: Okay. It’s worth noting, I think, too, that most of these complementary therapies, what they are used for, as you said, are for side effects, or anxiety and stress to help somebody feel better about themselves, to manage their stress, to control fatigue, maybe help them sleep better, give them better quality of life, control pain, nausea, vomiting, and neuropathy, and even some of them have been shown to help a little bit with hot flashes. So, none of them are really shown, like, “Oh, this is going to kill cancer cells.”

Dr. Brian Wojciechowski: Yeah. Exactly.

Jamie DePolo: Okay. That’s good to know and yeah, we do get quite a few visitors to our site that tell us that they’ve been helped quite a bit by complementary therapies, especially yoga and meditation. Those I would have to say are the two biggest ones that people talk about. So, if you are interested, if you’re experiencing some treatment-related side effects, or if you’re having stress or anxiety because of a breast cancer diagnosis, this may be something that you want to check out. But definitely always talk to your doctor to tell your doctor that you’re considering these therapies, so he or she knows just what’s going on. I mean, it’s just like any vitamins that you would take, or anything else that you take, you do need to keep your doctor informed about what you’re doing so he or she has the whole picture of your treatment.

Dr. Brian Wojciechowski: I couldn’t have said it better.

Jamie DePolo: Well, thank you. So, our third study, we’ve talked about this before, but the evidence just keeps coming in, that more women in the United States are choosing mastectomy over lumpectomy as surgery to remove early-stage breast cancer. And doctors aren’t sure exactly why this is happening, but there seem to be some ideas. Have you seen this in your practice, Dr. Brian?

Dr. Brian Wojciechowski: I have, and this is despite the evidence that is very strong, high-level evidence, that lumpectomy and radiation is just as good, if not better, than mastectomy for early-stage cancer.

Jamie DePolo: Do women in your practice, do they talk to you about why they’re making that decision? Do you have any insights as to maybe why this trend is increasing?

Dr. Brian Wojciechowski: I think there’s a psychological effect where if the breast is removed, you know, the breast is gone, women feel more reassured by that than if they’re keeping the breast that had cancer in it. I think that’s the most common reason. Also, you’ll notice that younger women tend to opt for mastectomy more often than older women, I guess thinking that they’re going to be alive a lot longer with the breast, and they would rather just have it out of sight, out of mind.

Jamie DePolo: Okay. Now, do you think reconstruction choices play a role in that at all?

Dr. Brian Wojciechowski: I think so. I think without good reconstructive options, more women would probably choose lumpectomy.

Jamie DePolo: Okay. Because I didn’t know if a woman decided she was going to have reconstruction and maybe she thought she could achieve better reconstructive results if she had a mastectomy versus a lumpectomy, I don’t know.

Dr. Brian Wojciechowski: Yeah. I’m not sure that is the biggest factor that goes into it.

Jamie DePolo: Okay.

Dr. Brian Wojciechowski: I think it’s just the whole “out of sight, out of mind” thing, but you know, you always have to remember, whether the breast is there or not, if breast cancer comes back, it doesn’t always come back in the breast, sometimes it comes in the bone, or the liver, or the lungs, or that sort of thing. So, even with a mastectomy, that is not a 100% guarantee.

Jamie DePolo: Okay. And certainly, the type of surgery that anyone has is a very personal choice, and there’s really no right or wrong answer, it’s whatever is right for you and your unique situation. But we do, at Breastcancer.org, encourage everyone to talk to your doctor about all your treatment options, just so you have all the information in front of you and can make the most informed decision.

It’s good to keep in mind that mastectomy and double mastectomy are bigger surgeries than lumpectomy, so it’s a long recovery time, but on the other hand, if you think that you’re going to get greater peace of mind from one surgery over another, then maybe that is the best choice for you. But it’s just interesting that this trend keeps continuing, because I know we talked about a story like this about a year or a year and a half ago, so the trend keeps growing.

Dr. Brian Wojciechowski: Yup. Yeah, we probably do more mastectomies than we really have to.

Jamie DePolo: Okay. Then, our last story we’re going to talk about today, there is a new experimental target therapy called olaparib and some research suggests that it could help treat people who have been diagnosed with advanced-stage cancer -- and there’s several types of advanced-stage cancer, breast, ovarian, pancreatic, or prostate. If that cancer is because the person has an abnormal BRCA gene, then this targeted therapy olaparib may help. So, Dr. Brian, if you could just explain a little bit what olaparib is and how it works and why it seems to be so helpful for people with this abnormal gene.

Dr. Brian Wojciechowski: So, when someone has an abnormal BRCA1 or 2 gene, that means that they’re not very good at fixing DNA damage, because that’s what the BRCA1 and 2 functions as normally, to repair DNA damage. So, this drug, o-la-PAR-ib or o-LA-pa-rib, depending on how you want to pronounce it --

Jamie DePolo: Oops, I’ve probably been pronouncing it wrong my whole life and I didn’t know.

Dr. Brian Wojciechowski: I’m not sure, I just kind of say it however… these drugs are very difficult, and I just try to say whatever rolls off the tongue easier.

Jamie DePolo: Right, and this is just the chemical name, too. If it does get on the market, it will probably have a brand name that will be completely different.

Dr. Brian Wojciechowski: That’s exactly right. So, it’s a PARP inhibitor, and PARP is an enzyme involved in DNA damage repair. And we believe that by inhibiting this enzyme, it makes it less likely that those cancer cells could survive because of the damage to DNA.

Now, the PARP inhibitor story goes way back. A couple years ago, there was a lot of excitement about a PARP inhibitor study that came out in the New England Journal of Medicine, which is the big medical journal, and it was in phase II, and as you know, phase II is sort of a preliminary type of study. When it went to phase III, it didn’t pan out, so that was a big disappointment for all of us. So, we’ve kind of been burned on this one in the past, and this study still is a phase II study, so it’s considered to be preliminary, and we won’t really have a good final answer until they complete a phase III study. But hopefully the drug has finally found its niche. It’s an exciting drug because it’s a pill, it’s not like an IV chemotherapy. So, convenience for the patient is going to be a big thing. I and all of us in the cancer community are very hopeful that this drug pans out and will be useful for our patients because if I think it did, it will be a major game-changer.

Jamie DePolo: Okay, and especially, too, it seems like because it is aimed at treating advanced-stage cancer, we have comparatively fewer treatments for advanced-stage then we do for early-stage, is that a fair statement? I should say not fewer, but fewer new ones. It seems like there are fewer new treatments being found for advanced-stage disease.

Dr. Brian Wojciechowski: Well, you know, lately, we’ve had some interesting developments with HER2-positive disease with the introduction of Perjeta, or pertuzumab, which is being used in early- and advanced-stage. Usually, these drugs are first developed in advanced stage disease before they can go on. They have to be proven in advanced-stage before they can go on to early-stage.

Jamie DePolo: Okay. So I’m completely wrong. I take it back.

Dr. Brian Wojciechowski: So, there’s a lot of new drugs in the pipeline. We haven’t had a whole lot of big developments in early-stage recently, but all these drugs have to prove themselves in late-stage first and then they move onto early-stage.

Jamie DePolo: As you mentioned, this study that we’re talking about was a phase II study. Do you think that the results were promising enough that this will go onto a phase III trial for olaparib?

Dr. Brian Wojciechowski: Absolutely.

Jamie DePolo: Okay. Have you heard anything about when that might start, or is it still too premature?

Dr. Brian Wojciechowski: Not specifically. I haven’t heard anything specifically, but hopefully we’ll find out something in San Antonio this year.

Jamie DePolo: Okay. Yeah. That starts next week and I’ll just give everyone a little teaser, make sure you keep listening and keep checking on our website because we’re going to be doing some podcasting about things presented at San Antonio next week, so we will strive to get you information as soon as we have it.

Thank you so much, Dr. Brian. Those are our four studies for today. Thanks, everybody, for listening, and as I said, make sure you tune in or check out our website next week, which would be the week of December 9. We will be broadcasting about San Antonio.

So again, thank you, Dr. Wojciechowski. Have a good week.

Dr. Brian Wojciechowski: You, too.

Editor’s Note: On Jan. 12, 2018, Lynparza (chemical name: olaparib) was approved by the U.S. Food and Drug Administration to treat metastatic HER2-negative breast cancer in women with a BRCA1 or BRCA2 mutation that has been previously treated with chemotherapy.