Beating Out Breast Cancer with New Treatments | Medical | Hudson Valley | Hudson Valley; Chronogram
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Beating Out Breast Cancer with New Treatments 

New medical innovations help treat breast cancer

click to enlarge 2017 Miles of Hope Community Walk for Breast Cancer.
  • 2017 Miles of Hope Community Walk for Breast Cancer.

As a dancer, Mary Ritter has always been in close conversation with her body. So, in the fall of 2010, when a lump developed in her right breast, she knew something was wrong. "I wear leotards and tights and all kinds of things that are close to my body," says Ritter, a dance instructor at Yanarella School of Dance in Beacon. "I was always very conscious of what was going on, so I knew this thing was happening. It just happened to be two weeks before my dance recital." Yet even her keener-than-average body awareness couldn't keep up with the speed of the tumor that was growing inside her. As recently as January, she'd had a clean mammogram—but in the space of ten months, a tumor had taken root and quickly claimed her entire right breast. "They brought me in and did another mammogram, and basically had the technician read it immediately because they suspected something," she says. "They did a biopsy, I had my dance recital, and two days later they called me with the news."

It was Stage 3 cancer and very aggressive, so the doctors had to work quickly. To get the tumor to stop growing, Ritter went through five rounds of chemotherapy. "I lost my hair right after Christmas," she recalls. "At one point I was hospitalized because I was so weak." By April she was ready for surgery, electing for a double mastectomy because even though her left breast was cancer-free, she knew she was susceptible. "I was close to 50 and didn't need my breasts anymore," says the mother of grown children. A plastic surgeon performed reconstruction the same day as her mastectomy. "I wanted to be able to put on a leotard and not have people say, 'Oh my god, what happened to that woman?'" Ritter also started radiation about a month after the surgery, because the doctors couldn't say for sure whether her lymph nodes were clear. She wasn't going to take any chances. Today she is a seven-year breast cancer survivor, a grandmother of two with a third on the way, and she's never stopped dancing.

The Rise of Tumor-Melting Smart Bombs

Going from Stage 3 to cancer-free is not always a given, but success stories like Ritter's are becoming more prevalent these days. What's more amazing: Sometimes these stories don't include aggressive chemotherapy anymore, and the hair loss and sickness that come with it. Over the last 10 to 15 years, modern medicine has made tremendous strides with breast cancer, and an arsenal of new, less toxic medications is stripping many diagnoses of their lethal edge. New-to-the-market treatments are even giving Stage 4 metastatic breast cancers, which currently have a 22-percent five-year survival rate, a run for the money. "Surgery has made some improvements, but it's the systemic treatments, the chemotherapies and targeted therapies, that are the reason why women are doing so much better with breast cancer now," says Julia Schaefer-Cutillo, MD, a medical oncologist with Hudson Valley Cancer Center. "It's been such an exciting ride for me since I began my career 12 years ago, with all the changes we've seen and the new drugs that we have."

Gone are the days when a one-centimeter tumor automatically meant a total mastectomy. Gone as well is the assumption that a breast cancer patient will need chemotherapy in all scenarios. "Now we send a molecular test in most cases where we determine whether or not the patient will actually benefit from getting chemo," says Schaefer-Cutillo. With a test like Oncotype or MammaPrint, doctors can figure out what makes a tumor tick and match it with a medication designed to kick it where it counts. The de-escalation of chemotherapy, once considered unthinkable, is a new line of discussion that's only made possible by recent advances and new pharmaceuticals. "The science has advanced, and we're using more molecular, targeted treatments than ever before. This allows some patients to avoid a lot of the toxicity of chemotherapy, and also get them to the treatment they need faster. We do have to use chemotherapy in some situations, but we really try to use more targeted, less toxic drugs so we can help people maintain their quality of life and treat their cancer more effectively."

The transformation in breast cancer treatment started in the early 2000s with the FDA approval of a drug called Herceptin to treat HER2-positive breast cancer (that is, breast cancer that tests positive for a protein called human epidermal growth factor receptor 2). While HER2-positive accounts for just 25 to 30 percent of all breast cancers, historically it has had very poor outcomes with a high risk of the cancer coming back after surgery. Researchers found that adding Herceptin to chemotherapy resulted in a 50-percent reduction in the rate of the cancer's recurrence. Yet since the Herceptin-chemotherapy combo also increased the risk of heart failure, they took it one step further by reducing the amount of chemotherapy that patients needed—and in so doing, reducing the heart-failure risk.

As exciting as it is effective, the fine-tuned Herceptin treatment is the first in what is becoming a long line of game-changing therapies for breast cancer. New medications like Perjeta and Nerlynx also specifically target the HER2 molecule. "It actually gives me goose bumps to talk about Perjeta, because when it's combined with Herceptin, the tumors just melt away," says Schaefer-Cutillo. "I've never seen anything like it." For estrogen-positive cancers, which make up close to 75 percent of all breast cancers, research has found that combining an anti-estrogen drug such as Faslodex with a CDK4/6 inhibitor medication like Ibrance can yield better outcomes compared to using anti-estrogens alone, even in Stage 4 patients. The CDK4/6 pathway acts like an escape mechanism in estrogen-resistant tumors, explains Schaefer-Cutillo. "The women don't lose their hair, they don't get sick. They are able to live totally normal lives and go to work and take care of their kids and grandkids. It's been quite an amazing advance for estrogen-positive cancer."

There's even new hope for very hard-to-treat populations, such as triple-negative and BRCA-positive patients (like Angelina Jolie, who carries the BRCA gene mutation for breast cancer and opted for a prophylactic double mastectomy in 2013). Researchers are looking at androgen receptors as a possible new treatment for triple-negative disease (that is, breast cancer that is neither HER2-positive nor estrogen-receptor positive). Immunotherapy drugs, while not yet approved for breast cancer, have shown some promise for triple-negative patients in early trials, so it's an area to watch. And for BRCA patients, a brand-new drug called Lynparza offers a pill-form treatment that's much less toxic than chemotherapy. Trailblazing medications like these are coming to market faster, fueled by patient-driven need and fast-track approvals from the FDA.

A Support Net Woven from Pink Ribbons

Local breast cancer patients not only have the new treatments available to them at regional hospitals and community oncology practices; they also have access to an incredible organization dedicated to easing the burden of breast cancer on people's lives. Created in 2004, Miles of Hope has given away over $2 million in support programs for people affected by breast cancer in the nine counties of the Hudson Valley. "I emphasize 'programs' because we don't give money to research; there are enough organizations for that," says Pari Forood, executive director of Miles of Hope. "We wanted to help people, families, and communities affected by breast cancer, and our mission is exactly that."

One of Miles of Hope's signature programs is its Medical Gap Fund, which puts money directly into the pockets of patients. "We want to help pay your bills when you're going through breast cancer treatment, whether it's your rent, mortgage, medical copays, cellphone, or summer camp for your kids," says Forood. "If you have a bill that you can't pay and you're in treatment for breast cancer, we're going to help you with it." Miles of Hope has partnered with six social service organizations in nine counties to help find and identify people who need them most, and also to help manage and augment the support they give. "A woman called the other day and said, 'I don't have a proper winter coat and boots, and I'm going back and forth to Vassar Brothers hospital,' and I said, 'Call LL Bean and send me the bill!' Another gal once called and said, 'My mother is in a wheelchair and in treatment for breast cancer, and we can't afford to have a ramp built to get her in and out of the house.' I said, 'Get a carpenter and start building—we'll pay for it!'"

It's easy for Miles of Hope to get overwhelmed with requests, which is why they cap the amount of monetary help at $1,000 in most cases. "We're trying to help you in the emergency part of your treatment, so you can get over that hump," says Forood. "We cap it because there are so many people out there who need our help." Meanwhile, several other programs allow the organization to keep giving—including a scholarship program for college-bound students whose lives have been affected by breast cancer, and a peer-to-peer hotline that's manned by trained survivors who offer help and support to breast cancer patients.

Miles of Hope raises money for its programs from individual and corporate donations, as well as through annual sporting events such as the Hoops for Hope women's basketball tournament (March 11), a Goals for Hope soccer tournament (August 4), and the Community Walk for Breast Cancer (September 30). "Our events are not just fundraising," explains Forood. "It's a giant support group, a solidarity movement. Our walks get 800 to 900 people, all there to honor someone who has breast cancer. Everybody feels that collective love and support."

The events also inspire people to get out and exercise, which plays a role in keeping cancer at bay and in improving the outcomes of those already affected. "Just three years ago, researchers said you can reduce your breast cancer risk by adopting a healthy lifestyle. This is new—no one ever said that before," says Forood. "We used to think, if one in eight women get breast cancer, then we're sitting ducks. But we can do something about it. I'm begging everybody to eat more fruits and vegetables." Also essential: getting regular mammograms. If you can catch breast cancer at Stage 1 or 2, the survival rate is well over 90 percent.

Ritter, the seven-year survivor who is a runner as well as a dancer, feels certain that her active, healthy lifestyle translated into a better outcome from her Stage 3 cancer. "I believe that's why I stayed so strong," she says. Ritter also found a buoy in the outpouring of support from family and friends. "I had people coming out of the woodwork to call me and text me, make food for me, and just be with me when I couldn't physically leave the house. It was totally uplifting and the best part of what happened." Her life these days is back to normal, and her trials with breast cancer are a receding dream. "I like to say there was a before and after, and the after is just as good as the before."

Miles of Hope's "Hoops for Hope" basketball tournament will take place on March 11 in the McCann Recreation Center at Marist College in Poughkeepsie.

RESOURCES

Miles of Hope 

Julia Schaefer-Cutillo, MD


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