Breast cancer research at Upstate: Which drug will work best in each patient?

Advances in the understanding, diagnosis and treatment of breast cancer begin in laboratories. Here’s a peek into one lab at Upstate that received grants this year from the Carol M. Baldwin Breast Cancer Research Fund:

005371Which drug will work best in each patient?

A family of molecules known as the Wave Complex interact within our cells. Which molecular family members are present at any given time in the life of a cell determines how that cell will behave: how it gets nutrition, whether and how it moves, whether it remains stationery.

This complex appears to play a major role in the invasive types of breast cancer, says Leszek Kotula, PhD, associate professor of urology and biochemistry and molecular biology. Working on the theory that the Wave Complex could be a target for therapy are Kotula and two colleagues, Steve Landas, MD, professor of pathology and urology, and Mira Krendel, PhD, assistant professor of cell and developmental biology.

When they increase some specific molecules in the complex, the cancer spreads, Kotula says. He adds that by decreasing certain molecules, “we may actually stop metastasis, or greatly affect it.”

The next step will be to test the effects of existing cancer drugs on these molecules. Landas, a diagnostic pathologist for 35 years, sees the potential. “Wouldn’t it be a wonderful thing if we find ourselves in a situation where we can look at certain members of this family of molecules and know with a high degree of certainty which drugs will work and which will not?”

Hear an interview with Kotula and Landas about this project

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Options for women to rebuild breasts after cancer are more plentiful

Prashant Upadhyaya, MD, provides many breast reconstruction options.

Prashant Upadhyaya, MD, provides many breast reconstruction options.

A woman who faces mastectomy also has to consider whether and how to reconstruct the breast that will be removed, and her options have improved in recent years.

“Immediate reconstruction, in which the reconstruction is done when the breast is removed, is the gold standard now, and it is done in most of the patients who are reconstructed,” says plastic surgeon Prashant Upadhyaya, MD, an assistant professor of surgery at Upstate. He says no longer is it common for a woman undergoing mastectomy to wake up from surgery with a flat chest.

Up to 90 percent of breast reconstructions are “immediate,” but some women have to defer reconstructive surgery for medical reasons, and some want to complete cancer treatment before considering reconstruction.

factorstoconsiderBreast reconstruction can be done using implants, or it can be “autologous,” meaning the patient’s own tissue is used to create a new breast. Either way, most health insurers are required to pay for reconstruction of both breasts after mastectomy.

An autologous reconstruction requires an extensive surgery in which tissue is either transplanted from the abdomen to the chest, or moved from the patient’s back to the chest. This appeals to patients who do not want implants containing silicone or saline in their bodies, but not every woman is a candidate for autologous reconstruction, Upadhyaya says.

A woman who opts for implants may also be able to have a surgery that leaves her nipple intact. Newer techniques involve an incision that is made away from the nipple. “It’s actually very well hidden below the breast,” Upadhyaya says. The implants are often inserted through the same incision, and “the patient wakes up with breasts completely intact.”

Although sensation won’t be the same, the surgeon says after a woman recovers from the operation, her breast may appear much as it did before.

He favors silicone gel implants. “Saline implants do not have the natural feel or the look of silicone gel implants. I offer both to patients. But I think the longevity of the results is better, and the feel of the breast is better with silicone implants.”

Implants carry the risk of infection. Upadhyaya says from 5 to 10 percent of patients with implants will face infection, which means having to remove the implants and then, months later, undergoing another reconstruction.

So which surgery provides the best outcome?

The surgeon says the answer has to be based on each individual patient’s expectations – and the realization that they may not be happy with any outcome during the post-operative period. Healing and recovery is liable to take months.

Hear an interview with Upadhyaya about breast reconstruction options

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Bicycle will blend smoothies in cafeteria today

Stop into the cafeteria at Upstate University Hospital’s downtown campus from 11 a.m. to 1:30 p.m. today to sample smoothies blended from fresh fruits and vegetables. Morrison Food Services is hosting a smoothie bike, designed to blend smoothies as a rider pedals.

Dietitians and a chef will be on hand to answer nutrition questions and distribute smoothie recipes. Fresh fruits and vegetables will also be available for sale.

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Breast cancer research at Upstate: What will stop the spread of breast cancer?

Advances in the understanding, diagnosis and treatment of breast cancer begin in laboratories. Here’s a peek into one of the labs at Upstate that received grants this year from the Carol M. Baldwin Breast Cancer Research Fund:

005371What will stop the spread of breast cancer?

The protein, paxillin plays an important role in cell movement. What scientists are trying to determine is exactly how paxillin affects the movement of cancer cells away from a primary tumor, into the blood stream and on to colonize distant organs. It’s important to know because “If we can develop ways in which we can limit paxillin’s function, we may be able to block the process of metastasis,” says Christopher Turner, PhD, professor of cell and developmental biology.

Many of the drugs used to fight breast cancer tumors target microtubules, the proteins that makes up the cytoskeleton that helps cells maintain their shape and internal organization. These drugs create toxic side effects for patients.

“We found that the level of expression of paxillin in tumor cells may actually influence the microtubule cytoskeleton and, therefore, may influence how those drugs actually work in individual patients,” Turner says.

Nicholas Deakin, PhD, research assistant professor of cell and developmental biology, points out that the deaths of 95 percent of the 40,000 American women who die from breast cancer each year are linked to metastasis. “It’s not the tumor in the breast that really is the problem. It’s the ability of the cells to move away from there,” he explains. “If we can detect the tumors early, and if we can then treat them with a drug or know what drug to go with to stop their spread, then that’s going to greatly influence the survival of these patients.”

Hear an interview with Turner and Deakin about their work

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How one workplace supported a co-worker with cancer

Stacy tTo know the real value of a pink cotton t-shirt, you would have had to see the tears streaming down Stacy Wilson’s face.

It was soon after her diagnosis with breast cancer in 2013. She returned to work from a doctor’s appointment. When she walked in, 27 of her coworkers wore bright pink t-shirts with a coupon printed on front.

“This coupon is worth the support of one friend in your fight against breast cancer. Expiration date: Never,” the shirts said.

Wilson was blown away.

She works as an application coordinator in information management technology at Upstate. She’s mother to seven children ranging in age from 11 to 19.

Her co-workers raised about $200 by selling the t-shirts. They also contributed a variety of comfort foods for her family while she was going through treatment.

Wilson finished her treatment in July and has a good prognosis. And she remains ever grateful for the support shown by her coworkers. “It was a huge deal, what they did for me.”

Should you share your diagnosis at work? A psychiatrist gives her advice.

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Breast cancer research at Upstate: How do genes affect drugs that fight cancer?

Advances in the understanding, diagnosis and treatment of breast cancer begin in laboratories. Here’s a peek into one Upstate lab that received a grant this year from the Carol M. Baldwin Breast Cancer Research Fund:

005371How do genes affect drugs that fight cancer?

A gene called ECRG2 was recently identified as a tumor suppressor, and preliminary studies at Upstate reveal that it can “strongly inhibit” breast tumor cell growth, says professor of pharmacology, Ying Huang, MD, PhD.

She says ECRG2 also appears to play a role in the development of resistance to multiple anticancer drugs commonly used to treat breast cancer. Her project focuses on understanding how this happens.

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Pinpointing prostate cancers

Srinivas Vourganti presents the UroNav to Central New York media.

Srinivas Vourganti presents the UroNav fusion biopsy system to Central New York media earlier this year.

Upstate became the only provider in Central New York (and one of a few sites in the country) to offer breakthrough technology to help pinpoint hard-to-locate prostate cancers when it acquired the UroNav fusion biopsy system.

Traditional biopsies of the prostate gland rely on ultrasound to guide surgeons to areas where cancers tend to form, and random samples are taken.

The UroNav system uses technology similar to GPS navigation to guide a surgeon to where cancer may be hiding, such as an area within a man’s prostate where the blood supply is abnormal. This allows more accurate samples to be taken and reduces the need for multiple biopsies.

Here’s how it works.

The patient undergoes magnetic resonance imaging; those images are analyzed.

During the patient’s biopsy procedure, UroNav fuses the MRI images with real-time ultrasound images to guide the surgeon to the precise area within the prostate where the cancer might be growing. Tissue samples are removed for laboratory analysis.

Pathologists in the lab determine the extent and aggressiveness of the cancer, so that surgeons can tailor the appropriate treatment.

Hear an interview with Vourganti about UroNav and prostate cancer

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Breast cancer research at Upstate: Can we better protect bone from radiation therapy?

Advances in the understanding, diagnosis and treatment of breast cancer begin in laboratories. Here’s a peek into one lab at Upstate that received grants this year from the Carol M. Baldwin Breast Cancer Research Fund:

005371Can we better protect bone from radiation therapy?

Targeted radiation therapy can be effective in reducing the size of a tumor, but it can leave bones more susceptible to fractures in the years after cancer.

Studying stem cells for possible solutions are Megan Oest, PhD, assistant professor of orthopedic surgery, and Timothy Damron, MD, professor of orthopedic surgery, cell and developmental biology and neuroscience and physiology. Stem cells have the ability to develop into many different cell types, depending on the body’s needs.

Of the bone cells that are alive at the time of radiation, Oest and Damron have noticed that some die and are never replenished. They are experimenting with chemical or biological methods to prevent damage to these particular cells. Perhaps in the future, patients could receive an injection of a protective substance before undergoing radiotherapy.

It’s also possible, Oest theorizes, that patients could undergo something like a stem cell transplant after their therapy. Healthy cells could come from a donor, or from elsewhere in the patient’s body. She and Damron have learned that when radiation is applied to one leg, cells from the opposite leg remain undamaged. “In theory, if it worked, you could actually take cells from the healthy side of the patient and put them into the unhealthy side,” she says.

Listen to an interview with Oest about this project

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Most breast cancers occur in women with no family history

Illustration by Getty Images International.

Illustration by Getty Images International.

Women at increased risk for developing breast cancer have a growing number of options to help prevent the disease — but you may be surprised to learn who is at high risk.

Angelina Jolie garnered media attention in May 2013 when she underwent a preventive double mastectomy, revealing a family history of breast cancer and a faulty genetic mutation.

“It’s important to keep that in perspective,” says Jayne Charlamb, MD, who directs Upstate’s Breast Cancer High Risk Program. “The vast majority of women who get breast cancer have absolutely no family history.” She says only about 5 to 10 percent of breast cancers are thought to be hereditary, caused by abnormal genes passed from one generation to the next.

Women with a mutation in the same gene as Jolie’s, known as BRCA, are at increased risk — but so are many others.

As a woman ages, her risk increases. Not having children, or having children later in life puts a woman at higher risk than one who bears children when she is young. “Not breastfeeding puts you at a higher risk,” says Charlamb. Also, a woman with dense breast tissue has an increased risk of developing breast cancer.

Some women with a BRCA mutation are opting to have their breasts removed, like Jolie, to reduce their risk of developing breast cancer.

Others at high risk for the disease are choosing “chemoprevention,” a 5-year course of medications that reduces risk by about 50 percent during, and sometimes beyond, those five years, Charlamb says. The medications include selective estrogen receptor modifiers, which block the effects of estrogen on breast tissue, and aromatase inhibitors, which stop a key enzyme from changing other hormones into estrogen.

In addition, Charlamb and other breast cancer experts are studying the promise of vitamin D for breast cancer prevention, especially in women with dense breast tissue.

Prevention remains important, especially for women with an increased risk. Charlamb tells her patients to exercise regularly and to eat a diet rich with fruits and vegetables that includes a variety of foods and avoids processed foods and red meats. She also discusses alcohol intake.

“There is pretty clear evidence now that even very moderate alcohol intake — one drink a day — is enough to significantly increase a woman’s risk of developing breast cancer,” the doctor says.

Though it’s impossible to entirely eliminate breast cancer risk in any woman, a healthy lifestyle can bring down a woman’s risk of developing breast cancer, even if that woman is at very high risk due to a genetic mutation.

Women interested in the Breast Cancer High Risk Program can call 315-464-8224 to schedule an appointment.

Hear an interview with Charlamb about the Breast Cancer High Risk Program

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Breast cancer research at Upstate: What is the best way to restrict estrogen?

Advances in the understanding, diagnosis and treatment of breast cancer begin in laboratories. Here’s a peek into one Upstate lab that received grants this year from the Carol M. Baldwin Breast Cancer Research Fund:

005371 What is the best way to restrict estrogen?

Estrogen is crucial to human life for men and women, but once a woman enters menopause, excess estrogen can lead to breast cancer. Up to 80 percent of the breast cancers detected in women after menopause are triggered and proliferated by estrogen, explains Debashis Ghosh, PhD.

Ghosh, a professor of pharmacology, collaborates with Juntao Luo, PhD, assistant professor of pharmacology, about ways to deliver new inhibitors of aromatase, the molecule that makes estrogen, to the tumor sites in animal breast cancer models.  Having elucidated the molecular mechanism of how aromatase works, the Ghosh group has designed novel aromatase inhibitors, which are being tested in his lab.

“Some of our compounds have performed better, much better in breast cancer cells than the current drug, which is known as Aromasin or exemestane,” says Ghosh. The next step would be testing the compounds in laboratory animals.

Listen to an interview with Ghosh on HealthLink on Air

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