New Therapies Significantly Cut the Risk of Recurrent Breast Cancer
The aromatase inhibitor letrozole (Femara) can prevent late recurrence of breast cancer, even when patients start on the drug long after stopping adjuvant tamoxifen, stated Paul Goss, MD, PhD, in the Journal of Clinical Oncology. Read More >

"What our results have shown for the first time in breast cancer treatment history is that taking an anti-estrogen anywhere along that line appears to have a dramatic reduction in the risk of recurrence," said Dr. Paul Goss.
Read More > | NPR Interview

New Phase III TEACH [Tykerb Evaluation After CHemotherapy] of new targeted drug, Tykerb for HER2- positive breast cancer tumor.

Listen to interview on Tykerb (TEACH) trial

Watch a video describing Tykerb on BostonChannel.com

The new Phase III clinical trial will investigate the experimental drug Tykerb (lapatinib) in patients with early-stage, HER2-positive breast cancer who have not been treated with Herceptin, another targeted drug used for the same type of tumor. The Cancer Center is the lead institution for the international trial, which is being sponsored by GlaxoSmithKline, the manufacturer of Tykerb. “This trial represents another step toward understanding the role of targeted therapies in extending disease-free survival,” said Paul Goss, MD, PhD, director of Breast Cancer Research in the Cancer Center.

About 25% of breast cancer patients have tumors that produce too many copies of a cell receptor called HER2. Because cellular growth is stimulated by the overactivity of this molecule, which also is called ErbB2, these tumors are more likely to recur and are less responsive to hormone-based treatments.

Tykerb blocks both the HER2/ErbB2 receptor and a related molecule called ErbB1. Earlier clinical trials have indicated that it may have advantages over Herceptin, a HER2 receptor blocking drug, in a number of settings related to treatment of HER2-positive breast cancer without significant side effects. The TEACH study is a Phase III trial of Tykerb’s use in patients with early-stage HER2-positive tumors. To enroll in the study, patients must have completed adjuvant chemotherapy but not have received Herceptin. Study participants will be randomized to receive a daily oral dose of either Tykerb or a placebo for up to one year.

“The TEACH study will be the first to investigate the use of a dual ErbB1 and ErbB2 inhibitor as an adjuvant treatment for women with HER2-positive breast cancer, who are at a high risk of their disease recurring,” says Goss. The results of this study could reveal whether the targeted therapy Tykerb could benefit women several years after the initial diagnosis of breast cancer.”

Tykerb has not yet received approval from the U.S. Food and Drug Administration.

For information regarding TEACH trial call: 617-726-8117

Cancer Genetics

Researchers have known for years that breast cancer is caused by alterations in certain genes...

But until very recently, trying to identify those genes and figure out what roles they have in a complex disease like breast cancer has been like looking for needles in a haystack. Now, thanks to a promising new technique called gene-expression profiling, those needles are beginning to glisten in the sun.

While still in its infancy, gene-expression profiling may someday enable doctors to predict far more accurately which breast cancer patients are at high risk of recurrence and, therefore, require more aggressive treatment, such as chemotherapy, following surgery. Conversely, it may help identify patients who are at low risk of recurrence, sparing them the side effects of these often-toxic, systemic treatments.

Equally important, this new technique will make it possible for researchers to identify genes that play key roles in the growth and spread of tumors-genes that could become the targets of new therapies.

Paula Ryan, MD, PhD is a medical oncologist and clinical researcher who specializes in breast cancer within the Gillette Center for Breast Cancer. In collaboration with Daniel Haber, MD, PhD, director of the Cancer Center, and Dennis C. Sgroi, MD, director of Breast Pathology at Massachusetts General Hospital, Ryan is involved in the first prospective clinical research study in the U.S. to evaluate gene-expression profiling as a potential new tool for predicting breast cancer prognosis.

Gene Discovery for Breast Cancer...

Dennis C. Sgroi, MD, director of Breast Pathology led a multidiciplinary team to discover a two-gene "signature" that appears to predict which breast cancer patients will respond to tamoxifen therapy and those who will not. Sgroi stated, "The goal is to tailor treatment to the individual patient early on, so that each has the best opportunity for treatment success."

Radiation Oncology

Radiation Therapy...which breast cancer patients benefit and which ones do not...

In the New England Journal of Medicine, Kevin Hughes, MD, co-director of the Avon Foundation Comprehensive Breast Evaluation Center, challenges that patients over 70 yrs with smaller breast tumors should routinely get radiation. ''When treating patients, you always look at the risk-benefit ratio. Up until now, we've said [all] patients must have radiation. Now, we can go in and say this is what your real risk is, and this is what your real benefit is." To read the complete article (Boston Globe) >>>

Surgical Oncology

Lymphatic Mapping for Breast Cancer

Breast cancer unfortunately commonly spreads to the lymph nodes under the armpit (axilla). The presence or absence of cancer in these nodes is the most important prognostic factor for women with potentially curable breast cancer. Most general surgeons today continue to surgically remove all of these lymph nodes to determine tumor stage in an operation referred to as an axillary dissection. This operation is associated with morbidity, including arm swelling, decreased shoulder mobility, and underarm/chest-wall numbness. Although more limited axillary dissections are associated with decreased post-operative morbidity, these types of operations may compromise the accuracy of staging.

Others and we have pioneered an alternative to this traditional approach which is a technique referred to as sentinel lymph node mapping. By using a combination of blue dye and a radioisotope, surgeons can follow the lymphatic channels draining a breast cancer to a lymph node ("sentinel node"), which is surgically removed in a much less invasive operation. We have demonstrated that the presence or absence of breast cancer in this sentinel lymph node accurately determines whether the breast cancer has spread to the axilla. The ability of a surgeon to find the sentinel node(s) during surgery is highly dependent on the number of these operations he/she has performed. Sentinel lymph node mapping surgery is less invasive than the traditional approach of removing all lymph nodes, and is therefore associated with less morbidity. Another potential advantage of this sentinel lymph node mapping is that the pathologists can focus their analysis on sentinel lymph nodes, rather than on numerous lymph nodes removed from the axilla. They are therefore able to examine more areas of the lymph node and use special stains. These techniques have been demonstrated to identify microscopic foci of breast cancer that are missed by standard techniques.

Between 18% and 35% of patients with stage I and II breast cancer will have spread of their disease to axillary lymph nodes. In many cases, the only node containing cancer will be the sentinel lymph node. It is unknown whether complete removal of axillary lymph nodes in these patients improves local control or enhances odds of survival. Several published series have shown that radiation therapy alone is effective in controlling recurrence in the axilla.

The goals of this clinical trial are:

1. Determine the lymph node recurrence rates in patients with cancer in their sentinel lymph node that undergo axillary radiation
2. Assess reduction in morbidity associated with sentinel lymph node mapping compared to traditional full axillary dissection
3. Determine the frequency with which breast cancer is identified in sentinel lymph nodes using more sensitivity pathologic analytic methods.

If you are interested in learning more about lymphatic mapping for treatment of your breast cancer, or if you would like more information on this clinical trial, please contact Beth Sawyer, PA at 617- 724-4800.

Michele A. Gadd, MD
Division of Surgical Oncology, Massachusetts General Hospital

Imaging Techniques

New Type of Advanced Imaging Technique Can Detect Breast Cancers at an Early Stage.

The Massachusetts General Hospital Cancer Center is world-renowned for its pioneering research endeavors in the early detection and diagnosis of breast cancer. Early detection has been shown to save lives: there is a 97% five-year survival rate when breast cancer is caught before it spreads to other parts of the body. At the Avon Foundation Comprehensive Breast Evaluation Center, our patients have access to new approaches that are not available anywhere else.

Digital tomosynthesis of the breast is different from standard mammography in the same way that a ball is different from a circle – one is 3-D and can be picked up, rotated and viewed from all angles, while the other is flat.  

In traditional mammography, one image is taken across the entire breast, in two directions: top to bottom and side to side.  These images can be difficult to read especially when cancers are small and breast tissue is dense.  In addition, the compression of the breast that is required during a traditional mammogram causes breast tissue to overlap, sometimes “hiding” a cancer.  As a result, it can be difficult to determine if something seen on the mammogram is cancer or if it is normal tissue.  In fact, in 25% of the patients who are called back because their mammogram showed “something”, closer examination reveals only normal tissue. 

Digital tomosynthesis overcomes these issues by taking multiple pictures of the breast from many angles.  These pictures are then collected electronically and synthesized to create a 3-D view that provides much more detail and can be rotated in space for more careful examination.  While the breast is positioned in the same way as in a conventional mammogram, only slight pressure is applied, providing a more comfortable experience for the patient and making abnormalities more visible by minimizing the overlapping of breast tissue.

Standard Mammogram	Same Part of Breast using Digital Breast Tomosynthesis
Enlarge Image
The cancer looks like a star with lines radiating out from it, and is much more clearly seen with the digital tomosysnthesis than with standard mammography.

 “We believe that with tomosynthesis, we will find more cancers, and we will find them earlier.  Because it is a more comfortable experience for the patient, we also hope more women will seek out mammograms on a regular basis,”  according to Daniel Kopans, MD, director of Breast Imaging.

Digital tomosynthesis is currently only available at the Cancer Center only as a research protocol.  However, with FDA approval pending, Kopans and his team hope it will soon become the standard of diagnostic care across the country.