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.
Back to topEvaluating 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.
Back to topComments
Catherine Javier
Jun 15, 2014 • 4:57 PM
Stephen Trevathan
Jun 18, 2014 • 1:56 AM
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/
Zoe Moghaddam
Jul 3, 2014 • 3:02 PM
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.
Susan
Jul 5, 2014 • 6:19 PM
Robyn
Aug 10, 2014 • 6:15 PM
Maria Canino
Aug 21, 2014 • 10:35 AM
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.
Memorial Sloan Kettering
Aug 21, 2014 • 11:21 AM
In reply to A dear friend has end stage by Maria Canino
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/CancerCenterPuer….
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.
Graeme Finlayson
Oct 18, 2014 • 7:59 PM
Thanks you for this article and the multi-media panel session on immunotherapy treatment of breast cancer tumours. My wife is now 3 years breast cancer free after having an operation and 6 rounds of chemotherapy, but immunotherapy was not available at that time. We are based in Queensland, Australia. Is there any research yet that indicates whether the new immunotherapy treatment you have trialled for breast cancer tumours has a place after chemotherapy and surgery to reduce risk of recurrence? As an added complication, my wife also suffers from rheumatoid arthritis so we are always having to balance the impacts of the cancer and RA treatments.
Thanks Graeme
Memorial Sloan Kettering
Oct 19, 2014 • 1:10 PM
In reply to Thanks you for this article by Graeme Finlayson
Dear Graeme, we are happy to hear that your wife is three years cancer free. Immunotherapy for breast cancer is still early and investigational, and researchers are still gathering evidence to confirm whether, when, and in whom it would be helpful. For more information about immunotherapy for breast cancer, you may call the US National Cancer Institute at 1-800-4-CANCER or go to www.cancer.gov, which offers a database of clinical trials results and may be of interest. Here’s the breast cancer trial results page, which is updated frequently: http://www.cancer.gov/clinicaltrials/results/type/breast
We hope this is helpful. Thank you for your comment.
AnonymousLW
Jun 3, 2015 • 9:30 AM
We have several open trials for metastatic breast cancer that utilize various types of immunotherapy. To find out more about these trials and whether one of them might be right for your or your loved one, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment.
Erin Hall
Nov 23, 2015 • 3:29 PM
Erin, the trial discussed in this study has already closed, but a larger, randomized trial is expected to open soon. If you’d like to arrange for a consultation at MSK to find out more about this and other trials for breast cancer, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.
Padmini
Apr 12, 2016 • 6:23 AM
Padmini, we’re sorry to hear about your diagnosis. We recommend you contact our Bobst International Center at international@mskcc.org. You can go to https://www.mskcc.org/experience/become-patient/international-patients for more information. Thank you for your comment.
Jack DS
Jul 31, 2016 • 5:16 PM
Dear Jack, we are continuing to study immunotherapy as a treatment approach for people with breast cancer. Some of these trials can be found here: https://www.mskcc.org/cancer-care/types/breast/clinical-trials?keys=imm…. If you have questions about any of these studies or would like to make an appointment, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.
Leslie Boyd
Sep 28, 2016 • 4:21 PM
Memorial Sloan Kettering
Sep 29, 2016 • 10:16 AM
In reply to I was diagnosed with stage… by Leslie Boyd
Hi Leslie, to look for immunotherapy trials for breast cancer in your area, we recommend you speak with your doctors or go to www.clinicaltrials.gov. This database maintained by the National Institutes of Health lists clinical trials throughout the US and the rest of the world. Best wishes to you, and thank you for your comment.
Rev Susan Miller
Apr 17, 2018 • 12:02 PM
Memorial Sloan Kettering
Apr 17, 2018 • 5:32 PM
In reply to 43 yo woman metastatic… by Rev Susan Miller
Dear Susan, we recommend that your friend call our Patient Access Service and speak with someone about arranging a consultation. The number to call is 800-525-2225. She can go to https://www.mskcc.org/experience/become-patient/appointment for more information.
If she is not able to travel to New York City, she may want to consult with an expert closer to home. To find a list of National Cancer Institute designated cancer centers, you can go to https://www.cancer.gov/research/nci-role/cancer-centers
Thank you for your comment and best wishes to you and your friend.
Vibhor
Oct 5, 2018 • 2:55 PM
Hi tita hope you find this helpful.
This is a good article in hopes for better treatment option.