Innovative treatment options for women with locally advanced breast cancer and more operable disease

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Wendy Wilson, 56, had begun to make healthier lifestyle choices but in May 2010 she was told the lump in her right breast wasn’t one of the many benign cysts she had before. She heard those life-altering words: breast cancer.

Soon after her diagnosis, Wendy met with Dr. Jean-Francois Boileau who now heads the Neoadjuvant Locally Advanced Breast Cancer Clinic at Sunnybrook’s Odette Cancer Centre. She was getting prompt care and on her way to contributing to research that may one day substantially shift the treatment approach for many women newly diagnosed with breast cancer.

A breast cancer diagnosis is generally treated with surgery followed by cancer-cell killing chemotherapy and or radiation. Dr. Boileau is involved in leading two large clinical trials focused on delivering novel chemotherapy agents before breast cancer surgery. These studies are being conducted across North America at over 100 trial sites with the Odette Cancer Centre as one of only a select few in Canada. Dr. Boileau is Sunnybrook’s principal investigator with the National Surgical Adjuvant Breast and Bowel Project (NSABP), the international collaborative group behind these trials who are also known for publishing other landmark studies in breast cancer.

Dr. Boileau explains the thinking behind neoadjuvant or pre-surgical chemotherapy this way: “Instead of removing the tumour first, giving chemotherapy second, crossing your fingers and hoping that there will be no recurrence of the cancer in the future, you instead give the chemotherapy treatment first, and after you do the surgery. For an increasing number of patients, we cannot identify any residual cancer cells at the time of surgery. The response to the treatment is known right up front. If there is not an optimal response, you can change the treatment, or the patient may be a candidate for novel therapies within clinical trials. Neoadjuvant therapy is a good example of personalized care.”

The Montreal-trained surgeon notes that NSABP researchers first began using chemotherapy before surgery more than 50 years ago (albeit for different reasons), when women in a randomized study were given a dose of chemotherapy before surgery and two doses after. “It was the first time we discovered that treatments other than surgery could actually improve survival and change the natural history of breast cancer.”

Usually, neoadjuvant chemotherapy is given to patients with locally advanced and inoperable breast cancer to reduce tumour size before surgery. Increasingly, neoadjuvant chemotherapy has been given to patients with less advanced or operable breast cancer. Wendy is one of over 500 participants in the Phase III trials for women with operable breast cancer.

The pre-surgical chemotherapy approach is especially interesting for measuring response to therapy for women diagnosed with certain high-risk breast cancer subgroups like HER-2 positive (a form of breast cancer that tests positive for human epidermal growth factor receptor 2 or HER2 and which is treatable with targeted therapies such as Herceptin) or ‘triple negative’ (a form of breast cancer that does not respond to hormone-based treatments like tamoxifen or Herceptin).

“Although these are aggressive cancers, when we treat them with chemotherapy before surgery, we see a much higher rate of response. With the current clinical trials, we’re trying to improve on the existing treatments to achieve higher rates of complete response. In this setting, the rate of complete response correlates very well with long term survival,” says Dr. Boileau.

A key part of the patient care approach at the Odette Cancer Centre is collaboration across the many disciplines. In the Neoadjuvant Locally Advanced Breast Cancer Clinic Dr. Boileau works closely with medical oncologists and radiation oncologists.

For Wendy, having the support of family –daughter Melissa, son-in-law Sunny and her grandsons – helped get her through chemotherapy over the past year. She then underwent a lumpectomy (surgery) performed by Dr. Boileau in January and completed radiation treatments in April.

“When I first heard the words ‘you have breast cancer’, I felt like my life was completely upside-down. Then I made up my mind: there’s no way I’m giving in to cancer. I still have things I need to do.” She credits Dr. Boileau and his team for being a lifeline of sorts. She was recently with her daughter who welcomed her third child into the family – another grandson for Wendy who loves spending time with all of her grandchildren.