In order to give patients with breast cancer the most cutting-edge treatments available, City of Hope continues to look to the future and pursue the most recent developments, led by Veronica Jones, M.D., the recently appointed chief of the Division of Breast Surgery in the Department of Surgery.
Doctors and surgeons at City of Hope are offering cutting-edge treatments that maximize survival and quality of life, from clinical trials of innovative immunotherapies for breast cancer that have progressed to the greatest surgical alternatives to help recreate the look and feel of a breast.
Modern therapies are being offered by the physicians and surgeons at City of Hope to maximize survival and quality of life.
“It is untrue to say that breast cancer always results in death. It’s a myth, according to assistant professor Jones. “We are able to prolong life and treat many cases of breast cancer. Furthermore, many breast cancers are treatable.
“Our surgical techniques, such as robotic mastectomies and ablative procedures, are becoming increasingly precise,” she added. “To reduce potential complications and side effects, we are also combining advances from novel imaging technologies and precision medicine with surgery.”
According to Jones, prevention should adopt the same individualized approach as treatment programs, which are now more customized than ever thanks to advancements in genetic testing.
According to her, the most crucial thing is to talk to your doctor about your specific risk factors and to schedule breast cancer screenings, including mammograms and/or magnetic resonance imaging, appropriately.
Screening guidelines differ. There is no one-size-fits-all approach to screening or therapy. The greatest suggestion is for each patient to address their unique risk in detail with their physician.
It is necessary to determine your degree of comfort and risk assessment; screening needs to be customized for each person.
Treatment of Breast Cancer using CAR T Cells
Chimeric antigen receptor (CAR) T cell therapy is a form of immunotherapy that was created on-site and is being used in a clinical trial led by physicians at City of Hope to treat patients with HER2-positive breast cancer that has progressed to the brain.
The Phase 1 experiment is being led by Jana Portnow, M.D., a professor in the Department of Medical Oncology & Therapeutics Research and co-director of the Brain Tumor Program.
Patients’ T cells are gathered for this experiment, and in a City of Hope facility, they are subsequently genetically altered to actively seek out and eliminate malignant cells.
To be more precise, the T cells are genetically modified to produce a CAR, which enables the immune system to recognize and destroy HER2-positive cancer cells.
“Our goal is to teach the immune system to eradicate cancer,” stated Portnow. “Cancer cells find a means of evading the immune system. T cells are the “soldiers” who can destroy cancer cells, as others have stated.
Funding is provided for patients’ hotel accommodations and transportation to City of Hope, Portnow continued. To take part in the trial, patients will have to spend roughly six weeks in City of Hope or close by.
A Phase 1, first-in-human trial is being conducted at City of Hope to examine the efficacy of blood cells modified to express an anti-HER2 chimeric antigen receptor in patients with solid tumors that overexpress HER2.
Patients with solid tumors that are metastatic or recurrent and for which there is no available treatment must be eligible to enroll in the trial.
CAR T cell therapy for patients with metastatic breast cancer is being investigated in a different Phase 1/2 experiment. Joanne Mortimer, M.D., head of the City of Hope Women’s Cancers Program, co-leader of the breast cancer program, and Baum Family Professor in Women’s Cancers, is leading both trials.
More Lifelike Tattoos of the Nipples
While surgically removing one or both breasts is a common and successful treatment for breast cancer patients, it can also have a detrimental effect on a woman’s perception of her body.
The areola and nipple are frequently removed during the treatment, which can significantly alter the breast’s look.
Modern surgical treatments that assist restore the appearance and feel of the breast are provided by City of Hope to help mastectomy victims regain their self-image and confidence.
City of Hope plastic surgeons are now providing 3D nipple areolar complex tattooing, a reconstructive treatment that restores a more natural appearance to patients whose nipple and areola were removed after a mastectomy.
Although 3D nipple areolar tattoos are not truly three-dimensional, this cutting-edge surgical method employs a variety of nontoxic ink tones and skilled procedures based on an awareness of skin tone, shadows, and highlights to give the nipple and areola a more realistic appearance.
Following nipple repair, concentric circles were usually created on the breast using just one or two colors in previous nipple tattooing techniques. In addition to being more realistic, 3D nipple tattoos don’t require further reconstructive surgery.
A few years back, a few extremely talented tattoo artists created three-dimensional-looking nipple tattoos.
Hence, that implies not having surgery but rather getting a tattoo — albeit a complicated one to make it appear as though something is there, according to Wai-Yee Li, M.D., Ph.D., an associate clinical professor in the plastic surgery division at City of Hope.
Improved Surgical Methods for Breast Cancer
Li also specializes in reconstructing latissimus dorsi flaps for mastectomy patients who are not candidates for implants after radiation treatment.
In order to create a reconstructed breast, a piece of the patient’s back’s skin, fat, and muscle are removed.
Unlike another widely used surgery that involves transplanting stomach fat into the chest cavity, this method does not divide blood arteries, thus the dangers are reduced, the recovery period is shortened, and the recovery time is faster.
The latissimus dorsi flap gained a lot of popularity in the 1970s and even into the 1980s, but free tissue transfer gained popularity as operating microscopes improved.
In a free tissue transfer procedure, the abdominal tissue is removed, the blood vessels are cut, and the vessels in the chest wall are then rejoined.
Compared to the latissimus flap, that method of breast restoration has been far more common, according to Li.
By comparison, the latissimus flap technique has the advantage of just moving the blood vessel into place as opposed to cutting it.
According to Li, this implies that there is a lower possibility of blood supply loss, which could result in tissue death.
Apart from honing the technique and bringing the latissimus flap back, Li is also conducting clinical research aimed at enhancing the post-operative pain management protocol of the surgery.
In just one day following latissimus flap surgery, patients are able to return home thanks to the use of a long-acting local anesthetic that blocks the nerves in the front and back of the chest.
Chemotherapy to be Replaced with a Shot
Herceptin and Perjeta, two immune targeted therapy medications, is the first-line treatment for individuals with metastatic HER2-positive breast cancer.
When used in conjunction with chemotherapy, this medication combination is quite successful when administered intravenously (IV), however the procedure can take up to 2.5 hours.
Patient Jennifer Pio has nothing but good things to say about Phego, which she uses instead of the customary Herceptin/Perjeta infusion.
“The shot takes five minutes, and my normal infusion took about an hour and a half,” she states. “I love the time savings in the chair and how quickly I am in and out of the infusion room for my visit. Being able to get my port removed was a bonus for me because it was extremely unpleasant and a daily reminder of my condition.
Treatments for Breast Cancer: A Forward Look
When Jones looks to the future of City of Hope’s breast cancer program, she is excited about what she sees ahead, including the new surgical methods and treatment possibilities.
“In order to address side effects and minimize discomfort, we are bringing integrative oncology to the breast cancer space,” the spokesperson stated. “We’re updating our procedures to use new, more accurate imaging technologies.
In an effort to improve breast cancer care globally, we are revolutionizing oncology and growing not only domestically with our new locations in Atlanta, Phoenix, and Chicago but also internationally.
Research on health care disparities is becoming more and more prevalent. One such study I worked on examined the potential genetic differences that could lead to differing outcomes for Black and White breast cancer patients.
I have a strong interest in how different populations respond to therapy and how that changes. Moving future, innovation and health equity will receive a lot more attention. Our objectives are innovation, equity, and quality of life.
However, what strikes me the most is her relationship with her patients.
“That relationship with patients—realizing that we’re all in this together and that they want us to succeed as much as we do—and spending time with them and conversing with them,” she says.
It gives me inspiration to know that I’m not doing this alone and that there are individuals who depend on me to keep moving forward. My ties with my patients are excellent. It’s their presence that gives me strength.
