Study Divides Breast Cancer Into Four Distinct Types
Elizabeth Stark, a patient of Dr. Ellis, with her family in St. Louis on Friday, said she was hopeful about future treatments.
By GINA KOLATA
Published: September 23, 2012
Brandon Thibodeaux for The New York Times
Dr. Charles Perou is the lead author of the study, part of a federal project.
Dilip Vishwanat for The New York Times
Dr. Matthew Ellis was a researcher for the study.
These discoveries, published online on Sunday in the journal Nature, are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new ideas for more precise treatments aimed at genetic aberrations that now have no known treatment.
The study is the first comprehensive genetic analysis of breast cancer, which kills more than 35,000 women a year in the United States. The new paper, and several smaller recent studies, are electrifying the field.
“This is the road map for how we might cure breast cancer in the future,” said Dr. Matthew Ellis of Washington University, a researcher for the study.
Researchers and patient advocates caution that it will still take years to translate the new insights into transformative new treatments. Even within the four major types of breast cancer, individual tumors appear to be driven by their own sets of genetic changes. A wide variety of drugs will most likely need to be developed to tailor medicines to individual tumors.
“There are a lot of steps that turn basic science into clinically meaningful results,” said Karuna Jaggar, executive director of Breast Cancer Action, an advocacy group. “It is the ‘stay tuned’ story.”
The study is part of a large federal project, the Cancer Genome Atlas, to build maps of genetic changes in common cancers. Reports on similar studies of lung andcolon cancer have been published recently. The breast cancer study was based on an analysis of tumors from 825 patients.
“There has never been a breast cancer genomics project on this scale,” said the atlas’s program director, Brad Ozenberger of the National Institutes of Health.
The investigators identified at least 40 genetic alterations that might be attacked by drugs. Many of them are already being developed for other types of cancer that have the same mutations. “We now have a good view of what goes wrong in breast cancer,” said Joe Gray, a genetic expert at Oregon Health & Science University, who was not involved in the study. “We haven’t had that before.”
The study focused on the most common types of breast cancer that are thought to arise in the milk duct. It concentrated on early breast cancers that had not yet spread to other parts of the body in order to find genetic changes that could be attacked, stopping a cancer before it metastasized.
The study’s biggest surprise involved a particularly deadly breast cancer whose tumor cells resemble basal cells of the skin and sweat glands, which are in the deepest layer of the skin. These breast cells form a scaffolding for milk duct cells. This type of cancer is often called triple negative and accounts for a small percentage of breast cancer.
But researchers found that this cancer was entirely different from the other types of breast cancer and much more resembles ovarian cancer and a type of lung cancer.
“It’s incredible,” said Dr. James Ingle of the Mayo Clinic, one of the study’s 348 authors, of the ovarian cancer connection. “It raises the possibility that there may be a common cause.”
There are immediate therapeutic implications. The study gives a biologic reason to try some routine treatments for ovarian cancer instead of a common class of drugs used in breast cancer known as anthracyclines. Anthracyclines, Dr. Ellis said, “are the drugs most breast cancer patients dread because they are associated with heart damage and leukemia.”
A new type of drug, PARP inhibitors, that seems to help squelch ovarian cancers, should also be tried in basal-like breast cancer, Dr. Ellis said.
Basal-like cancers are most prevalent in younger women, in African-Americans and in women with breast cancer genes BRCA1 and BRCA2.
Two other types of breast cancer, accounting for most cases of the disease, arise from the luminal cells that line milk ducts. These cancers have proteins on their surfaces that grabestrogen, fueling their growth. Just about everyone with estrogen-fueled cancer gets the same treatment. Some do well. Others do not.
The genetic analysis divided these cancers into two distinct types. Patients with luminal A cancer had good prognoses while those with luminal B did not, suggesting that perhaps patients with the first kind of tumor might do well with just hormonal therapy to block estrogen from spurring their cancers while those with the second kind might do better with chemotherapy in addition to hormonal therapy.
In some cases, genetic aberrations were so strongly associated with one or the other luminal subtype that they appeared to be the actual cause of the cancer, said Dr. Charles Perou of the University of North Carolina, who is the lead author of the study. And he called that “a stunning finding.”
“We are really getting at the roots of these cancers,” he said.
After basal-like cancers, and luminal A and B cancers, the fourth type of breast cancer is what the researchers called HER2-enriched. Breast cancers often have extra copies of a gene, HER2, that drives their growth. A drug, Herceptin, can block the gene and has changed the prognosis for these patients from one of the worst in breast cancer to one of the best.
Yet although Herceptin is approved for every breast cancer patient whose tumor makes too much HER2, the new analysis finds that not all of these tumors are alike. The HER2-enriched should respond readily to Herceptin; the other type might not.
The only way to know is to do a clinical trial, and one is already being planned. Herceptin is expensive and can occasionally damage the heart. “We absolutely only want to give it to patients who can benefit,” Dr. Perou said.
For now, despite the tantalizing possibilities, patients will have to wait for clinical trials to see whether drugs that block the genetic aberrations can stop the cancers. And it could be a vast undertaking to get all the drug testing done. Because there are so many different ways a breast cancer cell can go awry, there may have to be dozens of drug studies, each focusing on a different genetic change.
One of Dr. Ellis’s patients, Elizabeth Stark, 48, has a basal-type breast cancer. She has gone through three rounds of chemotherapy, surgery and radiation over the past four years. Her disease is stable now and Dr. Stark, a biochemist at Pfizer, says she knows it will take time for the explosion of genetic data to produce new treatments that might help her.
“In 10 years it will be different,” she said, adding emphatically, “I know I will be here in 10 years.”
For Our World
by Mattie Stepanek
We need to stop.
Stop for a moment…
Says or does anything
That may hurt anyone else.
We need to be silent.
Silent for a moment…
Before we forever lose
The blessing of songs
That grow in our hearts.
We need to notice.
Notice for a moment…
Before the future slips away
Into ashes and dust of humility.
Stop, be silent, and notice…
In so many ways, we are the same.
Our differences are unique treasures.
We have, we are, a mosaic of gifts
To nurture, to offer, to accept.
We need to be.
Be for a moment…
Kind and gentle, innocent and trusting,
Like children and lambs,
Never judging or vengeful
Like the judging and vengeful.
And now, let us pray,
Differently, yet together,
Before there is no earth, no life,
No chance for peace.
Mattie J.T. Stepanek ©
September 11, 2001
|My friend Keri Morrissey passed away last month, right before John and I married. Here is her OBITUARY. We went through very similar things, although she leaves behind 2 young children. She fought hard, she was brave and now she is at peace and whole again.||
Born: September 23, 1977
Keri Lindh Morrissey Walker, born in Ancon, Canal Zone, Republic of Panama, on September 23, 1977, went home to be with the Lord on Tuesday, July 10, 2012. Keri was predeceased by her daughter Mallory and is survived by her beloved husband, Justin Walker; her children Jillian and Jake; her parents, Robert and Frances Morrissey of Rockledge; her sister Tristan Adelman (brother-in-law Craig Adelman, nieces Haley and Camryn, nephews Alex and Nathan) of Melbourne; her brother, Sean Morrissey (sister-in-law Angelica Morrissey) of Merritt Island and many other extended family members and friends.
Keri enjoyed spending free time with her children, family, and friends. She met the love of her life, Justin, while they were both working at Brevard County Detention Center in 2010. They married on March 31, 2012. Keri and Justin loved to enjoy the outdoors; going to the beach, riding ATV’s, boating, and camping together and with her children. During the months that Keri was fighting her illness, she and Justin made the best out of every situation, whether home or in Houston. Keri remained strong, positive and hopeful until the very end. Her strength was admired by all.
A Funeral Mass will be held Saturday, July 14 at 10:00 am at Divine Mercy Catholic Church on Merritt Island, Florida. In lieu of flowers, the family requests donations be made in Keri’s memory to MD Anderson Cancer Center, Cervical Cancer Research, PO Box 4486, Houston, TX 77210-4486. http://www.mdanderson.org/gifts
Happy Labor Day or as I will say Anti-entitlement Day!! Allow me to expound.
I am not coming from a place of ignorance or inexperience. I have been hard pressed on all sides. Just 3 years ago, the rug was completely pulled out from underneath the fabric of my life. In a matter of eight weeks I went from being a working business owner, married, healthy, home owning woman to the complete antithesis of all of that. I LOST it all…….in one fell swoop.
Consequently, I needed help and a lot of it. Having worked my entire adult life, not working was a difficult spot to be in. Believe it or not, I did not qualify for “assistance”. I applied and was repeatedly denied. If someone who is battling cancer, is unemployed, homeless and with a 17-year-old son with them, does not qualify, I am not sure who does. But apparently, I did not. It was actually the fact that I had worked all my life that saved the day. I had to file an unemployment claim against the company I had help to build, in order to “live”. And I put that in quotes because Tucker and I lived on $1000 a month. My anti nausea pills alone, cost $300 while on chemo. Needless to say, I went into chemo without my anti nausea medication most of the time.
I am painting a picture here folks. The programs for “assistance” were just that. Meant to assist for a season. If you needed help for a limited period of time, a safety net, if you will. It was not meant for the Flying Wallendas to throw a block party in!!!!! It really burns my buns that someone like me did not qualify, when you have GENERATIONS of folks who have sucked the life out of the system so those in true need “do not qualify”. The system is seriously broken folks. Having had this experience, it makes me crazy when I encounter people who feel they are entitled.
As Americans we have inalienable rights guaranteed by The Bill of Rights. And NONE of these are FREE. Someone paid for them, at times with their own BLOOD (thank you servicemen and women). So what am I saying??…………the bible says it best.
Ephesians : 4:28
King James Bible (Cambridge Ed.)
Let him that stole steal no more: but rather let him labour, working with his hands the thing which is good, that he may have to give to him that needeth.
I am happy to be a laborer. My Nana says: “There is dignity in ALL labor”. I now work to try to help those that I KNOW are in need and in a temporary tough patch, like I was. I raise money for the truly needy that are stuck in the same non qualifying state that I was. One of my new favorite quotes:
“Blessed are those who can give without remembering, and receive without ever forgetting”……..AMEN!!!!!
Happy Anti- Entitlement Day!!!
Lately, I have had women run across the room to ask me this question……….so, what are you doing? You look great. And as I have done in the past, I am happy to share my regime and what I am doing for my well being, with others. Anything that has to do with this subject I will title “Healthy Life style”.
So, I guess it is obvious by now that I have lost weight that I had picked up following my cancer treatment. Let’s talk about that for a moment. I picked up approximately 15 lbs in the year of treatment due mostly to the fact that food tasted weird. You would think that would make me lose weight. I found that the only food that tasted reasonably good while on chemo was bland foods. Consequently, I ate things I don’t normally eat like mashed potatoes, oatmeal, cream of wheat etc. Having not had carbs in my diet for YEARS and also being much more sedentary, I put on some 15 lbs of weight. Then, I think the Tamoxifen did not help etc. Oh, and let’s not forget menopause .
With all these changes at once, my weight changed. I was pushing 150. I know that is not horrible on my 5’7″ frame but I was not happy with it. Then let’s talk about the biggest challenge of all, chemo fatigue. If I tried to exercise at all, for the next 3 days I was a zombie. I functioned but was completely drained of all energy.
I digress to some historical info……….. In the summer of 2011, I was asked to cover a man named Marshall Reeves herculean attempt to race a bike across America. See RAC to find out more (www.raceacrossamerica.com). I was getting info via text at 2 and 3 AM at times of Marshall’s progress in the race which I shared on social media channels. I was in complete awe of Marshall, I would be sound asleep and wake up to realized that he had biked through the night to gain distance in the cool of the night. I found myself catching a bit of the biking bug. I knew the odds of me being able to ride in such a ride was fantasy but it piqued my interest. Then in march, I helped to bring the first high level bike race to Brevard County, the Gran Fondo. It was exciting to see an idea that a few friends had to raised money for KLD take wings and fly. While helping with this 123 mile race and meeting some of the cycling celebs, my interest grew even stronger. I wanted to ride. By the time race day dawned I was in full out LUST to get a race bike and ride.
At the Gran Fondo a race bike was being raffled off to raise $$$ for KLD so I bought a healthy amount of tickets, figuring that it was good regardless if I won the bike. So on the day of the race, I announced to God and everyone, I wanted that bike. When I laid my eyes on it….it was beautiful. I heard whispers that it was worth $3500, wow I had no idea that race bikes cost as much as my motorcycle. This was my chance because I sure could not afford to buy the bike without selling my motorcycle. And so I put it out there all day……that bike was mine! When it came time for the drawing, I waited anxiously………..and then it appeared the drawing was done and I was NOT the winner. Oh well, that was that. As I packed up my stuff to head home, someone came and put their arm around my shoulder and told me……..I WON THE BIKE! No way……………..really? Sure enough they wheeled it over and John and I were trying to figure out how to get it home. How could this be? I KNOW I did not win this bike. Later that night as I sat home with my beautiful prize someone texted me and clued me in. Someone else won but saw my desire to embrace the sport and GAVE IT to ME!! So now I did not know what to think. I cried and thanked God (and that person) and asked why I did not win the bike directly. The still small voice said “because you need to know just how much you are loved”. And that voice is right, I lose sight of that easily (but I am getting better). What a wonderful gift and reminder each and every time I get on it. I am LOVED. I am HEALTHY. I am WORTHY. The same mantra I repeated in the chemo chair, I now say as I ride the bike. And let’s not forget….”.I can do ALL THINGS through CHRIST, who strengthens me”.
So now I have this beautiful bike and I was trying to ride it. I had no trouble riding for 16-20 miles but then I was a zombie for days. I had to figure this out. I talked to my doctor but he did blood work only to announce I was in perfect health. A familiar story was developing. Something was wrong with me but no one could figure it out. Finally in desperation again, I called upon my friend Roxanne Guy and she recommended I see Dr. Rebecca Hunton. And so in May I did.
I love the type of medicine that Dr, Hunton practices. She calls it Integration medicine. It is EAST meets WEST medicine. She dug about three layers deeper than the other physicians and found out that there were some very serious things wrong with me. I will write more about this later and in detail. Bottom line, she had me change my diet, put me on supplements and got to the bottom of the issue. Starting within about 3 weeks, I was feeling great and better with each passing day.
So……..I am riding my bike a minimum of an hour a day. I bought a trainer so that I can ride indoors during the week. The weight is definitely down and the muscle is definitely building. I am back in my size 4 pants and my mojo is definitely back.
I will write more in detail about the diet and supplements………………….OH and my hair is growing LIKE WEEDS. More on all of this soon. I rode the bike this morning for a half an hour and will most likely do another hour tonight. I FEEL BETTER THAN I HAVE IN 5+ years!!!
So, I am in training to ride the 123 miles in the Gran Fondo this year with John to raise money per mile for KLD. We will raise money per mile, let me know if you want to support us. We are excited about this ride.