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Legacy Cancer Institute helps improve outcomes for women through cancer research, treatment advances

The Scribe

October 2014

While upwards of 40 percent of Americans will contract some form of cancer in their lifetime, much progress is being made globally, nationally and regionally. Legacy Cancer Institute is working hard every day to not only find the silver bullet to forever eliminate cancer, but also to improve research, screening, and cancer treatments and surgery methods. These efforts include improving outcomes for women with cancer.

A new option for breast reconstruction
Legacy is now offering breast cancer patients who have undergone a mastectomy a new breast reconstruction option: Deep Inferior Epigastric Perforator or DIEP flap breast reconstruction. Microsurgeons Shane Kim, MD, and Hema Thakar, MD, perform the highly specialized procedure, which involves transplanting a patient’s own tissue and blood vessels to recreate a breast that contains no foreign bodies, has a more natural-looking anatomy and is able to age, gain and lose weight with the patient throughout her life.

After the mastectomy, fat and skin from the patient’s abdomen is used to create a new breast. Zero or very little abdominal muscle is removed, and blood vessels are relocated to supply the transplanted tissue with blood. DIEP flaps have better longevity than implants as there is no chance of leaks or ruptures and only one surgery is required. Just a few U.S. surgeons are trained to perform the procedure, and Kim and Thakar are the only Oregon physicians who perform the surgery as a team. DIEP flap requires highly developed microsurgery skills (few plastic surgeons are also microsurgeons), and the procedure typically takes about five and a half hours. The team approach allows for decreased operative time, less anesthetic, increased patient safety and a quicker healing process.

“DIEP flap is the most advanced form of breast reconstruction available today; unfortunately, many women don’t even know it exists,” said Kim, who is fellowship-trained in the surgery. “As the gold standard for breast reconstruction for women who have undergone radiation, we want to raise awareness of this option.”

Vaccine clinical trial shows promising results

Legacy Cancer Institute (LCI) is participating in a promising new vaccine clinical trial targeting breast cancer that could reduce by half recurrence in survivors, even those diagnosed with the most aggressive subtypes. The trial aims to prevent or delay recurrence in women who have survived triple negative breast cancer, or who have had lymph node involvement, and achieve remission after surgery, radiation and chemotherapy. The clinical trial combines Herceptin, a drug used to treat other types of breast cancer, and E75, a peptide-based vaccine. The study is entering Phase II after results from Phase I showed a 50 percent reduction in recurrence for patients with triple negative breast cancer. Phase II trials, which have 96 patients enrolled so far nationwide, are placebo-controlled studies conducted to determine the effectiveness, side effects and potential risks of a new drug that is in development. If it is successful, Phase III trials would involve a much larger group of patients. 

“The biggest fear of most cancer survivors is that their cancer will return,” said Nathalie Johnson, MD, medical director of Legacy Cancer Institute and principal investigator. “The ultimate goal of this research is to apply the science of this vaccine to other cancers and eventually one day prevent cancer from occurring in the first place. Vaccines are the next frontier in the fight against cancer.”

LCI was one of 20 hospitals across the United States selected to take part in the study and the only one in the Pacific Northwest.

Nipple Sparing Mastectomy
LCI also is offering nipple sparing mastectomy surgery, a revolutionary technique that leaves all of the breast’s skin in place, including the nipple and areola. The mastectomy is performed through an incision that is closed primarily, which bolsters cosmetic outcomes and avoids additional scarring. Early follow up of nipple sparing mastectomy in selected patients has shown low rates of nipple tumor recurrence and decreased rates of nipple necrosis. Immediate reconstruction is now available, lessening some of the emotional effects associated with undergoing a mastectomy. Women are able to have a tissue expander, implant, or autologous tissue placed at their initial operation rather than in a delayed approach. These options allow a more cosmetically appealing result with skin sparing techniques and a shorter recovery process.

A new approach to symptom identification and management

Female cancer patients frequently experience a host of symptoms, including sleeping problems, increased anxiety, and decreased appetite, that can be easily managed if properly addressed. LCI recently started utilizing the Edmonton Symptom Assessment System (ESAS) to systematically improve patient/provider communication and help patients manage a wide range of symptoms, including pain, nausea, depression, anxiety, fatigue, appetite changes, and shortness of breath. ESAS tracks symptoms on a numeric scale and is projected onto a graph so the progression of symptoms is better understood by patients, physicians and caretakers and care plans can be adjusted as needed.

A pill to replace chemotherapy?
LCI is also participating in a clinical trial for postmenopausal women who have estrogen receptor positive breast cancer. The trial, which is being sponsored by the Alliance for Clinical Trials in Oncology, is to help gauge the effectiveness of promising new drugs. The specific purpose is to determine if fulvestrant or fulvestrant combined with anastrozole is superior to administering anastrozole alone in shrinking tumors before surgery. Fulvestrant degrades estrogen receptor in the cancer cell and anastrozole lowers estrogen in postmenopausal women and is the standard of care for pre-surgery. Both are considered endocrine therapy drugs and do not cause the same side effects as chemotherapy.

Nationwide enrollment for the trial began in December 2013, and Legacy started the trial in January. About 2,820 women will take part in the study.

To read the story online click here (page 8).