In the Clinic

New Immunotherapy Approach for Breast Cancer Shows Promise

Pictured: Helen McArthur Medical oncologist Heather McArthur

A new form of immunotherapy treatment — the first of its kind for breast cancer — is showing promising results in early research.

The treatment combines a technique called cryoablation, or freezing of the tumor, with an immunotherapy drug that has already proved effective in advanced melanoma, an aggressive form of skin cancer. The results of this early-stage investigation were presented yesterday at the American Society of Clinical Oncology ’s annual meeting in Chicago.

“Attempts have been made to harness the immune system as an anticancer mechanism for more than 100 years, but progress in this field has been relatively modest until recently,” says Heather McArthur, a Memorial Sloan Kettering breast oncologist who was the senior author of two studies reporting the findings. “However, given the recent successes in treating melanoma, we are looking at immune therapies in other types of solid tumors, including breast cancer.”

Making Tumors More Accessible to Treatment

The drug employed in this study is ipilimumab (Yervoy®), which was developed largely by Memorial Sloan Kettering investigators for the treatment of melanoma. Ipilimumab works by blocking a protein called CTLA-4, which normally puts the brakes on the immune system. If the brakes are turned off, the immune system is able to mount a robust response and ideally destroy tumor cells.

The role of ipilimumab is being actively investigated in a number of solid tumors “Our approach is unique, however, in that it combines tumor freezing with immune stimulation. The treatment is based on that idea that a tumor mass is difficult for the immune system to infiltrate and digest. But if you break the tumor mass down into tiny fragments, the immune system will have an easier time processing it,” Dr. McArthur explains.

In this technique, investigators use cryoablation to break the tumor into smaller pieces. Using MRI for guidance, a small needle is inserted into the tumor to create an ice ball, which freezes it and breaks it into tiny fragments.

The patients are also given a single dose of ipilimumab. The intent of the treatment is to enable the immune system to recognize breast cancer fragments, remember that information, and consequently seek out and destroy any tumor cells that may appear in the body if the cancer recurs months or even years after surgery.

Evaluating Safety with a Stepwise Approach

The women who participated in this pilot study had newly diagnosed, early-stage disease and had already decided to have a mastectomy.

The first group of six patients underwent cryoablation alone to make sure that it wouldn’t interfere with the ability to later undergo mastectomy, which is intended to cure the cancer. The second group of six underwent immune therapy alone, receiving a single dose of ipilimumab to ensure there were no unexpected side effects.

After confirming that the two approaches were safe on their own, six additional patients were given the full treatment of cryoablation and a single dose of ipilimumab before their surgery. The women were then followed for three months to measure their immune responses and to make sure the treatment did not compromise the standard of care.

“The primary goal of the study was to show that we can combine the two strategies of cryoablation and immune stimulation without compromising a woman’s ability to have her curative-intent surgery, and that’s what we were able to demonstrate in this study,” Dr. McArthur said.

“This was also a unique opportunity to be able to collect tissue samples from before any treatment had been given and then again afterward, and to compare the changes in the tumor cells,” she continued. “Based on the tissue and blood analyses, performed in partnership with [physician-scientist] Jedd Wolchok and our collaborators at the Immune Monitoring Facility, we found that there was indeed a signal of immune activity with the combination of cryoablation and immune stimulation.”

Based on those findings, Dr. McArthur expects a larger study to launch sometime in the fall.

This research was supported by the Terri Brodeur Breast Cancer Foundation and the Cure Breast Cancer Foundation. Bristol-Myers Squibb supplied the drug for the study.

Comments

Hi tita hope you find this helpful.
This is a good article in hopes for better treatment option.

Speaking of promise, have you read the story about Melinda Bachini? This 43 woman was facing death as her advanced-stage cancer had begun to metastasize, but her doctors were able to able to obtain the genome sequence for her disease and pinpoint the immune response cells that would attack a specific mutation within the cancerous cells. It's a story worth looking into if you want to know more about the applications for immunotherapy: http://www.knowcancer.com/blog/doctors-saved-woman-immunotherapy/

Hi. I had 7 weeks ago a lumpectomy and one of my lymph node is positive . My oncotype result is 20. Do you think I need this treatment or CmF to TC?
Thank you.

Zoe, thank you for your comment. Unfortunately we cannot answer specific personal medical questions such as this, which are best left to a medical professional familiar with an individual patient's entire history. If you would like to make an appointment to speak with one of our experts you can contact our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

I do hope that some of the research includes those patients with metastatic breast cancer, especially those who have been in constant treatment for so many years. It would be wonderful for them !

Very exciting news. Keep up the great work, thank you all for your dedication to curing this awful disease.

A dear friend has end stage metastatic breast cancer. She is currently not under an oncologist’s care having eschewed radiation and chemotherapy early on, but undergoing a mastectomy. She resides in Puerto Rico and is too weak to travel to NY. Is there a colleague here in Puerto Rico with whom you are collaborating or is conducting clinical trials for which she would want to participate. Thank you so very much for your dedicated work.

Dear Maria, we are sorry to hear about your friend's diagnosis. It was recently announced that the University of Puerto Rico is working with the National Cancer Institute (NCI) and MD Anderson in Houston to bring superior, comprehensive cancer care to the island. They are building a new facility in PR but it won't be open until 2016. Having said that, UPR may have specialists who can help her now - they mention here that they are conducting clinical trials for people with breast cancer: http://www.cancer.gov/newscenter/spotlightonscientists/CancerCenterPuertoRico.

Here is a link directly to the Centro de Cancer de Puerto Rico with the phone number to call: http://www.md.rcm.upr.edu/ccpr/index.htm

For more information about NCI-designated comprehensive cancer centers, visti http://www.cancer.gov/researchandfunding/extramural/cancercenters

We hope this information is helpful.

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