patient can have more than1 breast cancer, points at treatments

Great article, although this shouldn't surprise anyone. It's common sense, since cancer is an evolutionary process that evolves over time and space.

The problem with using systemic drugs (whether chemo, targeted therapy like kinase inhibitors, SERMs like Tam, AI's, even natural approaches) is that tumors are very heterogeneous and genetically unstable. It's all about Evolution and natural selection. There are always sub-populations within tumors which are intrinsically resistant to therapy (or become resistant via evolution) and these are then "chosen" by natural selection. It's possible that the right immune cells (for example the NK [Natural Killer] cells) wake up and finish off the cancer, but if not, the end result is this: you can prolong life with drugs but invariably you may end up with a harder to treat/aggressive cancer.

To reiterate, tumors are heterogeneous (even at the earliest stage of disease) and they are always evolving, so drugs that are designed to kill cancer cells directly by targeting cell-intrinsic pathways inherently select for resistant clones that can lead to relapse.

To quote the "Emperor of All Maladies", "if cancer exploits the power of evolution to survive, perhaps only a commensurate weapon, equally adaptable, also perfected over millions of years, can overcome it. That weapon, many scientists believe, is the human immune system". Watch the video and skip ahead to the 1:11:00 mark (1 hour 11 minutes), here: http://www.pbs.org/video/2365450734/

I've been screaming advocating about using Immunotherapy (CAR-T, Oncolytic viruses, next generation checkpoint inhibitors) approaches for a while now - www.facebook.com/groups/TheCancerCure.
Is anyone listening?

Harnessing immunotherapy drugs to activate the proper Immune cells is the key. Immune cells are like a "living drug", and can generate a coordinated and adaptive anti-tumor response with capacity for memory, potency and specificity that is not achievable using any other therapeutic modality.

Hi tinkerbells...

Cell therapy is very promising. For example, I think CAR-T Immunotherapy has a lot of potential for solid tumors, but the key is finding the proper target on the surface of breast cancer cells. This target must be expressed on the tumor initiating cell (like a stem cell). Unfortunately, to this day, science has only identified a few of these targets that are on the surface of the cancer cell and unique to the tumor. In other words, nearly all over-expressed targets are also partially expressed on normal cells, which creates toxicity when trying to target them with drugs.

One approach to solve this issue is to engineer a CAR-T cell that has multiple receptors capable of recognizing multiple cancer antigens. (A T-cell is born with only one receptor which can only recognize one antigen). If a cancer cell has two antigens expressed that are not commonly found together on the surface of a normal cell, that becomes a wildly promising therapeutic. Such a CAR-T therapy will only be activated and take action against the cells that harbor both antigens on the surface of the cancer cell. Since normal cells will not harbor both antigens, they will be spared, thus avoiding toxicity. This immunotherapy approach enforces "specificity" and "safety", which is a major goal of all cancer therapy.
This is being worked on but will take a few years to mature. To use a software analogy, we are at version 2.0 for CAR-T in blood cancers, but version 1.0 for CAR-T in solid tumors like breast cancer.

Vaccines among all cancers (not just breast cancer) continue to fail. We are obviously missing something. Maybe vaccines need to be combined with some other mystery therapy to unleash their raw potential. I can't speculate those combo's though.

Another Immunotherapy approach is using oncolytic viruses. Take for example, the HIV virus. Nature made the HIV virus exquisitely good at smuggling genes into the cells. This makes it an attractive weapon against cancer. But before we can use HIV, we have to neuter the virus to make it safe. You do this be removing the dangerous genes that cause illness (i.e. AIDS). They you add good genes that turn it into a guided missile. In fact, this oncolytic viral vector is used to add the CAR to the T-Cells to create CAR-T immunotherapy, which has cured 90% of Stage 4 leukemia and lymphoma patients in some studies.

Hi Licata,
I hate to derail threads with 'off topic' replies, but I'll quickly comment about your FB link.
Your comment refers to Dr. Hadiyah-Nicole Green's 2012 PhD dissertation called: "A Minimally Invasive Multifunctional Nano-Enabled Approach For Selective Targeting, Imaging, and Near Infrared Photothermal Therapy of Malignant Tumors".
I downloaded this last year and only skimmed the first few pages. It's 102 pages long and dives into areas I know little about.
Photothermal therapy (PTT) employing near-infrared (NIR)-absorbing Nanoparticles.

Her approach combines Nanoparticles and tumor-specific Antibodies to form a Conjugate. This Conjugate binds to the cancer cells. The Conjugate is heated up by a laser until it explodes. Sounds great in theory. Lots of interesting science.
How this would work in lobular breast cancer (or any cancer) is beyond me.

I might come back and create a new post about this topic, so I'm adding the following tags for future searches: Fluorescent antibody technique, Thermotherapy, Phototherapy, Infrared radiation, Nanoparticles, Gold Nanorods (AuNRs), Ablation... rocket science, furry bunnies, too much coffee