Research on Side Effects at ASCO 2024

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: At the 2024 American Society of Clinical Oncology Annual Meeting, there were a number of poster presentations on studies looking at breast cancer treatment side effects. I talked to the scientists and asked them to explain the research to us.

Dr. Miriam Klahr: My name is Miriam Klahr. I'm a second-year internal medicine resident at Columbia University/New York-Presbyterian, and this is a project looking at chemotherapy-induced peripheral neuropathy. So, this is a side effect specifically of Taxol chemotherapies that, unfortunately, we don't have much to offer patients in terms of relieving the symptoms.

We do know that there's a relationship between poorly-controlled diabetes and chemotherapy-induced peripheral neuropathy, or CIPN. So, we wanted to look at whether there's also an association between hyperglycemia, or high glucose values, and CIPN development. We specifically looked at breast cancer patients. This was a secondary analysis, using data we already had from a past randomized controlled trial, and overall, it was a small trial. Only 59 patients.

So, we don't have statistical significance, but we showed that, in patients who developed chemotherapy-induced peripheral neuropathy, about half of them had hyperglycemia, compared to, in patients who didn't develop chemotherapy-induced peripheral neuropathy, only a third of them developed hyperglycemia. So, it suggests that there is a relationship between the two. Moreover, you could see over here that it's not just overall in time, but there's a relationship over time.

So, at baseline, week 12, and week 24, this relationship, continued, so that patients with CIPN, at all time points, have higher rates of hyperglycemia than those without CIPN, and we want to repeat this with a larger group of patients to show statistical significance, but the relevant outcome is that this could be a way, by better controlling glucose values for our patients, whether with diet or metformin or other medications, we might be able to proactively reduce the rates of chemotherapy-induced peripheral neuropathy.

Dr. Ana Ferrigno Guajardo: Hi, I'm Dr. Ana Ferrigno Guajardo. I'm from the Yale School of Medicine, and I'm here presenting the poster-named Factors Associated with Sexual Function and Satisfaction in Young Women with Breast Cancer. So, we have a cohort of young women with breast cancer in Mexico. We collected information from approximately 570 patients, and we followed them throughout five years, and here, we're presenting the data on sexual function and satisfaction in those five years.

So, what we see is that, personally, 80% of the patients remained sexually active throughout their diagnosis, treatment, and then the survival period. We see that over 90% have, or meet, criteria for hypoactive sexual disorder. We do see that 30% of patients have female sexual dysfunction, a diagnosis, and that increases at six months to about 50% of the patients, and at one year, to approximately 60%, before returning to a baseline of about 39%, 37% at two and three years and four and five years post-diagnosis.

Then we also see that, in terms of sexual satisfaction, almost 20% to 30% remained with low sexual satisfaction throughout their journey. We evaluated what factors could be associated with those three outcomes. We found that, in terms of being sexually inactive, we found that those patients that had a higher level of education, those that [didn’t] have a partner, those that had children, and those that suffered from higher burden of systemic therapy side effects were less likely to be sexually active.

In terms of having less scores in the sexual function survey that we used, we found that those that didn't have a partner; those that became menopausal from treatment; those that had depression, anxiety, worse body image; and those with higher systemic side effect burden exceeded at higher levels of sexual dysfunction, and in terms of sexual satisfaction, we found a lot of the same variables associated.

So, overall, what this study found is that there's a high prevalence of sexual dissatisfaction, high prevalence of sexual dysfunction in our patients. We're able to identify key factors that could alert the clinicians want patients to pay more attention to this issue, and this is a call to action for all oncologists to pay attention and offer treatments to avoid exacerbating sexual dissatisfaction because, at the end of the day, we found that worse sexual outcomes were associated with worse quality of life.

Dr. Mingxiao Yang: Hi, my name is Mingxiao Yang from Dana-Farber Cancer Institute. One of the trials is called Acupuncture for Chemotherapy-Induced Peripheral Neuropathy Treatment Trial. This is a phase III randomized clinical trial. So, in this trial, we're trying to assess the effect of acupuncture versus sham acupuncture on the treatment of CIPN in cancer survivors who experienced moderate to severe chemotherapy-induced peripheral neuropathy pain. This is our ACT trial.

Then we have a YCT trial, because most of the cancer survivors who experienced chemotherapy-induced peripheral neuropathy, they may also have motor weakness and balance difficulties. So, it is equally important to manage their pain as well as their balance difficulties. As we know, many people practice yoga to improve their neuromuscular function to maintain their balance control. So, we hypothesize that maybe yoga can be beneficial to cancer survivors who experience balance difficulty, motor weakness, with chemotherapy-induced peripheral neuropathy. Our preliminary data shows these interventions might be useful to help the patients, so, stay tuned.

Erin Hong: Hi, I'm Erin Hong. I work at the Providence Cancer Institute, and we did a pilot evaluation of the new Amma cooling cap device, mainly to see, as a primary endpoint, feasibility of the device in the clinic. It was done on early-stage breast cancer patients, and about 14 of them in the trial...or 13 successfully completed the treatment.

So, the main difference between Amma and other first-generation mechanical cooling cap devices, like Paxman or DigniCap, is the portability aspect of it, whereas patients would have to sit 30 minutes prior to chemotherapy and two hours afterwards, they, instead, have the options to move around, use the restroom, and that being said, we looked at patient-reported outcomes for how their experience was, and generally, across the board, we saw some very positive feedback. So, 93% of them said it was worthwhile, 100% would recommend participating in it again. And about 93% said their quality of life either improved or stayed the same.

In terms of results, we had 10 patients who completed the TC [Taxotere and Cytoxan] regimen, and half of them had grade one where the other half had grade three, and four patients were under the TH [Taxol and Herceptin] or THP [Taxol, Herceptin, and Perjeta] regimens, and three-quarters of them had grade one, where one of them had grade two. So, we saw that as very positive, although this is a smaller study. So, we hope to see other studies that will continue this type of work.

Jamie DePolo: When you say grade one, grade three, are we talking about amount of hair loss?

Erin Hong: Yes, great question. Grade one would be up to 25% of hair loss via the Dean’s Alopecia Scale. Grade two is anywhere from 25% to 50%, and then grade three would be 50% to 75% of the hair loss.

I'd also like to note, this was done in Portland and done between September 2002 to, I think, January 2024, and since there are about only 14 patients, I don't think we were able to include any...I guess, a large variety of racial or ethnic groups, which we would've loved to include.

Another addition that I forgot to mention of the Amma scalp cooling, is the addition of a very, very customized cap. So, the patients go through training with some of the representatives, and they have them on call for 24 hours when they're going through the treatment, and in addition to this, for the cooling, they have a little bladder that's attached to the cap, where you can squeeze it, and the cooling liquid goes all around the scalp, kind of adjusting or putting more pressure on uneven areas of the scalp, which might help for better coverage. Again, we still need to test these and see exactly how that stuff works.

Jamie DePolo: Is the Amma system, is that something, then, that a patient would buy, or would it be purchased by an infusion center, and then the patient rents, or how does that work? Do you know that yet?

Erin Hong: Yes, actually, I do. So, it requires costs from both the hospital institution itself as well as the patient. So, there is one up-front cost for the entire treatment for the patient, which is defined by the company or by the hospital, institution. I'm not exactly sure, but the part in which the hospital has to buy something would be they have to invest in getting the portable cooling units themselves. So, they're the things that you drag around.

The cooling cap itself is bought by the patient, and the pricing on that I think is still up on the air. What I do know is that it's just a one-time fee, whereas other cooling caps, they may do per treatment, and I think that may be a reason why we saw a lot of our patients complete the treatment. You bought it once, and you could just keep going, and we didn't see very many toxicities as well.

Dr. Laila Agrawal: So, I'm Dr. Laila Agrawal. I'm a medical oncologist and breast cancer specialist, and I did this study with my co-investigators, Dr. Eleonora Teplinsky and Dr. Corrine Menn, and we wanted to look at sexual health concerns in women with breast cancer. So, our study's called WISH Breast, which is Women's Insight on Sexual Health after Breast Cancer, and we did a survey using Instagram and email, and we got over 1,700 responses.

What we found was that almost 90% of patients reported that breast cancer diagnosis and treatment caused a moderate to severe amount of sexual health changes, and 85% said that these changes caused a moderate to great deal of distress. So, the most common sexual health symptom that was reported was actually decreased interest in sex, so decreased desire, also called low libido sometimes, followed by symptoms of the genitourinary syndrome of menopause, like dryness, decreased lubrication. Almost 60% reported painful sex, and more than 40% had changes in orgasm.

So, what we know is that patients are not getting this information from their healthcare team. So, 73% of respondents to our survey said that they did not get this information from their healthcare teams, and of those who did talk about it, most of them brought it up themselves. So that patients were initiating that conversation. We're finding that even standard, known treatments are not being routinely offered to patients, and as a result, we're seeing that patients are turning to social media for information about sexual health.

So, in this study, 80% of respondents got information about sexual health from social media, and most of those were actually coming from healthcare professional accounts. On social media, there's a lot of great, accurate information, like what comes from Breastcancer.org, but we can't always be sure of the quality and accuracy of the information. So, we do see a huge opportunity here for accurate, important information about sexual health being spread through social media, and I think that's one way that, potentially, we can meet this huge need.

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