Road to a Cure - ADC & SARM
The podcast Road to a Cure team meets up with renowned hematologist oncologist, Dr. Hope Rugo of USCF's Carol Franc Buck Breast Care Center. Dr. Rugo is also co-director of UCSF's breast cancer clinical trials program. She is also an investigator with the Bay Area's SPORE (Specialized Programs of Research Excellence) on breast cancer.
The hosts Victoria Goldberg and Dr. Ellen Landsberger take some time to unpack Dr. Rugo's view of what a "cure" looks like for metastatic cancers, the exciting leadership shown with dosing, and a very clear review of the latest treatments and upcoming clinical trials that could help those with both triple-negative and hormone-positive breast cancer.
Dr Rugo is principal investigator for many clinical trials focusing on combining immunotherapy and targeted therapeutics with standard treatment to improve treatment of metastatic breast cancer. Most recently, she was the lead researcher of the ASCENT trial ( cited below) which excited oncologists and patients alike with the improvement in progression-free and overall survival in those treated with the antibody drug conjugate sacituzumab govitecan than with single-agent chemotherapy among patients with metastatic triple-negative breast cancer.
In addition to her leadership in multiple drug trials, Dr Rugo has taken a keen interest in reducing toxicity from treatment of cancer. She participated in the development of scalp cooling to reduce hair loss from chemotherapy and a steroid mouthwash to reduce stomatitis.
We were not surprised to learn that Dr Rugo is the recipient of multiple awards both for excellence in patient care and education of patients and medical professionals alike. Both Victoria and Ellen learned so much during our interview session and we are excited to share this episode with you.
What is Triple Negative Breast Cancer (TNBC)?
A subset of breast cancers that is characterized by absence of the hormone receptors estrogen and progesterone and an absence of the protein Human Epidermal Growth Factor (HER2)
Gene Expression Profiling
TNBC and Racial Disparities
Racial Disparities in Triple Negative Breast Cancer: A Review of the Role of Biologic and Non-biologic Factors. Prakash O, Hossain F, Danos D, Lassak A, Scribner R, Miele LFront Public Health. 2020 Dec 22;8:576964. doi: 10.3389/fpubh.2020.576964. PMID: 33415093; PMCID: PMC7783321.
ASCO President’s Address on Equity in Cancer Care, August 15, 2021
Navigating a Path to Equity in Cancer Care: The Role of Patient NavigationNiharika Dixit, Hope Rugo, and Nancy J. BurkeAmerican Society of Clinical Oncology Educational Book 2021 :41, 3-10
Treatment for Metastatic Triple Negative Breast Cancer
Antibody Drug Conjugates (ADC)
Sacituzumab Govitecan is an antibody drug conjugate ( ADC) that was recently approved by the FDA for treatment of metastatic Triple Negative Breast Cancer. This ADC combines a potent chemotherapeutic agent with an antibody that is recognized by a unique cellular protein on the cancer cell that is not expressed on healthy cells, allowing this “smart bomb” to enter the cancer cell and kill it with minimal damage to healthy cells.
.Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer. N Engl J Medicine, Bardia A, Hurvitz SA, Tolaney SM, Loirat D, Punie K, Oliveira M, Brufsky A, Sardesai SD, Kalinsky K, Zelnak AB, Weaver R, Traina T, Dalenc F, Aftimos P, Lynce F, Diab S, Cortés J, O'Shaughnessy J, Diéras V, Ferrario C, Schmid P, Carey LA, Gianni L, Piccart MJ, Loibl S, Goldenberg DM, Hong Q, Olivo MS, Itri LM, Rugo HS, ASCENT Clinical Trial Investigators . PMID: 33882206.
A plain language summary of the ASCENT study: Sacituzumab Govitecan for metastatic triple-negative breast cancer.Bardia A, Hurvitz SA, Rugo HS, Brufsky A, Cortes J, Loibl S, Piccart M, Cowden J, Spears P, Carey LA.Future Oncol. 2021 Oct 1;17(30):3911-3924. doi: 10.2217/fon-2021-0868. Epub 2021 Sep 1.PMID: 34467774
Biomarker analyses in the phase III ASCENT study of sacituzumab govitecan versus chemotherapy in patients with metastatic triple-negative breast cancer. Ann Oncol. 2021 09; 32(9):1148-1156.Bardia A, Tolaney SM, Punie K, Loirat D, Oliveira M, Kalinsky K, Zelnak A, Aftimos P, Dalenc F, Sardesai S, Hamilton E, Sharma P, Recalde S, Gil EC, Traina T, O'Shaughnessy J, Cortes J, Tsai M, Vahdat L, Diéras V, Carey LA, Rugo HS, Goldenberg DM, Hong Q, Olivo M, Itri LM, Hurvitz SA. PMID: 34116144
Immunotherapy
An Overview of PARP Inhibitors for the Treatment of Breast Cancer. Target Oncol. 2021 05; 16(3):255-282. Cortesi L, Rugo HS, Jackisch C. PMID: 33710534.
Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of breast cancer. J Immunother Cancer. 2021 Aug; 9(8). Emens LA, Adams S, Cimino-Mathews A, Disis ML, Gatti-Mays ME, Ho AY, Kalinsky K, McArthur HL, Mittendorf EA, Nanda R, Page DB, Rugo HS, Rubin KM, Soliman H, Spears PA, Tolaney SM, Litton JK. PMID: 34389617.
Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer.Schmid P, Adams S, Rugo HS, Schneeweiss A, Barrios CH, Iwata H, Diéras V, Hegg R, Im SA, Shaw Wright G, Henschel V, Molinero L, Chui SY, Funke R, Husain A, Winer EP, Loi S, Emens LA; IMpassion130 Trial Investigators.N Engl J Med. 2018 Nov 29;379(22):2108-2121. doi: 10.1056/NEJMoa1809615. Epub 2018 Oct 20.PMID: 30345906 Clinical Trial
Selective Androgen Receptor Modulators: SARMS
.Selective androgen receptor modulators (SARMs) negatively regulate triple-negative breast cancer growth and epithelial:mesenchymal stem cell signaling.Narayanan R, Ahn S, Cheney MD, Yepuru M, Miller DD, Steiner MS, Dalton JT.PLoS One. 2014 Jul 29;9(7):e103202. doi: 10.1371/journal.pone.0103202. eCollection 2014.PMID: 25072326 Free PMC article.
.Development of selective androgen receptor modulators (SARMs). Narayanan R, Coss CC, Dalton JT.Mol Cell Endocrinol. 2018 Apr 15;465:134-142. doi: 10.1016/j.mce.2017.06.013. Epub 2017 Jun 15.PMID: 28624515 Free PMC article. Review.
A Phase II Clinical Trial of Pembrolizumab and Enobosarm in Patients with Androgen Receptor-Positive Metastatic Triple-Negative Breast Cancer.Yuan Y, Lee JS, Yost SE, Frankel PH, Ruel C, Egelston CA, Guo W, Gillece JD, Folkerts M, Reining L, Highlander SK, Robinson K, Padam S, Martinez N, Tang A, Schmolze D, Waisman J, Sedrak M, Lee PP, Mortimer J.Oncologist. 2021 Feb;26(2):99-e217. doi: 10.1002/onco.13583. Epub 2020 Nov 24.PMID: 33141975 Free PMC article. Clinical Trial.
Androgen Receptor: A Complex Therapeutic Target for Breast Cancer.Narayanan R, Dalton JT.Cancers (Basel). 2016 Dec 2;8(12):108. doi: 10.3390/cancers8120108.PMID: 27918430 Free PMC article. Review.
Scalp Cooling
Scalp Cooling
https://pubmed.ncbi.nlm.nih.gov/28196257/
Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. Rugo HS, Klein P, Melin SA, et al. JAMA. 2017;317(6):606–614. doi:10.1001
Mouthwash to Prevent Stomatitis
Hope S. Rugo, Lasikas Seneviratne, J. Thaddeus Beck, John A. Glaspy, Julio Antonio Peguero, Timothy J. Pluard, Navneet Dhillon, Leon C. Hwang, Chaitali Singh Nangia, Ingrid A. Mayer, Timothy F. Meiller, Mark Steven Chambers, Ghulam Warsi, Robert William Sweetman, J. Randy Sabo, and Jennifer Keating Litton
Journal of Clinical Oncology 2016 34:15_suppl, 525-525
Mentioned in this Series
The Future of Metastatic Breast Cancer Treatment Is Bright (HealthCentral, 2020) Simple summary of research updates / reasons for hope, by subtype
Sledge Jr. (2016) Curing Metastatic Breast Cancer
Susan G. Komen Breast Cancer Statistics
