Read Video Transcript
00:00:00:00 – 00:00:36:19
Unknown
Hello, everyone. Welcome to this SHARE MBC Matters Meet Up video presentation titled Understanding Liquid Biopsies and Biomarkers. Today we’re diving into the fascinating worlds of biomarkers and liquid biopsy. In metastatic breast cancer or MBC. These advancements are transforming how we diagnose and treat MBC, offering new hope and precision in patient care. I’m Katie Fetzer, the metastatic breast cancer program director at Share.
00:00:36:21 – 00:01:01:16
Unknown
And I’m Victoria Goldberg, one of the producers of the podcast Our MBC Life. This program is brought to you by Share, a national nonprofit that supports, educates and empowers anyone who has been diagnosed with breast or gynecological cancers and provides outreach to the general public about signs and symptoms. Now, I’d like to hand it over to Dr. Heather Parsons to introduce herself.
00:01:01:18 – 00:01:27:03
Unknown
Thank you so much, Kate and Victoria, for the invitation to talk here today. I am Heather Parsons. I am a medical oncologist at Dana-Farber in Boston and an assistant professor of medicine at Harvard Medical School. And I care for patients with breast cancer. And in my non-clinical time, I do research in the field of liquid biopsy. So we’re going to start off by just talking about biomarkers writ large.
00:01:27:03 – 00:01:55:28
Unknown
So what is the biomarker? It really can be almost anything that can tell us something about a patient’s cancer. In the case of metastatic breast cancer and the ones we most commonly face can come from tissue. It can come from imaging, it could come from blood or urine. But in the case of liquid biopsy, we think about circulating tumor DNA as well as seeds or circulating tumor cells.
00:01:56:01 – 00:02:36:03
Unknown
The biomarker helps us to guide somebody’s therapy to help understand their disease. And some of the most common biomarkers that we think about in breast cancer are the three biomarkers you may have heard about with your diagnosis of metastatic breast cancer. So estrogen receptor progesterone receptor or E, R and PR, and then HER2. And those are really critical biomarkers that comes from the tissue, from the tumor tissue, and tell us whether somebody’s cancer is likely to be responsive to treatments that attack the estrogen receptor pathway or in the case of her, to the HER2 pathway.
00:02:36:05 – 00:02:58:23
Unknown
We get excited about new technologies and new things, but those are critical for patients to understand and critical for the care of breast cancer and metastatic breast cancer, specifically. And so you may hear your doctor talking about those things. And if you haven’t heard your doctor talking about those things, it’s important to ask those. Those are things that every patient should be able to know about their breast cancer.
00:02:58:25 – 00:03:24:20
Unknown
We also think sometimes about molecular subtypes in breast cancer, and those are more commonly talked about in early stage breast cancer or related to research. So they’re not commonly talked about in metastatic breast cancer or as it relates to treating some of these cancer. The other area that we think about, a newer area of biomarker testing is next generation sequencing or NGF.
00:03:24:22 – 00:03:51:03
Unknown
This is something that is looking at the genes that are specifically changed in someone’s cancer. The first way that we use NGF or induction sequencing is typically on the tumor tissue that’s been removed from the body, either from a biopsy or from a surgery. And we can take that tissue and isolate the DNA, take the DNA out. DNA is the instructions to the cell on how to behave and what to do.
00:03:51:06 – 00:04:17:11
Unknown
And we can look for specific changes in the cancer to be in the DNA from the cancer. And those changes can sometimes help us understand how to better treat a person with metastatic breast cancer. So, for example, we might find a PIK three CA mutation or sometimes called a three kinase mutation, and that might help us know that we could use a specific type of drug for a patient’s cancer that was likely to be effective.
00:04:17:19 – 00:04:43:08
Unknown
Another common one that can be identified from testing is ESR one. And similarly can guide our therapies or which therapies we shouldn’t use in metastatic breast cancer. The other place we can use NGS testing, which is newer and is a been the focus more of my research is in liquid biopsy. So it’s very similar idea to what we do with a tissue biopsy.
00:04:43:10 – 00:05:02:27
Unknown
But we know that the DNA from the tumor cells gets out into circulation and because of that, we can isolate those tiny pieces of DNA coming from the tumor and then look for whether there are changes in the cancer that we can find in the DNA, in the blood that can help us guide therapy in a similar way.
00:05:03:00 – 00:05:31:12
Unknown
And so we can look for ESR one mutations or PIK three mutations. We’re often finding new mutations or changes that we can address and target to better treat someone’s cancer. If you are someone who is living with metastatic breast cancer, biomarker testing should be an integral part of your treatment. Those first primary biomarkers are PR and her too, which are an essential part of the initial diagnosis of metastatic breast cancer.
00:05:31:15 – 00:05:54:03
Unknown
But not just those tests. We also know that there are therapies that are guided by biomarker testing, and so we like to do biomarker testing. At the beginning, when somebody is initially diagnosed with metastatic breast cancer. We like to do it repeatedly so that we can look for additional mutations that may have come up or evolved while someone’s been on treatment for cancer.
00:05:54:06 – 00:06:22:03
Unknown
And so those are really important parts. So I want to last we speak about something that doesn’t always fall under the category of biomarkers, but it really is is the importance of having germline genetic testing for someone with metastatic breast cancer. Germline genetic testing is looking at the genes that are in our cells and every one of our cells in our body that we’ve inherited from our mother and our father or biological parents.
00:06:22:06 – 00:06:41:05
Unknown
And we can inherit genes that can lead us to be more likely to develop breast cancer. It’s not just that cause that’s interesting, certainly. But if we already know someone who has breast cancer, some people would ask, Why should I do that test? And the reason to do it is both for your own care as well as for potentially for your other family members.
00:06:41:12 – 00:06:59:29
Unknown
So in the case of your own care, there are medications that can be very effective for people who have specific changes in their genes, their inherited genes. So that’s why it’s really critical for everyone with metastatic breast cancer to be tested with germline genetic testing. You can also pass down those genes to your children should you have them.
00:07:00:01 – 00:07:19:28
Unknown
Also, your your brothers and sisters would and your parents might be people who want to know about their genes as well. So you can also not just help yourself, but help your family members too. So I think I’ll stop there and I’m looking forward to discussions with Kate and Victoria about biomarkers in general. Thank you so much. That was so informative.
00:07:19:29 – 00:07:47:09
Unknown
We’re so grateful to have you here. You were talking about having a liquid biopsy done at the beginning and then repeatedly. How often should we be undergoing these liquid biopsies? Do you use it to monitor as well? Yeah, So that’s a great and important question. I like to get the liquid biopsy test done at the time of diagnosis, when it can help gather the most information about some of these cancer and again, potentially to help guide treatment.
00:07:47:12 – 00:08:11:16
Unknown
We can learn about things such as, as I said. ESR one mutations. PIK three S.A. or two mutations and some others. We can learn about something called TMB or Tumor mutational burden, which can help us. It’s rare, but it can help us also potentially guide therapies as well as microsatellite instability, which is also rare in breast cancer, but could be helpful if we identify it.
00:08:11:19 – 00:08:37:11
Unknown
So that’s at the time of diagnosis. I typically don’t check liquid biopsy when somebody’s cancer is very well-controlled because of two things. One is I’m not going to do anything differently with that information. So it might be not very helpful or a waste of resources. And second, we know that when somebody’s cancer is well controlled on a therapy, they’re much less likely to have detectable CTDNA or circulating tumor DNA.
00:08:37:18 – 00:08:57:12
Unknown
And so we might do the test, find that it’s negative. There’s not a result that it can tell us about, which we might wrongly assume that some thing that we’re looking for isn’t there. But it’s really just that the levels are so low that the test isn’t able to detect it. But at the time of progression, that’s the time when we we think about testing again.
00:08:57:12 – 00:09:20:24
Unknown
So it’s not that you have to check every single time. But if I am wondering whether there’s one of the therapies that we know about could be useful in that situation, I would get another test, a liquid biopsy to help guide therapy, and those tests come back pretty quickly so you can do it and not feel like you’re waiting for many weeks before you get to use that information to guide treatment.
00:09:20:26 – 00:09:52:25
Unknown
Are there any limitations or challenges associated with a liquid biopsy? There’s a couple big challenges. The one that comes up most often is that what does a negative test mean? I think this is the one that keeps people up most often. Again, the level of the DNA or circulating tumor DNA can be so low even in people with active cancer that the test that we typically use in metastatic breast cancer, these tests aren’t able to detect the even if the circulating tumor DNA is there.
00:09:52:28 – 00:10:15:00
Unknown
So that’s the big challenge. We don’t want to assume that something’s not there because it doesn’t come up on the test. Some of the more common tests are now starting to report something called tumor fraction, which tells you if there is any DNA present. So they can not just tell you whether there’s a mutation present, like an alteration you might seek to to guide your therapy.
00:10:15:05 – 00:10:35:16
Unknown
But any kind of sitting almost like a ctdna level. And then the second thing that comes up most commonly and is is a real problem is something called chipped or not a matter process. We’ve done some some work on this and there’s a lot of work ongoing, but no amount of pieces is a change in the normal white blood cells in your body.
00:10:35:22 – 00:11:07:17
Unknown
There are mutations that happen in a few cells. They’re not cancer, but they are common, especially as we age. So many people develop out that a process and very, very rarely can then go on to develop blood cancer. But most people walk around without knowing and without needing to know that they have gone on that list. The trouble is, is that when we do sequencing from the blood, we can pick up those alterations or mutations from the clonal matter places and think that they’re coming from the cancer.
00:11:07:24 – 00:11:31:17
Unknown
So if we saw, for example, a BRCA two mutation that’s coming from the actually coming from the amount of process we might think that’s coming from the cancer, we might wrongly treat that person as somebody who has a BRCA mutation that’s coming from the cancer and it’s not. And that could result in certainly not controlling the cancer because of that change.
00:11:31:24 – 00:11:59:01
Unknown
Again, that these are because of the progression of and a rapid uptake of liquid biopsy tests. This is very well known in the field that reports to doctors and patients are starting to note that on the test report at the top there typically report the alteration, even if they think it’s coming from CHIP, but then down lower. They’ll say specifically that this is probably not coming from the cancer, but is probably coming from the blood.
00:11:59:03 – 00:12:21:18
Unknown
So that’s the other big thing. And one other piece is that you asked a little bit about levels of the CTDNA and whether we should be checking them. So we hope that will be a useful test so that you might think of being able to track the level of ctDNA in somebody’s blood rather than needing to do scans frequently.
00:12:21:20 – 00:12:42:28
Unknown
Right now I would recommend against that because there are a lot of data that say that it does seem to track with higher ctdna but more cancer and lower levels with ctdna, with less cancer. But the direct sort of correlation between what we should when there’s the level bad, that’s a really important thing to know. And we don’t know that yet.
00:12:42:29 – 00:13:01:28
Unknown
So there’s a lot of work going on on that and I am very hopeful and expect that we’ll be able to use it soon, but not quite yet. Thank you. I actually want to ask a really basic question. So when you do some reading on circulating tumor DNA, you also come across something that’s called super cell free DNA.
00:13:02:01 – 00:13:25:12
Unknown
Is there a difference? And if there is, what is it? Yeah. So all of our cells in our body, the white blood cells, the cancer cells, they all give off these little pieces of DNA. And those little pieces of DNA in the blood are called cell free DNA. And we can most of the cell free DNA we find is actually coming from white blood cells.
00:13:25:12 – 00:13:54:24
Unknown
It’s not coming from the cancer. That was the big challenge initially, was seeing if we could sort out which is which. And there are some things like how big the fragments are and some other information that we can gather from the different kinds of cell free DNA or circulating tumor DNA. But I would think really sick of circulating tumor DNA or see DNA as a subset, a little group within cell free DNA, where, again, most of it’s coming from normal cells.
00:13:54:27 – 00:14:21:09
Unknown
Wow. So you mentioned Brucker just a second ago. Bracket is a germline mutation. And we everybody who has breast cancer has heard of it and knows about it. But we also know that could be a somatic mutation. Yeah, that’s something you will find by doing next generation sequencing. Right. So could you explain a little bit of the difference and how that works?
00:14:21:11 – 00:14:43:05
Unknown
Yeah. So you used the word somatic, which is a really important word. We think of germline genetics, meaning Gene, that you inherited from your parents and somatic genetics or somatic genes are the genes specifically in the cancer. And we differentiate them because the cancers develop changes in the genes. And so these are important targets that we can use.
00:14:43:05 – 00:15:07:23
Unknown
Then that’s what somatic to anything coming from the cancer. Specifically when we test germline genetics, it’s not a very large proportion of patients who will have bracket two or BRCA1 mutations that they’ve inherited. But as cancers evolve and change, they can develop these changes, The somatic changes in their in the cancer gene specifically that can lead them to be able to better grow and change.
00:15:07:23 – 00:15:32:24
Unknown
And so we do see, especially as cancers are around for a longer time as people are living for a longer time with metastatic breast cancer. And we’re testing for these genes that we see these these breakout one and two alterations that are coming from the tumor, not from the germline. We’ve seen in a recent study that we can use that information and then use the same drugs.
00:15:32:24 – 00:15:55:18
Unknown
These what are called PARP inhibitors to treat somebody with a somatic BRCA one or two mutation and it can be really effective. The other place where those can come from much more rarely is from the clinical mattapoisett. So it’s really tricky to figure out and we have to make sure that we know sort of where that’s coming from before we go using it as a target for therapy.
00:15:55:20 – 00:16:36:17
Unknown
But if it is real, it’s a really important and helpful target. And what about mutations in HER2? There is such a thing as well, right? And what does that entail? Yeah, Yeah. So HER2 and when we think of PR and her to that her two piece of breast cancers and about 15% of them being usually what we call amplified the way that a HER2 positive cancer happens is that the body or some cell in the body makes many, many copies of the HER2 gene and because of that the her too is sort of telling the cell to grow, grow, grow, grow, grow that leads to a HER2 positive breast cancer.
00:16:36:24 – 00:17:12:12
Unknown
But there’s another way that the HER2 gene can be changed, and that’s by a mutation, a change in the code. So instead of multiple copies of the gene, the gene has an error that it develops and that error also helps the cancer to grow, grow, grow. We can see them in HER2 positive breast cancer. So when we can see somebody who has both a code change and the genes or HER2 mutation as well as a HER2 amplification, and we can also see those two mutations in other cancers more commonly in hormone receptor positive or positive breast cancer.
00:17:12:15 – 00:17:40:08
Unknown
So it’s another one that we look for when we’re and we can actually use that as a guide to therapy. So there are medications, the one that has been studied most is something called neratinib, which can be used to target cancers with patients who have those HER2 mutations and it can work quite well. Thank you so much. So also these HER2 mutations, they would be considered more often than not HER2 negative right?
00:17:40:08 – 00:18:07:16
Unknown
Not her. Correct and not HER2 positive, but actually HER2 negative. And somebody could actually have a HER2 low cancer that also has a HER2 mutation. So that it’s confusing because the and the drugs we use might be a little bit different. So it’s not like a person with a HER2 mutation say great, I can take in HER2 now or I can take whatever other positive drug, correct.
00:18:07:16 – 00:18:32:17
Unknown
Yes. So that’s the HER2. When we think of her too low that’s actually measuring the protein amount in the cell which is related to those copies. So there’s somebody with the multiple copies of her two protein might have not have quite enough to have HER2 positive breast cancer, but may have enough that they might be called for too low, which is only really become important with the use of HER2.
00:18:32:17 – 00:19:06:23
Unknown
That trastuzumab directly can, which has been shown to be effective in cancer is not just in HER2 positive or the ones with the amplifications, but in the HER2 both cancers too, and now in the ultra low or no. Like everyone. Yes, we’re hearing a lot of patients talking about liquid biopsies and talking about eating too many and using that frequently along with scans and they’re having the negative liquid biopsy, negative ctdna, and then the scans are really good and they’ve been need for a long time now.
00:19:06:23 – 00:19:27:19
Unknown
A lot of patients are questioning, you know, what can we do with that information? Is it really useful at this point? So I’m hopeful and we’ll I think we’re going to talk a little bit about a study that we’re doing to sort of get at that a little bit. But right now, I would say I would be hesitant to use that information with a few caveats.
00:19:27:21 – 00:19:49:01
Unknown
So we know that, again, I mentioned that there can be levels of ctDNA that are low but are present so they can be below the level of detection of the test, but still there. And most of the tests that we use in metastatic breast cancer are tests that are the sensitivity is not the intention of it to be a super sensitive test.
00:19:49:01 – 00:20:28:27
Unknown
The intention is to to identify these changes in the cancer, to be able to guide therapy. If somebody says my scans are clean and I have no ctdna by this test, what should I do? I wouldn’t use that test to make any kind of decisions. The place where we hope that it’ll be helpful is what we sometimes people call them ultrasensitive CTDNA tests or MRI tests, which is we don’t usually talk about it in metastatic breast cancer, but in early stage breast cancer, meaning minimal residual disease or the tiniest bit of cancer present that can be detected but can’t be detected on a scan is how I might think about it.
00:20:29:00 – 00:20:49:18
Unknown
And so if I were really focused on doing that test, I would use one of those tests instead of the conventional next generation sequencing test. That said, we don’t know whether that’s really going to be an effective way to identify who should maybe stop their treatment. We don’t have any data to say if that’s the right thing to do.
00:20:49:18 – 00:21:08:22
Unknown
I’m not advocating for that. I hope that we’ll be able to use those tests soon in that way. But not not quite yet. But if somebody is having a lot of toxicity or there’s another reason why they really can’t stay on the treatment that’s been working, it could be one helpful tool to help understand the whole picture of what’s going on.
00:21:08:24 – 00:21:28:20
Unknown
That’s so interesting. I have heard about that in the early stage and was wondering about that. And there’s a lot of us that have been on treatment for a very, very long time and that so that is a concern. We’ve been on seven, eight, nine, ten years on the same treatment need for a very, very long time. Do we ever see that the science is going to catch up?
00:21:28:20 – 00:21:54:18
Unknown
Do we think we’ll ever get to that point? We know that a long time ago. So now, about more than 20 years ago, there were a lot of attempts using actually bone marrow transplants, so very high doses of chemotherapy to hopefully eradicate metastatic breast cancer. And unfortunately, those didn’t work. People had all the toxicity and did not have significant benefit from having that very high dose chemotherapy.
00:21:54:18 – 00:22:34:26
Unknown
So with that and some other studies that happened around the same time, we really have treated cancer that’s metastatic as something we worked troll for a long time but can’t get rid of completely. We are in a different time. We have much more effective therapies. We also have these ultrasensitive diagnostic tools that could, I think paired with those very effective therapies potentially will help us understand whether we really are getting rid of metastatic breast cancer or at the very least controlling it so well that somebody could take a long break from their treatment rather than needing to continue on it for their entire lives without a break.
00:22:34:28 – 00:22:55:23
Unknown
And and we actually are trying to test that right now. So we know that HER2 positive breast cancer we were talking about a little bit before is is a breast cancer that without treatment grows very, very rapidly and is very, very dangerous and spreads very quickly and can become lethal. But we have highly effective therapies now. Trastuzumab was the first one.
00:22:55:23 – 00:23:18:19
Unknown
We have a number of others now and we know that people living with HER2 positive metastatic breast cancer can be on that treatment for many, many years and without evidence of disease or with what may be just a scarring inside from the disease. And so we ask the question, could we try stopping treatments? Nobody has a protocol for how to do that.
00:23:18:24 – 00:23:40:17
Unknown
We talked with lots of colleagues and with lots of patients to think about what the right way to do this was. And together with colleagues through the TV CRC, the Translational Breast Cancer Research Consortium, we put together the Stop HER2 study. So the stop her two study is enrolling patients and we’re excited that it’s actually been going really well.
00:23:40:18 – 00:24:03:12
Unknown
We’re halfway there with HER2 positive metastatic breast cancer who had their disease controlled for at least three years on their therapy without signs of any cancer growth, and patients are asked if they want to participate. They can either stop their therapy or there’s a group of patients also who want to participate, who would like to contribute to research but not not stop their therapy.
00:24:03:15 – 00:24:27:25
Unknown
So what we’re doing is we’re stopping patients therapies again with their consent, and we are following them closely, both with a visit in the clinic and with scans done at the beginning. We do a quick visit at six weeks and then scans every 12 weeks through the first year of treatment. And we’re looking to see whether patients who are participate in that and stop their treatment are without disease, off treatment.
00:24:28:02 – 00:24:55:17
Unknown
And so we are really looking forward to those results. We anticipate the soonest we won’t have them is the end of next year trials going really well, But we still have to wait for everybody to get through that year to be able to report their results has certainly gone well from a patient enrollment perspective and provider enthusiasm and patient enthusiasm perspective, but that we might think about doing this in other kinds of breast cancer where we also have highly effective therapies are positive.
00:24:55:17 – 00:25:21:12
Unknown
Breast cancer is probably the the other one that comes to mind when we think about the setting. So I am hopeful and optimistic. And then I should say the last part of that is having the test that can really identify who might be safely able to do that. And with these ultrasensitive ctDNA tests that look for that minimal residual disease or MRI, which we are going to do in the stock or to study, but actually we’re going to test it after the fact.
00:25:21:15 – 00:25:41:22
Unknown
We didn’t have enough data to say that that was a safe way to guide who should participate in the study. And so with those data from the or to study that will be able to tell whether that’s a good way to help patients decide whether to stop treatment. And so we’ll be able to also share those results probably around the same time.
00:25:41:24 – 00:26:06:17
Unknown
Just for clarification, you’re still falling, right? Yes. So a little confusing if patients are interested when any trial is doing something like this, you want to make sure it’s really safe for everybody. And so we had to have a stopping rule that once we got through a certain number of patients who were enrolled and they got to six months on the trial that we had to check to make sure it was safe, meaning that patients weren’t having disease progression very quickly.
00:26:06:19 – 00:26:26:28
Unknown
And we’re just about done with that analysis and we’re going to restart the study very soon. It’s just dependent on finalizing the analysis. If people are interested in participating, I’m happy for them to reach out to me, it’s at a number of centers across the United States. We do think that it’ll enroll pretty quickly, so please reach out soon.
00:26:26:28 – 00:26:47:00
Unknown
If you’re somebody who would want to participate and we’re talking about both arms, right, both the actual arm and the. Yes. Tab three, although we only have three slots that the control arm is was much smaller because it was it’s not a randomized trial, as you know, that would not be possible or it’s really considered a cohort study.
00:26:47:00 – 00:27:06:06
Unknown
And it’s just 30 patients. We are three patients away from closing that part of the study. But for the control, we were interested to see which arm people chose and it was actually almost exactly the same. It was very similar people who wanted to participate and stop and those who didn’t. So I thought that was interesting. It is.
00:27:06:06 – 00:27:31:03
Unknown
I was I was actually going to ask you that question then. Yeah, we got there. We’re you know, that’s why both arms are closed right now, so we can ask that comparison. But it was almost exactly the same amount of patients in the two groups. When we stopped, I have a follow up to this, and it’s related to what you were saying about the idea of going further and maybe starting another trial for the positive people.
00:27:31:03 – 00:27:57:05
Unknown
So there is a is a subgroup of I guess it’s about 50% of HER2 positive people who are also R positive, right? The yes, the so-called triple positive group. There is a lot of hesitation, more hesitation I think in, in that group to stop treatments because again, you’re in your trial where you’re stopping her two treatments and estrogen receptor treatments.
00:27:57:05 – 00:28:26:02
Unknown
The end and the current treatments are up to a patient. Right? Exactly. Yeah. In you or not. Yes. The reason people with e R positive cancers and triple positive cancers are so concerned is because of all this late recurrences and dormancy. And how would that be if you start a trial like that? Is there a way for you to monitor that as well?
00:28:26:04 – 00:28:53:22
Unknown
It’s a good question and I think I agree that that’s why there’s there’s more hesitancy. It’s hard because the when you think about different biomarkers but dormant cells, we’re not sure if they are at that time releasing CTDNA. So it might not be a marker for somebody who has dormant cancer in their body. We don’t know. We think probably they’re not, but there aren’t good studies yet for for this.
00:28:53:24 – 00:29:20:24
Unknown
There are something called DTC phase, and those are dormant tumor cells. Those are in the bone marrow. Typically, it’s hard to monitor for those because you have to do a bone marrow biopsy, which is much more challenging than taking a tube of blood. I am hopeful we’ll learn more about the biology and be able to identify a biomarker and feel safe to potentially start treatment for patients with r positive breast cancer.
00:29:20:27 – 00:29:47:24
Unknown
We did do the study with CTDNA and in patients who had early breast cancer, it was stage two and three and they were five years or more from diagnosis. And we were able to pick up in that group of patients DNA before patients developed recurrence. There are some caveats to that. It’s a small study, but it does give you some hope that it could be a marker.
00:29:47:26 – 00:30:08:16
Unknown
We just don’t know yet if that’s is it catching you at the right time? We don’t know. So I think more more work to do that is so exciting. I don’t think you can get a patient with the question after this. I think it’s fantastic. But I do. I do. This is so important. The patient doctor communication is so very important and sometimes it’s difficult for us.
00:30:08:16 – 00:30:33:28
Unknown
So we always love to hear from you. If you have any advice for patients how they can advocate for themselves regarding the use of the biomarkers or liquid biopsies for their treatment. You almost want kind of a biography of your your cancer. So you want to know some very basic things about the cancer. And you should feel, I hope, comfortable asking just if you don’t know already.
00:30:33:28 – 00:31:09:13
Unknown
Most people do, but lots of people don’t know if you have a hormone receptor positive or positive or negative breast cancer or HER2 positive or negative. Those are critical things that everybody should know and and doctors should be communicating that, but certainly ask for it, if not in terms of the tissue testing or the liquid biopsy testing. I would also ask at the time of metastatic diagnosis for one of those, it’s part of the guidelines that a biopsy is done even if we think it’s metastatic breast cancer.
00:31:09:13 – 00:31:34:07
Unknown
When somebody comes in and has what looks like new cancer on a scan and you think it’s almost certainly coming from the breast cancer they had a long time ago or or more recently. But a critical part of that diagnosis is is making sure you know, that it’s cancer. So you should get a biopsy if even if somebody says, it’s it’s breast cancer, it’s probably breast cancer, get a biopsy, that’s something to to ask about.
00:31:34:07 – 00:31:57:29
Unknown
And if if you find that your your provider isn’t interested in that, I think it’s always okay to get a second opinion. Nobody gets offended about that. And even just asking your own doctor, what do you think about getting a biopsy if you’re in a position of not having that done? And then in terms of the sequencing and the liquid biopsy, those are things again, just asking about, what do you think about these tests?
00:31:57:29 – 00:32:21:20
Unknown
What’s your opinion about them? And and should they be helpful in my care and if you’re uncomfortable again, second opinions. Okay, There are lots of people who are happy to help to guide from afar a little better answer questions if needed. I want to ask a question about the future. You know, we’re getting closer and closer to personalized treatments, and that’s definitely exciting.
00:32:21:20 – 00:32:49:06
Unknown
And the treatments are evolving. And breast cancer just just recently another drug was approved, could be the surrogate based on some biomarkers. So are there any new biomarkers that will be or might be actionable in the near future? That is a great question. There are I think the AKT pathway mutations are and there are a group of mutations.
00:32:49:06 – 00:33:09:29
Unknown
So that’s another thing. And when you’re asking about bio markers and treatment, because they’re not it’s not just one gene that’s altered. It’s a it’s a group of genes that are involved in that that can be altered to make somebody eligible for that treatment. So that’s one I think it’s already available, but it’s also something that people aren’t yet using a lot of.
00:33:10:01 – 00:33:39:18
Unknown
So that’s an important one to know about. And then in terms of future targets, the other ones that are important, it’s been around for some time and people got kind of disillusioned by alcoholism, which is a three kinase inhibitor, which has a lot of toxicity, but there are a lot of targeted, more clean, if you will, specific PI3 kinase inhibitors that are that are coming around and look like they will be both effective and much better tolerated.
00:33:39:20 – 00:34:01:04
Unknown
And then there are some new markers that are related to the BRCA one and two mutation changes, but not again, as you said, somatic. So not germline that can make a cancer susceptible to sort of second generation PARP inhibitors. Those are earlier, but they also look like they could be effective and it’s exciting to change some of them.
00:34:01:06 – 00:34:30:00
Unknown
Yeah, there’s a lot of exciting work going on, so. You’re welcome. This was fun. Thank you so much, Dr. Parsons. We hope you found this information helpful and encouraging. Be sure to visit our Web site for more resources and support and subscribe to our NBC Life podcast. Until next time, take care and stay informed.
