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Developing Treatment Options for BRCA-Positive Breast Cancer Patients

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Published on October 26, 2016

Could more effective treatment approaches be available soon for BRCA-positive breast cancer patients? Rebecca Seago-Coyle, a BRCA-positive breast cancer survivor and Patient Power host, interviews her doctor, leading expert Dr. Julie Gralow. They explore current approaches, developing options, including PARP inhibitors and the importance of participating in clinical trials.


Transcript | Developing Treatment Options for BRCA-Positive Breast Cancer Patients

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Rebecca Seago-Coyle:

Hi. I'm Rebecca Seago-Coyle.  I'm a breast cancer survivor, and today I'm here with Dr. Julie Gralow, a leading expert in breast cancer. 

Dr. Gralow:

Thanks, Rebecca.  Glad to be here. 

Rebecca Seago-Coyle:

What research is being done now to further the treatment for the BRCA-positive men and women? 

Dr. Gralow:

Well, I think about BRCA1 and 2 and how we alter our approaches in families, in patients who have these mutations. I think about how can we possibly reduce the risk of getting a cancer in the first place?  I think about if you're going to get a cancer, how do we find it early? And then I think about if you already have a cancer, how might I treat you differently?  So there are different aspects of what we're thinking about depending on when somebody presents to us. 

So, for example, if somebody's just found out that they have a BRCA1 or 2 mutation and they don't have a cancer yet, then I'd be thinking about ways to reduce their chance of getting cancer or ways to find it early. 

So, for example, if we think about the Angelina Jolie example, she found out that she had a BRCA1 mutation and over time chose bilateral mastectomies.  That's an aggressive approach to reducing your risk of breast cancer. It's pretty effective, not 100 percent. We still leave a few breast cells behind, but that's not right for everybody. 

She also then chose to remove her ovaries because ovarian cancer is associated with BRCA1 and 2 gene mutations. So prophylactic or preventative surgeries are part of the recommendation for reducing your risk for cancer.

We also know that healthy lifestyle choices can impact all women's risk of cancer.  If you have a BRCA 1 or 2 mutation, Dr. King has shown that physical activity can delay the age of onset of that cancer.  So even if you're predestined to have a very high risk for getting cancer, you might be able to delay the age of onset.

We also have drugs that may be able to reduce risk of breast cancer, drugs like tamoxifen (Soltamox), and we're not entirely sure how helpful they are if you have such a strong risk. But we do have some data that they may reduce the risk, especially of BRCA2 breast cancers that tend to be more tied to the estrogen receptor. 

Now, if we think about how are we going to detect it early if we've chosen not to have bilateral mastectomies, then we would start screening early.  Mammograms at 25, MRIs of the breast as well regularly, annually, beginning at 25 or 30 are recommended to try to find the breast cancer at the earliest possible stage.  So more intensive screening. We don't have quite as good screening for ovarian cancer unfortunately, but we would still recommend more vigilant pelvic examples, maybe blood tests or ultrasounds, which are just less proven.

And then as far as treatment of breast cancer, now, if I have a BRCA1 or 2 gene mutations carrier who has developed breast cancer, I would be thinking about are they early stage or more advanced or metastatic stage?

There's one main category of drugs right now that are very tied to DNA repair, and that class of drugs are called PARP inhibitors, and PARP is an enzyme also involved in DNA repair. So it is the inhibition of that enzyme, especially after you give chemotherapy or radiation therapy, that is designed to kill cancer by damaging DNA.  Then you bring in a PARP inhibitor and you further reduce ability of cancer cell to repair itself again, that's what a PARP inhibitor does. If you already have one defect in DNA repair and then you add another inhibitor of DNA repair and you give chemo and radiation, then the tumor cell is less able to repair itself.

And these drugs, the PARP inhibitors, are currently approved for ovarian cancer, not yet approved in breast cancer, but the subject of clinical trials both in early?stage and later?stage breast cancer, and they're very exciting. 

Rebecca Seago-Coyle:

You just mentioned clinical trials. How can women learn more about trials that might be right for them? 

Dr. Gralow:

Clinical trials are really the only way that we advance treatments for cancer or all diseases.  We need to understand with a given drug, for example, how toxic is it, how much benefit does it have and what populations does it benefit? So we need to do research.  We need to do trials in order to better understand the drug, to prove that it's more effective than the standard of care or less toxic. That's another way a drug can get approved, and so we need to do clinical trials. 

The website I send my patients to is  I look at it myself when I'm looking for trials.  It will tell you, you can search by breast cancer, BRCA, for example, and it can tell you what trials are going on, which ones are open and presently accepting patients, what sites around the country or the world have them open, what's the eligibility criteria, etc.  So that's a great website. 

There are also other websites that can direct you to clinical trials specifically for breast cancer, but is our national registry of trials that have been approved at the national level. 

Rebecca Seago-Coyle:

How are you encouraged by developing research? 

Dr. Gralow:

Well, we've really entered the genomic era of cancer.  We now have sequenced the human genome, and we have The Cancer Genome Atlas.  We are learning so much about the genes that are related to cancer, genes that can be inherited from our mother and father, like BRCA1 and 2, and genes that can evolve over the course of our lifetime that aren't inherited that can contribute to cancer. 

Every cancer is the result of abnormal genes. And whether the first step in the process of developing cancer is something you've inherited or whether it's due to exposures, internal exposures, external exposures etc., is—in breast cancer it's a combination of all of them in many circumstances. 

So I'm really excited about how we're taking our better understanding of genes and the human genome and designing therapies that can target different areas, different pathways that contribute to cancer. And we're going to be making—we already are—much more specific therapies, and we're going to be much smarter about which therapies are given to which cancers and which patients. 

I think we're really entering a new era, and the big challenge is going to be taking massive amounts of data and a bunch of exciting new drugs and figuring out how we can condense it all down and then find the promising drugs, weed out the drugs that don't seem to be working, pull this all together so that it gets to the patient as soon as possible. 

Rebecca Seago-Coyle:

Thank you so much for joining us today. I'm Rebecca Seago-Coyle with Patient Power. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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