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Old 02-14-2013, 01:54 PM   #6
Joan M
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Re: Tumor Profiling Lab Tests

A mutated tp53 is common in cancer in general.

On Tuesday, I asked my oncologist whether patients could be tested for chemosensitivity, and he said, no. Then he mentioned that Precision Therapeutics has such tests and lung cancer oncs seem to go for this type of testing. I think that his "no" probably meant that the tests are not clinically relevant yet. Perhaps that's what "unethical" means in this context: that patients are being charged for a test that really has no clinical use. Or perhaps worse than that: the tests are bogus because the answer is not that simple.

Chemosensitivity tests would be great. Think of how such tests would save patients from having to deal with the side effects of chemo that isn't going to work for them.

One potential way to determine chemosensitivity is through neoadjuvant trials, and I believe that we'll be seeing more of these in the future. Most survivors do not obtain a complete pathologic response in such trials, and residual breast tumors could be used further to determine why not (neoadjuvant chemo is giving it before breast surgery) . These studies are very useful for studying aggressive bc, such as HER2 and triple negative. If a TNBC enrollee achieves cPR, they have a much greater chance of beating bc. Such patients do not yet have supplemental treatments like we do. Here's a 2-minute clip from SABC about testing residual tumors of TNBC patients. I attended Balko's presentation at the conference:

http://www.onclive.com/conference-co...ations-in-TNBC

An mTOR inhibitor might well be the next best place to go regardless of testing. It's being actively studied in bc. There's a phase 1 clinical trial (Merrimack Pharmaceuticals) for HER2+ metastatic survivors, which uses the compound MM-302. An mTOR inhibitor (I think Chrisy was in that trial).

http://clinicaltrials.gov/ct2/show/N...=mm-302&rank=1

According to clinicaltrials.gov, there doesn't seem to be a diagnostic test to indicate whether a survivor is likely to respond to MM-302.

Affinitor is another mTOR inhibitor for women with metastatic ER+/PR+/HER2 negative bc. It's used in combination with Aromasin for postmenopausal women who progressed on an endocrine drug (Bolero2 trial). The drug was recently FDA approved for advanced bc.


I gave my lung and brain nodules over to research and stay in contact with those folks (my brain tumor was HER2 negative). I recently had an email exchange with Sloan. They have a piece of my lung nodule, which was removed by NY Presbyterian/Weill Cornell. They're studying why patients who took Herceptin adjuvantly turned out to be refractory to it. I took it off-label when I was diagnosed with stage 2 in 2003. (I emailed to kindly remind the scientist that, FYI, I've been NED since January 2007 and on only Herceptin since my cancer advanced. So perhaps they need to rethink their refractory concept.) Sloan removed my brain nodule. They aren't doing anything with it yet, but I had a piece sent to Standford U for a study.

Joan
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Diagnosed stage 2b in July 2003 (2.3 cm, HER2+, ER-/PR-, 7+ nodes). Treated with mastectomy (with immediate DIEP flap reconstruction), AC + T/Herceptin (off label). Cancer advanced to lung in Jan. 2007 (1 cm nodule). Started Herceptin every 3 weeks. Lung wedge resection April 2007. Cancer recurred in lung April 2008. RFA of lung in August 2008. 2nd annual brain MRI in Oct. 2008 discovered 2.6 cm cystic tumor in left frontal lobe. Craniotomy Oct. 2008 (ER-/PR-/HER2-) followed by targeted radiation (IMRT). Coughing up blood Feb. 2009. Thoractomy July 2009 to cut out fungal ball of common soil fungus (aspergillus) that grew in the RFA cavity (most likely inhaled while gardening). No cancer, only fungus. Removal of tiny melanoma from upper left arm, plus sentinel lymph node biopsy in Feb. 2016. Guardant Health liquid biopsy in Feb. 2016 showed mutations in 4 subtypes of TP53. Repeat of Guardant Health biopsy in Jana. 2021 showed 3 TP53 mutations, BRCA1 mutation and CHEK2 mutation. Invitae genetic testing showed negative for all of these. Living with MBC since 2007. Stopped Herceptin Hylecta (injection) treatment in March 2020. Recent 2021 annual CT of chest, abdomen and pelvis and annual brain MRI showed NED. Praying for NED forever!!

Last edited by Joan M; 02-14-2013 at 01:58 PM..
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