What’s New in Breast Cancer Research and Treatment?

Criterium’s Academic Breast Cancer Consortium (ABRCC) is comprised of 15 renowned academic and community sites in North America, conducting translational research in Breast Cancer studies for major pharmaceutical companies who are working on the most current clinical trials for advanced treatments of breast cancer. While 2020 was a year dominated by COVID-19 news and tragedy, breast cancer research and breakthroughs can’t wait for COVID to “go away” – and research in this area continues on full-speed. Our ABRCC researchers reflect on 2020 and look ahead to 2021 with renewed hope.

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Podcast: ‘You Have to Personalize the Miracles’

For November’s Lung Cancer Awareness Month, Heather Smith and Melissa Turner share the stories of their cancer journeys. The women took very different routes to the CU Cancer Center and the world-renowned lung cancer care of Ross Camidge, MD. On this episode of the CU Anschutz 360 podcast, learn why they love everything about Dr. Camidge’s practice, especially the fact that he makes them laugh.

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Following NCCN Guidelines for Metastatic Breast Cancer Results in Lower Costs for Patients

Research from the O’Neal Comprehensive Cancer Center at UAB finds patients treated outside of NCCN Guidelines recommendations had significantly higher direct costs.

A new study from the O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), published in the October 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network, finds that direct costs for metastatic breast cancer (MBC) patients increase dramatically when their treatment differs from recommendations in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Previous studies have found that guideline discordant care results in higher health care costs overall1, but this is the first study to look specifically at the cost burden for patients.

“We thought that it was important to explore potential differences in out-of-pocket costs, since financial toxicity is a growing issue among patients with metastatic breast cancer,” explained Courtney P. Williams, MPH, Division of Hematology and Oncology, O’Neal Comprehensive Cancer Center at UAB. “We found about one in five women received an anticancer treatment that wasn’t listed within the NCCN Guidelines. Those women were responsible for higher out-of-pocket costs—including deductibles, coinsurance, and copayments—in the year following their metastatic breast cancer diagnosis than those receiving an anticancer treatment listed within the guidelines. This finding is especially important for older patients, which made up about 75 percent of our sample, since financial and psychological distress could be worse for patients living on a fixed income.”

The retrospective study used the SEER-Medicare database to look at patient costs for 3,709 women diagnosed with MBC between 2007 and 2013 who survived at least a year after diagnosis. Treatment regimens were matched to the version of the NCCN Guidelines® for Breast Cancer that were available at the exact treatment date. The definition of guideline-concordant care varied depending on date due to NCCN’s frequent guideline updates.

The median patient cost for the year post-diagnosis was $5,171 for care that fit within contemporary NCCN Guidelines, versus $7,421 for care that deviated from them. Both overtreatment and undertreatment—as defined by the guidelines—ultimately resulted in higher patient costs.

“The observation that out-of-pocket costs may be greater for guideline discordant care is important for both patients and physicians to understand, especially when many guideline discordant treatments may not improve clinical outcomes,” commented Matthew P. Goetz, MD, Mayo Clinic Cancer Center, Member of the NCCN Guidelines Panel for Breast Cancer, who was not involved in this study. “Clinical trials should be prioritized as a way to offer patients access to new drugs/treatments that might not otherwise be available to them, while limiting out-of-pocket expenses.”

Non-approved use of bevacizumab accounted for the highest increase in patient expenses, and was also associated with worse outcomes. The article cited this fact as a “cautionary tale for physicians who add novel agents without proven benefit to treatment regimens,” and argued that it might be better to provide no treatment, than to provide a “guideline-discordant treatment associated with mild but persistent and bothersome adverse events.”

“NCCN Guidelines exist to provide recommendations based on scientific evidence and expert opinion,” said Williams. “Although there will always be circumstances where off-guideline treatment is warranted, physicians should aim to comply with current guidelines for the safety of the patient, both physically and psychologically, as well as to decrease adverse outcomes such as financial toxicity.”

To read the entire study, visit JNCCN.org. Complimentary access to “Guideline Discordance and Patient Cost Responsibility in Medicare Beneficiaries with Metastatic Breast Cancer” is available until January 10, 2020.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.

Reprint by permission PRNewswire; Image courtesy of Pixabay Free License CC0

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Dr. John S. Macdonald Honored at 2018 Luminary Awards

John S. Macdonald, MD, is the Senior Medical Advisor for AGICC (Academic GI Cancer Consortium) and the consolidated Oncology Consortia of Criterium groups, including: AMyC (Academic Myeloma Consortium), ATOMIC (Academic Thoracic Oncology Medical Investigators Consortium) and ABRCC (Academic Breast Cancer Consortium). He is a leading supporter and advocate of the Translational Research methodology.

Dr. Macdonald was one of a few select honorees at The Ruesch Center for the Cure of Gastrointestinal Cancers Annual Luminary Awards on November 30th, 2018.

Dr. Macdonald successfully developed and led the Comprehensive Cancer Center at St. Vincent’s in New York City between 1997 and 2007. He is widely recognized as an industry and academic expert in gastrointestinal oncology and has written and lectured on the advantages of translational research. In addition to his responsibilities at Saint Vincent’s, Dr. Macdonald served as Chief of Medical Oncology there, and as the Lynn Wood Neag Endowed Professor of Medicine at the New York Medical College. He is acknowledged as a leading educator in Medical Oncology. 

Macdonald pioneered the use of chemoradiation after surgical resection of gastric cancers. This treatment regimen, aptly named the “Macdonald Regimen,” has helped turn the idea of a cure into a reality for thousands of patients with gastric cancers. This has also paved the way for the development of new treatment options for gastric cancers.  “[Macdonald] is a groundbreaking researcher, dedicated educator, and outstanding clinician,” said Sunnie Kim, MD, of the Ruesch Center for the Cure of Gastrointestinal Cancers, prior to presenting Macdonald with his award. “He has changed the lives of countless patients with some of the deadliest cancers.”

Dr. Macdonald has authored over 400 articles, abstracts and book chapters and has been both published in, and editor of, many prestigious medical journals. Macdonald has received numerous awards and distinctions, including being named among Good Housekeeping’s Best 300 Doctors in America and, over a seven-year period, New York magazine’s Best Doctors in New York.

Visit the website to see Dr. Macdonald’s profile and all the Consortia groups.

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Finding New Treatments for Breast Cancer with Brain Metastases

As if Breast Cancer or Brain Cancer alone were not enough to combat — patients with both now?have new hope in light of fledgling research that is showing progress.

Once breast cancer metastasizes into other areas of the body, particularly the brain, it becomes much more dangerous. And while the National Cancer Institute spends more than $500 million dollars per year on breast cancer research, only two to five percent of this funding goes to study how the disease spreads.

A clinical trial is open nationwide through the Academic Breast Cancer Consortium (ABRCC), giving access to an exciting novel drug therapy combination. The tucatinib, palbocilib and letrozole trial is coordinated by ABRCC and currently open for enrollment at the University of Colorado Cancer Center; University of Texas Health and Science Center in San Antonio, TX; Stony Brook University, NY; University of Arizona, Tucson, AZ; and University of New Mexico, Albuquerque, NM and will also be accruing patients at Northwestern University, Chicago, IL.

There are three well-established predictive markers of breast cancer. They are estrogen receptors (ER), progesterone receptors (PR), and the growth factor receptor HER2, these receptors may be blocked with targeted drugs to stop cancer growth. Breast cancers lacking these three markers are referred to as ?triple-negative? but clinicians and scientists are quickly learning more about cancers that have all three receptors, which are often called ?triple-positive.? There are treatments against each target individually, but when multiple drivers are present, as in ?triple-positive? breast cancer, blocking one often results in cancer nimbly switching to driving its growth with the other two.

The study combines tucatinib, which inhibits HER2, with letrozole targeting ER and PR hormone receptors, and the drug palbociclib, which targets CDK proteins that help cancer cells rush through the process of replication. The three had not been tried together until Elena Shagisultanova, MD, PhD, a breast cancer specialist at UCH, hypothesized there could be a way to target all three drivers at the same time with better results than targeting combinations of any two.

?When metastatic cancer spreads to the brain, it can be especially challenging,? says Dr Peter Kabos, the National Medical Director of the Academic Breast Cancer Consortium (ABRCC) and the Kabos Research Lab for Breast Cancer at UC Denver. ?Many medications aren?t effective in the brain, but exciting early clinical trial data for tucatinib shows that it may be one of the drugs that can penetrate the blood-brain barrier to combat brain metastases.

The trial is funded by the Pfizer ASPIRE Award in Breast Cancer Research. Cascadian Therapeutics and Pfizer are providing the study drugs tucatinib and palbociclib. For more information about trial eligibility and participation, contact brad.mackay@ucdenver.edu or emily.berens@ucdenver.edu

Article excerpted with permission from the University of Colorado Cancer Center blog — for the complete story, click here.