Wednesday, March 2, 2005

Therapy focus of cancer forum

Breast cancer specialists discuss future of research


By DANA DUGAN
Express Staff Writer

Slug: breast cancer forum

Initials: dd

Sometimes it seems the public knows far less about important issues than they realize. In fact, pull aside the curtain in any medical laboratory and you may find clinicians, scientists and researcher busy doing things the public won't know about for 20 years.

Sponsored by Expedition Inspiration Fund for Breast Cancer Research, the Ninth Annual Laura Evans Breast Cancer Symposium was held Wednesday, Feb. 23 through Sunday, Feb. 27, in Sun Valley. It featured some of the top breast cancer specialists in the world.

An Open Forum was held Thursday in the Limelight Room of the Sun Valley Inn to attempt to inform a segment of the public about what lies ahead in breast cancer treatment. The topic was "What is the Future of Breast Cancer Therapy?"

The audience was the largest ever for the Symposium's Open Forum. After an initial round of introductions and explanations of the doctors' various specialties and current therapy goals, a question and answer period more than filled the two-hour allotted time.

The Forum was opened by Expedition Inspiration's Medical Advisory Chair Dr. Julie Gralow, an associate professor with the Medicine/Oncology Department at the University of Washington School of Medicine and a member of the Clinical Research Department at Fred Hutchinson Cancer Research Center in Seattle.

"One of the most unique things EI does with funds is bring scientists and researchers out of the lab for this symposium," she said.

Their topic over the course of the week was "Novel targets and novel therapies," which is still a fairly broad subject with many possible components and responses.

"This is a group of people internationally known in their fields, the cream of the cream of breast cancer clinicians," added the Forum's Moderator Dr. Marc Lippman.

The Scientific Advisor for Expedition Inspiration Fund for Breast Cancer Research as well as the Chair of Internal Medicine at the University of Michigan Health System, Lippman is—if not the heart—than the provider of the gathering's laughter. His anecdotes and explanations are worthy of doctor clown Patch Adams. The heart of the Symposium still belongs to Laura Evans, the late Ketchum resident who created Expedition Inspiration in 1995. Virtually the entire medical advisory board of EI either treated Evans or became a part of the organization while she was still alive.

"Breast cancer is a disease of aging," Dr. Chris Benz of the Buck Institute for Age Research said. As such it's just as important to consider aging conditions as it is to look at family history. Therefore, target therapy is becoming more precise and broader at the same time. These cancer therapies are mostly in preclinical testing, though a few have moved on to stage two clinical trials. Two of the doctors present, Lippman and Kent Osborne were pioneers in the use of the drug Tamoxifen, which has been used to treat cancer for 20 years. These new targeted cancer therapies use drugs to block the growth and spread of cancer. The science is broad in the sense that there are many areas to consider.

Dr. George Sledge, Jr., professor of Oncology at the Indian University Cancer Center, may have put it best. "A cancer cell is a thug in the neighborhood forcing the other residents to feed it."

Once a mass of cancer cells reaches a certain size, it must develop a blood supply in order to grow larger. Cancer cells secrete substances that promote the formation of new blood vessels in a process called angiogenesis.

"We wondered 'would it not be possible to cut off the spigot?'" Sledge said. "Early clinical results (of a new therapy to prohibit the formation of new blood vessels) look promising."

Gralow is investigating tumor cells in the bone that go undetected waiting for breast cancer to metastasize. She is working on trials aimed at preventing cells in the bone from remaining active so they won't result in bone-dominant breast carcinoma.

"We all know there are cases of breast cancer that do come back. But we are looking for cells that can remain dormant."

Her colleague at University of Washington Medical Center, Dr. David Mankoff specializes in cancer Imaging. He discussed the use of MRIs for early detection versus mammograms, and sonograms. "MRIs can pick up things that are cancer as well as things that aren't. Without surgery there's no way to tell the difference. It may help with young women with high-density breast tissue but the jury is still out. But an MRI isn't a substitute. A mammogram is still the only imaging that has shown to save lives."

"Ultra sound is even less promising," he said, but he is looking at developing a PSA (prostate-specific antigen) type test for breast cancer.

Lippman rejoined: "This is one thing that can save a life. Imaging is for what you cannot feel. It still must be diagnosed with pathology."

Currently the normal course of action is for surgery to come immediately after the detection of cancer. However, even that may change, said surgeon Dr. John Lund of the Mountain States Tumor Institute in Boise.

"You are looking at a dinosaur. The role of the surgeon will be less necessary as therapy improves.

Benz added, "The future of Breast Cancer treatment is targeted therapy, but we'll still use chemotherapy in conjunction."

A minor verbal debate followed remarks by distinguished scientist Mina Bissell after being questioned about hormone replacement therapy.

"The drugs predated complete studies," Osborne said. "It was believed to be bad for the heart, but studies showed that there were other risks as well." Many women have gone off the replacement therapy drugs since studies showed they increased a woman's risk of breast cancer 30 percent came to light.

A very lively and youthful looking Bissell told the audience that she has taken estrogen for years. "It's important to understand the statistics."

She explained 30 percent referred to how much more a person is at risk from their initial risk factor. For instance, if a person has a risk factor of 10 percent, than 30 percent more of that is only 13 percent overall.

Bissell runs a laboratory at the University of California, Berkeley. She is studying micro-environments and cellular function as well as inflammation as they relate to breast cancer. She advised keeping a chart with the plusses and minuses. HRT can help lower the risk of colon cancer and osteoporosis, but puts a woman at slightly higher risk of breast cancer and heart attack.

Lippman jumped in. "Some things are undeniable. A woman who uses Prempro, (an estrogen progesterone combination drug), gains 5 percent risk factor a year. Over 10 years that becomes a 50 percent higher risk of breast cancer."

"Progesterone to my mind is really in some cases the culprit. I'm not doing so poorly," Bissell laughed.

Lippman said women need to make choices based on family history and needs for their individual lives.

Dr. Ronald Dorn, also of Mountain States Tumor Institute in Boise, discussed the phases of breast cancer. "It evolves over many years. In the first stage the cells are in the ducts. In the second stage it's not yet cancer but is visible on a slide and is called atypical hyperplasia.

"It is at this stage the cycle can be halted with Tamoxifen," he said.

Phases are important in the trail phases as well. Initially a compound is tested for its use as a drug and in combinations. The next phase is to determine safety. Finally it may be accepted in trial and compared to standards for use as a new treatment. This can take anywhere from five to 15 years, Lippman said.

"Hopefully at the end we have a new drug. Typically people can get into trails through health centers and universities. Or check on the National Cancer Institute site for trials in your area."

Someone in the audience asked about Bone Marrow transplants for breast cancer.

"The simple answer is we don't do bone marrow for breast cancer," Lippman said.

The dialogue returned to growth factors and how to stop cells from communicating with each other through small molecules.

"They send positive and negative signals to their neighbors. We are trying to stop the growth by pulling the plug on the negative conversation," Lippman said.

There are three dates that are of prime importance regarding risk factors for a women, Gralow said. When a woman starts her menses—later is better: when she has her first child—earlier is better, and when menopause begins—earlier is better.

Dr. Peggy Porter, head of Breast Cancer Research at the Fred Hutchinson Cancer Research Center in Seattle, said in China the risk of breast cancer rate "went through the roof" when the birth rate changed, in one generation, from six to eight children to just one child per woman.

Gralow ended the dialogue by reminding the audience that most of the time "lifestyle is the most important factor we can control. What we eat and drink. Genes are not controllable. Exercise, body fat and weight are.

"It's a very exciting time to be in oncology," she concluded.




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