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Innovations in breast cancer treatment offer hope for the present and future

Florida Cancer Specialists & Research Institute’s drug development center in Sarasota. COURTESY PHOTO

Florida Cancer Specialists & Research Institute’s drug development center in Sarasota. COURTESY PHOTO

Unraveling the mysteries of the human genome and the ability for scientists to peer inside the very core of cancer at the molecular level are driving rapid advancements in treating breast cancer — light years ahead of those used only a decade ago.

For Alexander Glick, M.D., and other local medical oncologists, the ever-expanding body of research and knowledge of genetic mutations and cancer abnormalities are revolutionizing the battle against breast cancer — and all cancers — introducing promising new treatments at an unprecedented rate.

New drugs and options not only successfully target specific types and stages of breast cancer, but they’re also replacing debilitating chemotherapy and radiation with fewer side effects and toxins.

“Treatment is no longer one size fits all,” said Glick, a physician in the Port Charlotte and North Port offices of Florida Cancer Specialists & Research Institute (FCS). “There are three to four main types of breast cancer, each with subcategories. In each category and subcategory, we now have precise agent targets. As I explain to my patients, chemo is like an atomic bomb — it wipes out everything. The targeted approach is more like a sniper with little to no casualties. We can avoid unnecessary toxicity.”



The new hyper-focused drugs, many tested in phased clinical trials at FCS’s drug development unit in Sarasota, home in on cancer at its cause, blocking estrogen from fueling the growth of cancer cells in estrogen-receptor positive cancer — the most prevalent form of breast cancer, accounting for 80% of all cases — which “are increasing cure rates,” said Glick.

“We now understand there are more sophisticated ways to target estrogen receptor blockers,” said Judy Wang, a medical oncologist who, as the associate director of drug development in the Sarasota medical office, oversees every aspect of phase 1 trails. “Next-generation options in the form of a pill are more convenient to patients. Treatment in general and particularly for breast cancer is moving away from chemotherapy. It’s not a good long-term answer, and response is often short lived.”



Innovations also include genetically based immunotherapies harnessing the body’s immune system to destroy cancer cells. Antibody drug conjugates deliver a mini payload of chemotherapy directly to cancer cells in patients with triple negative breast cancer, an aggressive cancer thought to be linked to BRCA1 genetic mutations, also known as breast cancer gene 1.

The side effects of new treatment options are typically minimal, allowing patients to take the therapeutics longer — especially important in late-stage breast cancer.

“We now treat advanced and metastatic breast cancer as a chronic illness as opposed to a death sentence,” said Glick. “The prognosis, in my opinion, is phenomenal. In the past, the prognosis for stage 4 breast cancer was unfortunately one to three years, which we can now double and sometimes triple. By using therapeutic treatments, duration of life increases and quality of life increases.”



New and on-the-cusp drug and treatment therapies add to an ever-expanding oncological arsenal, where genomic, genetic and molecular studies help physicians tailor therapeutic treatments. They also provide a proactive look at a patient’s individual predisposition for breast and gynecological cancer, pinpointing genetic markers and abnormalities long before the diseases present as physical symptoms or are detected by mammogram and screenings.

Preventative surgeries — bilateral mastectomies, hysterectomies and oophorectomies — have proven successful for high-risk patients who carry mutations for breast, uterine and ovarian cancer, Glick said.

Precision testing in early-stage forms of certain estrogen-receptor positive breast cancer also predicts the probability of recurrence within 10 years, as well as potential spread to other parts of the body. The test analyzes a number of mutations and generates scores that help oncologists determine the best treatment options.



“With the data points, we talk to patients and create a plan of care,” Glick explained. “By knowing the likelihood 10 years from now, we can eliminate the nasty side effects of chemotherapy for those who don’t need it.”

Glick often refers patients to ongoing phase 2 and 3 clinical trials in Sarasota. There are currently 12 breast cancer-related studies, aside from those led by Wang. The late-phase trials determine if new drugs and treatment protocols are better than the standard quality of care.

“We’re seeing excellent outcomes so far,” said Glick, noting primary investigators, including Wang, are published in the nation’s leading medical journals.

Wang joined physician-owned Florida Cancer Specialists in 2015, at the dawn of emerging scientific discovery in molecular abnormalities and genome research. She’s at the forefront of advancements in cancer treatment, leading phase-1 trials, which evaluate the initial safety, impacts on the body, potential side effects and efficacy of novel drugs and therapeutic agents compared to treatments already available.

“I’m seeing a lot more positive responses from when I started,” said Wang. “Trials now are incredibly detailed and tailored to the type of cancer and genetics. There are also interesting novel targeted therapies for early breast cancer with better rates for cure and stage 4 or metastatic cancers helping patient live better longer.”

On average, Wang heads eight early-phase trials with 50 to 150 patients, many from Southwest Florida; others making the journey from Tallahassee, Daytona and out of state.

“Right here in our own backyard in Sarasota, we’re providing high-quality next-generation studies contributing to drugs being approved in the country,” she said.

The Sarasota trials are identical to those conducted at major cancer institutes. The majority of new drugs approved in the United States in the past four years were studied at Florida Cancer Specialists.

Sometimes a new drug demonstrates potential beyond its original intentions. Trodelvy, an antibody drug conjugate developed for metastatic triple-negative breast cancer earned FDA approval this year as a treatment for all types of breast cancer. Because the efficacy and duration of established and new treatments differ between patients, the evolving cache of new options fills in the gaps when a drug that’s successful for most fails to provide the same desired outcomes for others or results aren’t long-lasting.

“First-gen drugs can be crucial in the management of breast cancer,” Wang said. “If the response is short lived, there are always other drugs approved or in testing.

“In the time I’ve been an oncologist, how we treat stage 4 metastatic and terminal cancer has been revolutionized.”

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