One key question in the breast cancer field today is: Do all patients need an aggressive combination of surgery, radiation and chemotherapy to treat their breast cancer? In the past, most patients were given “one-size-fits-all” treatments that included multiple rounds of chemotherapy, invasive surgeries and radiation. Today, researchers are exploring better options for patients through treatment de-escalation – an approach that offers tailored treatments to patients while providing them with the best quality of life possible.
In this episode of Susan G. Komen’s Breast Cancer Breakthroughs series, Susan G. Komen® Senior Vice President of Mission Victoria Smart joins Dr. Antonio Wolff, a medical oncologist at Johns Hopkins University, and Dr. Daniel Stover, a medical oncologist at The James Cancer Center at the Ohio State University, to discuss new possibilities for breast cancer patients through treatment de-escalation.
Komen Advocate in Science, Janice Cowden, has experienced the benefits of chemotherapy de-escalation firsthand during her own treatment for metastatic triple negative breast cancer.
“I suffered significant side effects that were debilitating, such as mouth sores, nausea, vomiting, GI side effects, an outbreak of cold sores and was eventually diagnosed with severe thrush,” Janice said. “As a result, I was unable to tolerate foods or fluids, and I became dehydrated.”
Janice and her doctor decided to reduce the next round of doses, and this helped her return to her original treatment plan.
Dr. Wolff and Dr. Stover also share recent advances in research that give patients like Janice the option to safely reduce or even eliminate chemotherapy altogether. The recent APT trial showed that treatment de-escalation could benefit HER2-positive patients.
“What we are learning today is that after 10 years of follow-up, the vast majority of patients – approaching 98% – are alive without issues,” Dr. Wolff said. “That is a dramatic improvement in what we have done and achieved so far.”
For some patients, the benefits of treatment de-escalation are not limited to chemotherapy and extend to surgery and radiation therapy as well. With new developments in surgical de-escalation, researchers are offering breast-conserving surgery or limiting the number of lymph nodes removed during surgery for patients who would historically be offered more invasive procedures.
“I think that trying to right size the amount of surgery – not only in the breast – but also for the lymph nodes, is something that could improve long-term outcomes for our patients in terms of the potential side effects from those surgical procedures,” Dr. Stover said.
These recent breakthroughs illustrate how treatment de-escalation can bring a perfect balance between treatment outcomes and quality of life for patients.
“We are really moving into what many would call the ‘Goldilocks’ era of oncology care,” Dr. Wolff said. “It’s the right temperature – not too hot, not too cold. The term de-escalation may imply that we are taking something away from people. In reality, what we are doing at the end of the day is optimization, and it falls into trying to give the right treatment for the right patient at the right time.”
Through precision medicine (or personalized medicine), doctors are identifying the right patients for treatment de-escalation and developing personalized treatment plans. Treatment de-escalation is only an option for patients who meet specific criteria, as other patients might still need more treatments to ensure optimal outcomes. Those who do meet the criteria may benefit from reduced side effects, less time spent at clinics, shorter recovery time from surgeries, and less financial burden from the cost of treatment. Treatment de-escalation also helps patients stay on their treatments longer by minimizing the risk of side effects.
Building upon her own treatment experiences, Janice is a passionate advocate for seeing more advances for patients in the realm of treatment de-escalation.
“All of this is very exciting for patients as we move towards personalized medicine, putting quality of life as a priority along with efficacy of therapies,” said Janice. “Patients not only want to live as long as possible; they want to live the best quality of life possible.”
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