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Breast Cancer Breakthroughs Episode 9 – New Frontiers in Early ER-Positive Breast Cancer 

Researchers are exploring new frontiers in early estrogen receptor-positive (ER+) breast cancer to improve outcomes and quality of life for patients. People with early ER+ breast cancer often see favorable outcomes from their treatment, but once treatment is done, many face the fear of not knowing if their cancer will come back. This risk of the cancer returning, or recurrence, is different for every person because every tumor is unique. Many patients with early ER+ breast cancer face a dilemma – side effects is worth having to ensure the cancer doesn’t return?  

In this episode of Breast Cancer Breakthroughs, we speak with emergency medicine doctor and breast cancer survivor Tracy Cushing about the importance of education and self-advocacy to identify the best treatment options for each individual. We also learn more from Dr. Sara Tolaney, medical oncologist at Dana Farber Cancer Institute and Dr. Aditya Bardia, medical oncologist at UCLA about the latest developments in research that aim to prevent recurrence for patients with early ER+ breast cancer. 

Making Personal Decisions  

When Tracy Cushing first learned a small lump in her breast was ER+ invasive lobular carcinoma (ILC), she knew immediately that she wanted a double mastectomy. “I just wanted to get my life back with one-and-done surgery, and I was happy with that,” Tracy says.  

Even though her healthcare team pushed back, Tracy eventually got the surgery she asked for. To further reduce her risk of recurrence, her doctor recommended surgical menopause, or surgical removal of her ovaries, and an aromatase inhibitor (AI) instead of chemotherapy.  

Since chemotherapy wasn’t recommended for her cancer, Tracy began to research other treatment options. “I just really wanted to make it my business to know everything I could about this disease so that I could advocate for myself,” she explains. 

Tracy approached her doctor about a potential new treatment for early ER+ breast cancer called a CDK4/6 inhibitor, which is designed to interrupt the growth of cancer cells. Even though CDK4/6 inhibitors weren’t available at that time for patients with early ER+ breast cancer, she had read promising results about these new drugs from the monarchE clinical trial.  

New Strategies for Treating Early ER+ Breast Cancer 

CDK4/6 inhibitors are just one of several new types of drugs that researchers are investigating for treatment of early ER+ breast cancer. Through studies like the monarchE trial and the NATALEE trial, patients like Tracy are seeing promising results from a combined treatment of CDK4/6 inhibitors and hormone therapies.   

In the monarchE trial, researchers found ER+ patients who were given a treatment of hormone therapy plus a CDK4/6 inhibitor called abemeciclib had about one third fewer recurrences than those who had hormone therapy only. In the NATALEE trial, another treatment pairing of a CDK4/6 inhibitor called ribociclib plus a hormone therapy, is already showing a 25% reduction in risk of recurrence for patients with early ER+ breast cancer, when compared to hormone therapy alone. 

Other drugs that are being studied for their potential to prevent recurrence include oral selective estrogen receptor degraders (SERDs), which “chew up” the estrogen receptor in cancer cells, and immunotherapies, which stimulate the body’s own immune system to kill the cancer cells.  

While researchers are excited about how these drugs have performed in early studies, they also acknowledge more data is needed to determine how effective they will be across diverse groups of patients. 

“I think the challenge has been picking out those patients who are at higher risk of recurrence, and can we figure out from the biology of the cancers which patients are those who are going to have their cancer potentially recur, and how can we prevent that.” Dr. Tolaney says. 

The Power of Self-Advocacy 

The risk of recurrence and progression to metastatic breast cancer is a source of fear and uncertainty for many patients. As Tracy explains, there is a theoretical question many patients face – how much of a treatment and/or side effects are worth having to ensure the cancer doesn’t come back? This is a very personal decision, and one that often requires additional research and self-advocacy.  

“A lot of women opt not to take hormone blockers sometimes because they feel the side effects are not worth it,” Tracy says. “Personally, for me, I’ll do just about anything to prevent my cancer from coming back.” 

To determine the best treatment options with your doctor, Tracy recommends talking to other patients, talking to advocates, knowing the right questions to ask and being as informed as possible.  

“I would rather live to a ripe old age and die of something other than breast cancer, if possible,” she says. “If I make it to my 80s and I look back and I never have to deal with breast cancer again, I will be completely happy that I did all the things, including a CDK4/6 inhibitor, AIs and surgery – all the things.”  

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