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  • BlueGirlRedState
    BlueGirlRedState Member Posts: 1,031
    edited May 2021

    Any knowledge or experience with unintended SEs with Exemestane/Afinitor? I was alarmed to read one article about very rare instances of lung damage. I'm off Afinitor during radiation, last day is Thrusday (hooray!), Other risks - kidneys, blood-sugar, BP..... Somewhere I saw a graph comparing Exemestane with/wiithout Afinitor, and it seems like the benefits drop rapidly

  • moth
    moth Member Posts: 4,800
    edited May 2021

    BlueGirlRedState, check out the pneumonitis thread started by DogersGirl https://community.breastcancer.org/forum/8/topics/...


  • BlueGirlRedState
    BlueGirlRedState Member Posts: 1,031
    edited May 2021

    Thanks moth, I've added it to my favorites

  • DodgersGirl
    DodgersGirl Member Posts: 2,382
    edited May 2021

    BlueGirlRedState- Ref Afinitor and pneumonitis: Report ANY sense of shortness of breath to your MO so they can monitor your lungs

    Thanks Moth for sharing the link. I shared my struggles hoping to help othet

  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    When I was diagnosed with DCIS in 2017, I felt somewhat pressured to go with lumpectomy/radiation. One of the questions I asked my MO was—if I get a future recurrence, won’t reconstruction be more difficult? She kind of scoffed at my silly question. Well, recurrence happened about 18 months later. Had a mastectomy which took a long time to heal due to radiated skin. I wasn’t able to consider any reconstruction due to Covid and I’m not even sure that I was able to get any other surgery due to radiated skin. Now, lo and behold recent mammogram identified suspicious lesion on right breast. I’m getting biopsy in a couple days. If I had been brave enough to get bilateral mastectomy in 2017, I believe I would be much better off today. Right now I’m just scared and sad. Hindsight is 20/20 but I think individuals need to be given enough info to make a truly informed decision that’s right for them. I was sold on the notion that DCIS doesn’t spread, etc, etc. I’m learning that the rate of subsequent cancer occurrence is higher than I really understood.

  • JACK5IE
    JACK5IE Member Posts: 760
    edited May 2021

    CDK inhibitors may boost the effectiveness of immune therapy in metastatic breast cancer

    Reviewed by May 10 2021

    A class of drugs that inhibits breast cancer progression when used with hormonal therapy might also boost the effectiveness of immune therapy in cases of recurrent, metastatic breast cancer, according to a new study led by researchers at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James).

    Published in the journal Cell Reports, the findings of the animal study suggest that drugs called CDK4 and CDK6 (CDK4/6) inhibitors might improve the effectiveness of immune therapies for metastatic, estrogen-receptor-positive (ER+) breast cancer.

    We know that CDK4/6 inhibitors effectively slow the progression of newly diagnosed breast cancer, but they don't kill cancer cells. Consequently, the disease often recurs, and then it is usually fatal because we have no effective therapies for recurrent disease. Our findings suggest that combining CDK4/6 inhibitors with immunotherapy might offer an effective treatment for recurrent, metastatic ER+ breast cancer."
    Anna Vilgelm, MD, principal investigator, a member of the OSUCCC - James Translational Therapeutics Program and assistant professor at the Ohio State College of Medicine

    Specifically, the study shows that CDK4/6 inhibitors can improve the efficacy of T-cell-based therapies such as adoptive T-cell transfer or T-cell-activating antibodies in animal models of breast cancer.

    Immune therapies are proving to be effective treatments for a variety of cancers but not for advanced breast cancer. One problem is that breast tumors often have low numbers of cancer-killing T lymphocytes within the tumor. Such tumors tend to respond poorly to immune therapies.

    Related Stories

    "In addition, breast cancer patients with low numbers of tumor-infiltrating lymphocytes often have worse survival compared to patients with high numbers of infiltrating lymphocytes in their tumors," says Vilgelm.

    The new study shows that CDK4/6 inhibitors cause breast tumors to secrete small proteins called chemokines that attract T cells. This can help to improve patients' response to cancer immunotherapies.

    For this study, Vilgelm and her colleagues used the oral CDK inhibitor palbociclib, mouse models, breast cancer cell lines and analyses of The Cancer Genome Atlas (TCGA) to study the influence of CDK4/6 inhibitors and chemokine production in the tumor immune microenvironment and on patient outcomes.

    Key findings include:

    • Pre-treatment with a CDK4/6 inhibitor improves recruitment of T cells into tumors and improved the outcome of adoptive cell therapy in animal models;
    • CDK4/6 inhibitor-treated human breast cancer cells produce T-cell-recruiting chemokines;
    • TCGA analysis showed that chemokine expression is a favorable prognostic factor in breast cancer patients;
    • mTOR-regulated metabolic activity is required for chemokine induction by CDK4/6 inhibition;
    • T-cell-recruiting chemokines may be useful prognostic markers for stratifying patients for immunotherapy treatment.

    "Overall," Vilgelm says, "our findings suggest that CDK4/6 inhibitors may offer a therapeutic strategy that can attract T cells into breast cancer tumors, which may increase their sensitivity to immune therapies."

    https://www.news-medical.net/news/20210510/CDK-inhibitors-may-boost-the-effectiveness-of-immune-therapy-in-metastatic-breast-cancer.aspx

  • buttonsmachine
    buttonsmachine Member Posts: 930
    edited May 2021

    Jetcat, I'm sorry you're going through this. I just wanted to chime in and say that prior radiation doesn't necessarily rule out implant reconstruction, although you're correct in that there can be more difficulty with healing. I had an implant after radiation with no trouble, although it has since been removed for other reasons related to the cancer and I'm half flat now. There's also the DIEP and other flap procedures.

    Anyway, don't lose hope, there are options out there. Best wishes.

  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    Thank you. When I was first diagnosed I was still working in a corporate type job and probably would have done some type of reconstruction. Now that I’ve retired at 62, I actually wouldn’t be upset about going flat. My surgeon did an outstanding job of a very tight, smooth closure. Half flat isn’t bad either but I really think I’ll pursue another mastectomy if I even have a choice.

    All the best to you !

  • BSandra
    BSandra Member Posts: 836
    edited May 2021

    Dear all, some fresh news on HER2+ drugs in HER2low sub-population (found by one silent member on these forums): https://t.co/xme5TSU2GD?amp=1

    Also, for the first time Enhertu's bystander effect is really proved: https://clincancerres.aacrjournals.org/content/ear...

    Saulius

  • Springdaisy
    Springdaisy Member Posts: 58
    edited May 2021

    it is like every time I want to read an article they want me to sign up but I’m not going to do that it’s really getting annoying. I’m not going tohave 10 million passwords floating around.

  • Simone80
    Simone80 Member Posts: 988
    edited May 2021

    Springdaisy, I was able to read the article without a password by selecting the option for a physician.

  • BSandra
    BSandra Member Posts: 836
    edited May 2021

    Springdaisy, usually abstract is enough to know if you want to read deeper. I'd say I am usually directly interested in 5 % of articles, and try to get those by choosing physician:) or looking around for other free-access. Saulius

  • debbew
    debbew Member Posts: 226
    edited May 2021

    New technology makes [mouse mammary] tumor eliminate itself

    Scientists at the University of Zurich have modified a common respiratory virus, called adenovirus, to act like a Trojan horse to deliver genes for cancer therapeutics directly into tumor cells. Unlike chemotherapy or radiotherapy, this approach does no harm to normal healthy cells. Once inside tumor cells, the delivered genes serve as a blueprint for therapeutic antibodies, cytokines and other signaling substances, which are produced by the cancer cells themselves and act to eliminate tumors from the inside out...

    With [this] system [called SHREAD: for SHielded, REtargetted ADenovirus] the scientists made the tumor itself produce a clinically approved breast cancer antibody, called trastuzumab, in the mammary of a mouse. They found that, after a few days, SHREAD produced more of the antibody in the tumor than when the drug was injected directly. Moreover, the concentration in the bloodstream and in other tissues where side effects could occur were significantly lower with SHREAD. The scientists used a very sophisticated, high-resolution 3D imaging method and tissues rendered totally transparent to show how the therapeutic antibody, produced in the body, creates pores in blood vessels of the tumor and destroys tumor cells, and thus treats it from the inside.


    https://www.eurekalert.org/pub_releases/2021-05/uo...


  • AlwaysMeC
    AlwaysMeC Member Posts: 167
    edited May 2021

    debbew, I came here to post the same news. It sounds so promising. They are trying to apply their process to covid 19, I wonder if it will help streamline clinical trials for actual patient use.

  • LillyIsHere
    LillyIsHere Member Posts: 830
    edited May 2021

    From April 21: Patients undergoing hormone therapy for breast and prostate cancers may be at increased risk for cardiovascular disease (CVD) as they age and should be closely monitored for potential cardiovascular events, according to a scientific statement from the American Heart Association (AHA).

    https://www.medpagetoday.com/hematologyoncology/breastcancer/92274?th=1&xid=fb-md-cbtm-onc-ptalz&trw=no&scrf=1&fbclid=IwAR31hAIO0h0H9AUT-ZDe939heoQGifo5eVDzgpMbUPksP8Ez9j6ZWHcx14M

  • JoynerL
    JoynerL Member Posts: 1,393
    edited May 2021
  • buttonsmachine
    buttonsmachine Member Posts: 930
    edited May 2021

    Joyner, thanks for posting that link. These two paragraphs really stood out to me, which were not quite as optimistic as the headline, but I'm still glad people are beginning to study this. (I added the bold, for emphasis.)

    "A total of 92 of the 102 cancer patients in the study were found to be seropositive for SARS-CoV-2 antispike IgG antibodies after the second dose of vaccine, compared with 100% of the controls, the researchers reported, adding, however, that the median IgB titer in cancer patients was significantly lower than in controls (1,931 vs 7,160 AU/mL).

    ...

    "As the correlation between antibody levels after vaccination and clinical protection has not yet been established, further research is required to determine the magnitude and duration of protection the vaccine provides to patients with cancer," the authors concluded. "Nonetheless, our findings do suggest that vaccinating such patients during anticancer treatment of any kind should be a top priority."

  • moth
    moth Member Posts: 4,800
    edited May 2021

    Immunotherapy & chemotherapy together might NOT give very good covid 19 vaccination response - or it might be having breast or lung cancer that drove the difference

    https://jamanetwork.com/journals/jamaoncology/full...

    "the only treatment regimen associated with significantly lower IgG levels on multivariable analysis was chemotherapy with immunotherapy; however, only 14 patients received this combination therapy, and no association was seen with either chemotherapy or immunotherapy alone. Given that chemotherapy combined with immunotherapy is only used in select cancer types (eg, lung cancer, triple-negative breast cancer), it is possible that other cancer-specific factors drove the observation in this small subset."

  • BSandra
    BSandra Member Posts: 836
    edited June 2021

    Some good insights from ASCO 2021 how science is slowly wining and how bad MBC actually is:

    1095 Survival among patients with untreated metastatic breast cancer. JK Plichta, SM Thomas, S Sammons, et al

    Take-Home Message

    • This study evaluated the survival outcomes of metastatic breast cancer (MBC) patients who opted to receive no treatment for their disease. The medial unadjusted overall survival (OS) in the untreated group was 2.5 months versus 36.4 months in the treated group (P < .001). Higher tumor grade, higher comorbidity score, increased age, and triple negative (vs HR+/HER2−) tumor subtype (all P < .05) were all associated with decreased OS in the untreated cohort; however, the number of metastatic sites was shown not to be associated with OS.
    • Patients with MBC who choose to forgo treatment are more likely to have comorbid conditions, be of advanced age, and have clinically aggressive disease. The prognosis for untreated MBC is extremely poor.
    Saulius
  • PAKNC
    PAKNC Member Posts: 72
    edited June 2021

    BSandra: Your post comes less than a week after I met a woman on the golf course who was diagnosed 8 years ago at age 57 with De Novo Stage 4 Triple Negative breast cancer. I wish that scientists could figure out why some women seem to come out on top of this damn disease and appear to flourish. I had seen her several years ago in my weight lifting class at the gym and of course, I had no idea that she had breast cancer. I don't know if this is relevant or not, but at age 65, she looks more like 45 and has a natural, lean, muscular build - I assume her body fat is very low. Perhaps she has an exceptional internal metabolism and immune system, or is simply a good responder to treatment. What is the bitter pill is that she had a mammogram 6 months before her diagnosis that was passed on as clear, and that she found the lump herself in the shower.

  • BSandra
    BSandra Member Posts: 836
    edited June 2021

    Dear PAKNC, every C is very personal. Science is looking for patterns and medians - it is so darn difficult (maybe even impossible!) to analyze single cases and find correlations. There's something special in her disease, for sure, but also stage 4 is not equal to another stage 4. One small metastasis in one organ is stage 4 too but can hardly be compared to an extensive multi-organ involvement. I am sure her good performance status helped to go through treatments - at stage 4, if we dream of a cure, we have to throw everything at it. Time window is also important. Good metabolism usually negatively correlates with disease progression. Then genetics too. Too many factors. But again, I'd like to meet such a person in person:)

    Also some interesting insights from ASCO 2021. Many publications are breath-taking. Like "Mastering the Use of Novel Anti-HER2 Treatment Options" by P. Tarantino that states

    "Finally, it is now established that a subset of patients with HER2-positive mBC can achieve long-lasting responses to HER2 blockade. Indeed, the CLEOPATRA trial showed that 16% of patients receiving frontline dual blockade are free from progression after 8 years of treatment.10 This observation raises the
    following compelling scientific questions: (1) Are these patients cured? (2) Can we identify this population up front? (3) For how long should these patients receive maintenance anti-HER2? (4) Can we increase this percentage by adopting more intensive treatment strategies?"

    Scientist are extremely careful about asking a question "Are these patients cured", so if they ask it, they believe there are some cures. Cures in MBC! With first line treatment! And yet there are 4-5 new treatment lines (very effective ones!) after the first one for this population, so... WE ARE GETTING THERE!

    Saulius

  • Anonymous
    Anonymous Member Posts: 1,376
    edited June 2021

    Oh, yes, Saulius, possibly curing deNovo HER2+ MBC was discussed at esmo 2021 also. I grabbed four slides that were shared on Twitter, I’ll try to post here. Also, I saw an older YouTube video, which I can’t find anymore, where the researcher talked about the need to study the question and how it could be similar to leukemia patients on Gleevec who were doing very well but no one knew how or when or if the medication could be discontinued until they finallyset up some trials.

    image

  • Anonymous
    Anonymous Member Posts: 1,376
    edited June 2021
  • Anonymous
    Anonymous Member Posts: 1,376
    edited June 2021

    of course at the end he asks “are we crazy” 😂 if daring to think outside the box is crazy maybe so. Wish I could

    have seen the whole presentation

    image

    image

  • morrigan_2575
    morrigan_2575 Member Posts: 824
    edited June 2021

    fascinating. Thanks and for posting

  • moth
    moth Member Posts: 4,800
    edited June 2021

    PAKNC, I'd be wondering where her mets are. I know another mTNBC long hauler online and her single solitary met was to a distant lymph node. I know there's discussion about reclassifying those as 3C as those tend to be the outliers in mTN & likely should be treaed with curative intent.


    my only takeaway from ASCO at this point is that it is increasingly clear that breast cancer is not one disease & so we can't really talk about a cure for breast cancer any more than it makes sense to talk about a 'cure for cancer' (as in generic cancer). We have some hope for groups in small subsets with very speciic presentations but I don't think that even takes us closer to cures for others - each one has to be painstakingly broken down and the pathways sorted. Given how much variability and how many genes are involved, I don't think it's a simple plan at all.

  • LillyIsHere
    LillyIsHere Member Posts: 830
    edited June 2021

    Dr. Winer is one of the best MO. He is my friend's MO and he was not taking new patients when I tried.

  • Anonymous
    Anonymous Member Posts: 1,376
    edited June 2021

    Yes, Lily, I searched him on YouTube and saw him speak in a few videos, he seems very caring as well as smart

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