Targeted therapies are fighting breast cancer with precision

From breakthrough research to new clinical trials in imaging, pharmaceuticals and high-tech therapies, women in Florida can now benefit from advancements that could improve the ability to detect or target various breast cancer types.

At the University of Miami, myriad clinical trials are underway offering alternate approaches to fighting breast cancer. In September, physicians at Sylvester Comprehensive Cancer Center at U-Health initiated two new immunotherapy trials to boost the patient’s own immune system to fight breast cancer cells. Immunotherapy is being used to treat a variety of cancers, with breast cancer being more recent.

“We are in early phases of this study, but there are hints of some activity,” said Dr. Charles Vogel, a breast oncologist at Sylvester.

Another promising area examines individual mutations within breast cancers and designs treatments for those mutations (rather than for specific cancer types).

“That allows patients with breast cancer to receive a drug targeted against that mutation,” Vogel explained.

Beyond targeting mutations, Sylvester oncologists are enrolling patients in clinical trials involving drugs that aim to shrink breast cancer tumors. These targeted therapies focus on newer drugs that zero in on gene changes in cancer cells that help the cells grow or spread. Vogel says some of the clinical trials will open and close within six months, others will go on for several years.

At the same time, newer imaging methods for breast cancer detection are in the works. At Mount Sinai Medical Center’s Comprehensive Breast Cancer Center in Miami Beach, a clinical trial will soon begin that could lead to improved early detection through better imaging.

By October, radiologists at Mount Sinai plan to try out a new ultrasound machine, called SoftVue, to scan for breast cancer in women with dense breast tissue, a category estimated to be about 40 percent of all women younger than 60. Women with dense breast tissue have a slightly higher risk for breast cancer, often because it is more difficult for radiologists to see the cancer in early stages on mammograms.

During the ultrasound, the patient lies on her stomach with one breast immersed in warm water. The SoftVue machine emits sound waves that circle 360 degrees around the breast to create 3D images that allow for easier detection of abnormalities that might be obscured by dense breast tissue on a mammogram, or difficult to spot on a traditional ultrasound.

“There is a lot of promise to add information that we don’t currently get on mammograms or hand-held ultrasound,” said Dr. Stuart Kaplan, section chief of breast imaging at Mount Sinai Comprehensive Cancer Center.

Until now, MRI has been the best single method for breast cancer screening, Kaplan said. But it is expensive, time consuming and used mostly for women at high risk.

“This would be a major breakthrough if we were able to find out more with an advanced ultrasound. We could end up using it for routine use,” he said.

Kaplan expects the clinical trial to last at least two years. As an incentive to enroll in the trial, Kaplan said women who qualify will receive an automatic free upgrade to 3D mammography to pair with the advanced ultrasound.

Along with new imaging tests for breast cancer, therapies are also advancing.

At Miami Cancer Institute, part of Baptist Health South Florida, physicians will soon offer a high-tech way to attack breast cancer cells. In 2017, the proton therapy center will open, giving breast cancer patients with left-sided tumors access to more precise form of radiation therapy.

In the past, women with these types of growths faced potential damage to their heart from traditional radiation treatments that pass through healthy tissue and organs on their way in and out of the body. By using proton therapy, doctors administer radiation with pinpoint precision to target only cancer cells. Proton therapy also has the benefit of creating less chance of a recurrence of cancer from excessive radiation exposure.

Dr. Minesh Mehta, deputy director and chief of radiation oncology at Miami Cancer Institute, expects to attract patients from Florida as well as Latin America and the Caribbean to receive proton therapy treatment.

In addition, Dr. Victor Guardiola, a medical oncologist at Miami Cancer Institute,, said there are several clinical trials currently available and new ones in the works, including a radiation oncology trial investigating whether radiation therapy can be avoided in patients who have responded well to pre-surgery chemotherapy.

In another major advancement, researchers at University of Central Florida College of Medicine in Orlando are examining a protein that leads to the death of immune cells. Metastatic breast cancer cells have especially high levels of the protein known as chaperonin; the higher the levels, the sicker the patient.

By discovering how a specific peptide inhibits the chaperonin, researcher Annette Khaled, who has a doctorate in molecular genetics and microbiology, is trying to kill the cancer cells. The peptide does not destroy healthy, non-cancer cells.

The next step is to put the therapy into clinical trials. That’s where SEVA Therapeutics Inc., a Massachusetts-based pre-clinical biotechnology company, comes in. The company has licensed the nanoparticle-peptide technology from UCF and has begun raising venture capital. It plans to begin clinical testing in patients in 2017 to deliver the therapy intravenously and gauge its effectiveness.

“From our current date, we are seeing good results,” Khaled said. “So many parts came together to make this happen, and this is just the beginning.”

This story was originally published September 23, 2016 at 8:35 AM with the headline "Targeted therapies are fighting breast cancer with precision."