Immuno-oncology approaches offer new options for some metastatic breast cancer patients

(OSUCCC – James)
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Sponsored by: OSUCCC – James

In late 2017, Cindy Fleming, now 44, noticed a lump forming in her breast. With no family history of breast cancer, she was concerned but also knew younger women often have dense breast tissue. She checked the lump once a week for changes and moved forward with her faith-driven, busy life as a working single mother of three busy kids.

But in spring 2018, the lump began to grow. Her ob/gyn immediately sent her to have a diagnostic mammogram, after which she was told that the lump was almost certainly cancer. Additional testing confirmed metastatic triple-negative breast cancer that had spread to her liver, lung and surrounding lymph nodes.

“This was an overwhelming and devastating game-changer in terms of treatment options. My original oncologist offered me very little hope,” recalls Cindy.

Cindy has a great support network, including large church community, family and friends. Her sister-in-law, Jo, was by her side at that initial oncology appointment. With Cindy’s permission, she called The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) to secure a second opinion from Bhuvaneswari Ramaswamy, MD.

“At my first appointment, Dr. Ramaswamy asked me about how I was feeling—it was clear she wanted to know everything about me as an individual facing something very real and life-changing. I knew right away she cared about me, and that made me feel hopeful … encouraged not discouraged,” says Cindy.

In June 2018, she was enrolled for treatment on a multi-institutional clinical trial testing a three-drug combination, including a targeted immuno-oncology drug (atezolizumab) and two chemotherapy drugs (carboplatin and paclitaxel).

“The concept behind this type of treatment is to boost the immune system’s ability to recognize cancer cells specifically so they are more receptive to the effects of chemotherapy drugs,” says Ramaswamy, who manages Cindy’s care.

Cindy remained on the trial for about a year until side effects prevented her from continuing chemotherapy. After a short period of only immunotherapy, she is back on a maintenance chemotherapy regimen (paclitaxel) given in combination with immunotherapy.

Cindy says her personal faith carried her through that initial year of navigating her cancer treatment, and continues to lift her up daily.

“I am thankful to God for working through the men and women in the trials and programs I’ve been privileged to participate in. In my mind my faith and my Savior Jesus, the ‘great physician,’ is the real reason I’m walking in healing today. I want everyone facing cancer to know they have choices and with God there is always hope!”

The Challenge of Triple-Negative Breast Cancer

The majority of breast cancers are fueled by estrogen, progesterone or the HER-2/neu gene. In triple-negative breast cancer, these receptors are not present, so common treatments like hormone therapy and drugs that selectively target estrogen, progesterone and HER-2 are ineffective. New treatment approaches are urgently needed. Daniel Stover, MD, a breast medical oncologist and researcher at the OSUCCC – James, says immuno-oncology approaches to care represent new hope for patients impacted by this disease.

In March 2019, the U.S. Food and Drug Administration (FDA) approved the immuno-oncology drug atezolizumab (marketed as Tecnetriq®) for the treatment of certain metastatic triple-negative breast cancers when given in combination with the chemotherapy drug paclitaxel (marketed as Abraxane®).

Atezolizumab is a monoclonal antibody that targets specific proteins (PDL1) in cancer cells. Studies have shown that combination atezolizumab and paclitaxel treatment are more effective than paclitaxel alone for metastatic triple negative breast cancer patients whose tumors infiltrating immune cells express PDL1.

“These targeted immuno-oncology therapies help make cancer cells more visible to the immune system, and it’s exciting to see momentum in this disease because it is urgently needed. We are just scratching the surface of immuno-oncology’s potential in breast cancer treatment,” says Stover.

The OSUCCC – James is involved in clinical trials to investigate the potential of immuno-oncology in various forms of breast cancer. This includes trials looking at a vaccine to prevent recurrence in patients with HER-2+ breast cancer, an engineered immune cell therapy for treatment of HER-2+ advanced tumors, and targeted drug therapy trials for metastatic disease, including triple-negative breast cancer. Another phase I study led by Robert Wesolowoski, MD, a medical oncologist and researcher at the OSUCCC – James, evaluates how well two targeted agents (ibrutinib and nivolumab) work in treating participants with solid tumors that have spread to other places in the body. The study also examines the therapy’s impact on immunosuppressive function.

To learn more about breast cancer care and research at the OSUCCC – James, visit cancer.osu.edu/breastcancer or call 800-293-5066.

Most women should begin annual screening mammograms at age 40. This imaging test is available at 8 locations across Columbus. Call 800-240-4477 to schedule an appointment.