By Patrick Hwu, M.D. - October 11, 2021
Approximately 1 in 8 U.S. women (about 13%) will develop invasive breast cancer over the course of her lifetime. Early detection is key and October is National Breast Cancer Awareness Month, an opportunity every year to share more about the disease.
Hwu: Brian, tell me about what’s going on recently with breast cancer therapeutics. There’s different kinds of breast cancer, right? The therapies are changing rapidly.
Czerniecki: The most common type is the hormone receptor or estrogen receptor-positive group, which accounts for about 75% of breast cancers. In that field, the most exciting changes have been these CDK, or what we call cyclin, inhibitors that are added with antiestrogen therapies. They’ve dramatically improved survival in patients with metastatic hormone receptor-positive breast cancer in the order of months to years.
In the HER2 field, the antibodies and the targeted therapies against HER2, the molecule that causes the growth of those cells, has dramatically improved. This tumor used to be one of the worst survivals in breast cancer period, and today is one of the better.
Hwu: Tell us about your dendritic cell vaccine. I know you’ve been working very hard on that.
Czerniecki: The dendritic cell vaccine is a hybrid. It’s a cross between a vaccine and a cell therapy. We can use it as a vaccine by just giving either peptides or little portions of tumor antigens to it and they can be injected into the body. These cells are little factories and they make other little molecules that activate other parts of the immune system. What we’ve found is, by injecting them into the tumor itself, we unlock a whole set of other immune parameters that gets activated. Currently, we’re injecting HER2 pulsed dendritic cells made from the patient back into their breast tumor before chemotherapy. It drives a wild immune response in the breast and helps the Herceptin and Perjeta antibodies actually create more complete responses.
Hwu: There’s been a lot about T cell therapy and CAR T cells against lymphomas. Do you see that a CAR T could be developed against breast cancer?
Czerniecki: I think the potential will be, once we identify some of these antibodies against some of these mutated proteins, it may be possible to create CAR T cells.
Hwu: If someone wants to get on one of your clinical trials, are they open right now, and which patients are you enrolling right now in your clinic?
Czerniecki: We’re currently enrolling for HER2, and then we have three others that just opened in September. One of these trials will be for HER2, one for triple-negative, and then right behind it, we have one that’s for brain metastasis and CNS, or what we call leptomeningeal disease.
Hwu: When should women start screening? What kinds of screenings should they get?
Czerniecki: For screening, we actually personalize that at Moffitt based on risk. If you’re an average risk woman, you should start getting mammograms at age 40, and either yearly or every other year. For those that are found to be at higher risk, there’s also additional screening that can be done, either with ultrasound or MRI. There are ample screening tools available to women, and I encourage all to get screened.