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Feature Article

Curing Breast Cancer Gets Personal

Published October 30th, 2020

A breast cancer diagnosis is still much too common. According to the American Cancer Society, 1 in 8 women will receive this devastating news in their lifetime. Fortunately, our ability to beat this cancer continues to improve, especially using highly personalized treatments made possible by advancements in molecular profiling.

Getting Specific

Breast cancer is an umbrella term for a series of cancers that affect the breast, each with its own characteristics. Some breast cancers are referred to as “hormone receptor positive”, meaning they feed on estrogen; others are “HER2 positive”, referring to the overabundance of a protein that drives their growth; and still others are “triple negative”, an inherently aggressive subtype that itself has a variety of subtypes with differing molecular characteristics. Effective treatment starts with identifying the specific type and sub-type of cancer.

Making It Personal

With the understanding that there is not just one type of breast cancer, the standard treatments of surgery, radiation, chemotherapy, hormone therapy, targeted therapeutics, and immunotherapy can now be evaluated for likely effectiveness based on the characteristics of the patient’s cancer. There should no longer be just a “standard of care” for breast cancer; there should be a personalized care plan.

Case in Point

After a routine annual check-up, a 31-year-old, otherwise healthy young woman, whom we’ll call Jessica*, was diagnosed with an invasive form of breast cancer. Jessica came to Private Health Management having undergone the initial standard of care diagnostic protocols. The typical standard of care treatment for Jessica’s type of cancer is to have surgery first. Based on the staging of the cancer, chemotherapy may come next, possibly followed by radiation, and finally, hormone therapy. Rather than immediately agree to the standard of care treatment plan, our team thoroughly reviewed her case. Because of her age and type of cancer, our team was particularly concerned about her risk of recurrence.

Jessica’s Private Health team, comprised of PhD researchers and clinicians with deep oncology experience, conducted an in-depth review of her clinical history and initial diagnostics. Our team recommended several additional tests, which gave us important clues about the types and the sequence of treatments that were most likely to be effective. We then identified and engaged leading experts with experience specific to her situation, collaborating to develop personalized treatment alternatives that gave Jessica confidence in the plan she ultimately chose.

One of the weapons in Private Health’s Intensive Case Management arsenal is comprehensive molecular profiling. Molecular profiling can provide an in-depth understanding into what drives cancer cell growth, informing the best way to kill those cells. In Jessica’s case, molecular profiling was instrumental in providing insight into two key decisions she was facing: whether she should have surgery or chemotherapy first; and, how best to prevent the cancer from returning.

“There should no longer be just a standard of care for breast cancer; there should be a personalized care plan.”

The additional tests the team ordered provided a sophisticated analysis of the RNA levels in Jessica’s cancer cells, giving us clues about how aggressive her cancer cells were and what types of molecular alterations were driving cell growth.

One test told us that Jessica was considered “high risk” for recurrence and revealed she fell into a subcategory of hormone positive breast cancer called Luminal B, which is characterized by faster growing, more aggressive cells. However, Luminal B cancers are also more likely to respond to chemotherapy than Luminal A cancers. This suggested that if she proceeded with chemotherapy first, there was a high likelihood that her tumor would respond to the treatment and make her eligible for a less invasive, less risky surgery with fewer long-term side-effects.

Another test provided a key piece of information regarding the last step of her treatment plan. The analysis revealed Jessica had a particular genetic abnormality called an RNA fusion hidden among some of her cancer cells. This RNA fusion is known to be resistant to hormone therapy. Following the current standard of care might put her at risk for recurrence if these cells were still present.

Fortunately, Jessica’s PHM care team also knew that cells with this type of RNA fusion could be killed by another type of drug, called a CDK4/6 inhibitor. Our team recommended a clinical trial testing this exact combination of drugs in patients with breast cancer at risk of recurrence and secured Jessica a spot in the trial. Notably, six months after she started the trial, a paper was published at a major cancer conference demonstrating the drug combination did indeed reduce the risk of recurrence in breast cancer patients. Following her treatments and the clinical trial, Jessica is now cancer free and looking to the future with confidence.

Progressive & Aggressive Care

Private Health’s research-based and highly personalized care approach empowers us to be progressive and aggressive. We provide this level of care and attention to all our clients when it matters most, changing the treatment of complex cancers for the better, one Jessica at a time.

*Name changed to protect privacy

About the Author

Dr. Eva J. Gordon, PhD

Senior Vice President, Research Services

Dr. Gordon has extensive experience as a medical researcher and science writer, with much of her career focusing on cancer and immunology. As a Damon Runyon-Walter Winchell Postdoctoral Fellow at Harvard Medical School, Dr. Gordon studied how viruses evade detection from the immune system.