Cancer
Scientists hail ‘new ways’ to improve breast cancer treatment
Scientists from the University of Sharjah say they have good news for breast cancer patients, particularly those afflicted with the most aggressive types of the malignant tumor known as triple-negative breast cancer.
The study, published in the European Journal of Pharmacology, provides “new ways for the treatment of the special type of breast cancer called the triple-negative breast cancer,” according to the research’s corresponding author, Prof. Raafat El-Awady.
Triple-negative breast cancers are more aggressive than other forms of breast cancer as they tend to grow and spread quickly, have limited treatment options and show resistance to available therapies.
“Our research has found that high HDAC6 levels lower the amount of progesterone receptors, making breast cancer cells less responsive to hormonal therapies,” Prof. El-Awady, a pharmacologist, adds.
“The implications of our research could extend beyond the lab, offering hope for more effective treatment options in the battle against aggressive breast cancer.”
HDAC6 or histone deacetylase 6 influence a broad range of signaling pathways and cellular processes in cancer cells involving response of cancer cells to therapeutics, and cancer metastasis, or development of malignant growth beyond the tumor’s primary site, while hormone receptors, like the estrogen and progesterone, cause the growth of only some types of breast cancers, which are hormone dependent.
But when these receptors do not function properly, according to Prof. El-Awady, breast cancer patients often struggle to respond to common hormonal therapies, leaving them with limited treatment options.
Prof. El-Awady described triple-breast cancer as “a type (of cancer) that lacks these hormone receptors and is aggressive and hard to treat. Hormone receptors, like the estrogen and progesterone receptors, play a significant role in how breast cancer grows and responds to treatments.
“When these receptors are not expressed or do not function properly, breast cancer patients often struggle to respond to common hormonal therapies, leaving them with limited treatment options.”
The main practical goal of the research is to identify a new therapeutic strategy to enhance the sensitivity of aggressive breast cancer cells to hormonal therapies, and the authors highlight HDAC6 as a potential therapeutic target, demonstrating how inhibiting this protein can restore progesterone receptor levels and potentially reverse resistance to hormonal treatments.
“By shedding light on the role of HDAC6, we aimed to provide insights that could pave the way for developing more effective treatments for patients, particularly those with challenging breast cancer subtypes that are difficult to treat,” says Prof. El-Awady.
The scientists claim that one best way to combat triple-negative cancer is by using a medicine with the ability to stop HDAC6, a process that can lead to a surge in the levels of progesterone receptors.
“By using a drug that blocks HDAC6, we were able to boost the levels of progesterone receptors in breast cancer that were previously lacked it. This change made the breast cancer cells more sensitive to common hormonal therapies.
“These findings suggest that targeting HDAC6 could enhance the effects of hormonal therapies, offering a new hope for patients, particularly those with aggressive types like the triple-negative breast cancer, which is typically aggressive and more difficult to treat,” Prof. El-Awady added.
Statistics show that breast cancer is the most prevalent type of cancer among women worldwide, with 2,296,840 new cases of breast cancer in 2022.
Dr. Wafaa Ramadan, a molecular medicine specialist and the study’s first author, said the research stands out in its discovery that high levels of HDAC6 are linked to low amounts of the progesterone receptors in tissues of breast cancer patients.
“This indicates that the presence of active HDAC6 leads to a reduction or loss of the progesterone receptors with subsequent resistance to anti-progesterone therapies.
“Most importantly, we found that by blocking HDAC6, breast cancer cells became more sensitive to hormonal therapies. This is especially important for types of breast cancer that are more challenging to treat like the triple negative breast cancer.”
The research, says Dr. Burcu Ilce, a specialist in bioinformatics and functional genomics and a co-author, opens up new ways for breast cancer treatment strategies.
“By understanding the role of HDAC6 in hormone receptor regulation, we can potentially develop targeted therapies that enhance the effectiveness of existing treatments.
“This approach is crucial for patients who may not respond to standard hormonal therapies, as it offers a new avenue for tackling their disease.
“Consequently, targeting HDAC6 could lead to better treatment outcomes, reduced resistance to therapies, and improved survival rates for patients with challenging forms of breast cancer.” Prof. Maha Saber-Ayad, a Clinical Pharmacologist and a co-author, adds.
The scientists say they hope for their findings to significantly advance personalised cancer therapy, offering new hopes for patients with limited treatment options.
“Given the growing focus on targeted cancer therapies and epigenetic drugs, it is likely that pharmaceutical companies and biotech firms could be interested in further exploring the development and clinical testing of HDAC6-targeted therapies,” said Varsha Menon, a co-author and research assistant.
“This interest could open the door to strategic partnerships that would accelerate the translation of our research into impactful therapies for breast cancer patients, particularly those with hormone receptor-negative or resistant tumours.”
Prof. El-Awady notes that once the research findings are translated into clinical practice by targeting HDAC6, “they could enhance treatment outcomes for patients with hormone receptor-negative breast cancer.
“By restoring or increasing hormone receptor expression, this approach could provide new therapeutic options, improving treatment efficacy and potentially increasing survival rates for patients who currently have limited responses to conventional hormonal therapies”.
Added Prof. Iman Talaat, a clinical pathologist and a co-author.
“We are excited about the possibility that our work related to targeting HDAC6 could lead to breakthroughs in how we treat breast cancer, giving hope to patients who may have limited treatment options.”
A vaccine trial will test whether an mRNA jab can help stop precancerous cells developing into bowel and ovarian cancer in people with Lynch syndrome.
The first stage is due to launch this summer and will assess whether the jab can train the immune system to recognise and eliminate precancerous cells before cancer develops.
Around 175,000 people in England have Lynch syndrome, but only five per cent, or around 10,000 people, know they have it.
The inherited condition increases the risk of developing bowel cancer by 80 per cent and is linked to around 1,100 bowel cancer cases each year.
Lynch syndrome is also linked to a far higher risk of bowel, womb and ovarian cancer, alongside other types including stomach, pancreatic, kidney and skin cancer.
While the syndrome does not directly cause cancer, the genetic changes can lead to more abnormal cells developing, which then multiply and increase the risk of cancers such as bowel, prostate and endometrial cancer.
It is caused by an alteration in a mismatch repair gene. Carriers do not have any symptoms.
The new Intercept-Lynch trial is part of a scientific collaboration between the University of Oxford and Moderna, while Cancer Research UK has backed the vaccine’s development.
Once patients receive the new mRNA-4194 jab, experts will analyse their immune responses, assess the best dose and check whether the jab is safe.
The second phase of the study will include multiple centres across the UK, including Oxford, and is expected to begin in 2027.
The aim of the trial is to train the immune system with a vaccine to recognise abnormalities and stop them developing into cancer.
Professor David Church, Cancer Research UK senior cancer research fellow in the University of Oxford’s centre for human genetics and lead investigator of the trial, said: “People with Lynch syndrome are at risk of cancers over their entire lives.
“So, it’s very common, for instance, a woman to have a first cancer of her womb, and then some years later have a bowel cancer, or vice versa.
“The targets we’ve chosen for the vaccine were chosen based on their sharedness across multiple cancer types in Lynch syndrome, so we think they should provide broad protection, if the vaccine works.”
In people with Lynch syndrome, mutations can build up, making the cells containing them more likely to turn into cancerous cells.
However, those mutations can be made visible to the immune system and, with enough stimulation, the immune system can attack the abnormal cells and stop cancer from forming.
Professor Church said the mRNA jab acts as “an instruction manual” for the body to attack precancerous cells.
He added that, as with many vaccines, patients may need a booster jab at some stage.
On whether similar approaches could help prevent cancers not caused by Lynch syndrome, Professor Church said: “In terms of proof of principle that we can train the immune system to recognise these cancer-associated alterations and enhance the immune response against them to prevent these pre-cancers or prevent the progression of pre-cancer to cancer, that proof of principle should give us insights that are generalisable.”
David Berman, chief development officer at Moderna, said: “By applying mRNA technology earlier in the patient journey, we aim to harness the immune system when it can have the greatest impact.
“We are proud to bring this innovation to the UK, building on our long-standing collaboration with leading UK institutions to advance mRNA research and development.”
Changes in lymph nodes may help show which breast cancer patients face higher or lower risk of the disease spreading, researchers have found.
The findings could support more tailored care, new treatments and help more people avoid unnecessary treatment.
Dr Simon Vincent is chief scientific officer at Breast Cancer Now, which funded the research:
He said: “These findings suggest that changes to the structure of the lymph nodes are more than just a consequence of the cancer. They can also play an active role in helping breast cancer progress.
“With one person tragically dying from breast cancer every 45 minutes in the UK, we urgently need research like this so that we can better understand who is most at risk of their cancer progressing and becoming incurable. Only then we can find ways to stop it.
“With a better understanding of how lymph nodes change as breast cancer spreads, we could find new targets for future treatments for types of breast cancer that are harder to treat.”
Lymph nodes, a key part of the immune system, help the body fight infections and cancer. In breast cancer, the lymph nodes in the armpit are often the first place the disease spreads to.
At the moment, everyone with invasive breast cancer has to undergo surgery to remove lymph nodes so doctors can check for cancer cells.
Invasive breast cancer means cancer that has spread beyond where it first developed in the breast into nearby tissue.
While this is effective, it can lead to long-term side effects such as swelling of the arm, known as lymphoedema, and may be unnecessary for some patients, particularly those with early-stage disease or those whose cancer responds well to treatment.
The study analysed 331 lymph node samples from people with different types of breast cancer and compared them with healthy lymph nodes from people free from the disease.
It found that breast cancer could change the structure of a network that supports the lymph nodes.
Crucially, some of these changes could occur before doctors were able to spot any cancer cells in the network.
Some changes were linked to a better chance of survival, while others were associated with a poorer prognosis.
Dr Amy Llewellyn and Dr Kalnisha Naidoo from King’s College London, together with professor Sophie Acton at University College London, compared the 331 samples with healthy lymph nodes in people free from the disease.
They looked at fibroblastic reticular cells, known as FRCs, a group of cells in lymph nodes that provide their structure, control fluid flow and activate different immune cells.
The study showed that the structure of this FRC network could change before the cancer had spread and differed depending on the type of breast cancer, any spread and whether someone had received chemotherapy.
Chemotherapy uses medicines to kill cancer cells or slow their growth.
The researchers said the findings could help doctors better understand who is most at risk of breast cancer spreading.
Dr Llewellyn said the first large-scale analysis of FRC in human lymph node tissue from breast cancer patients was addressing the “urgent need” for a better understanding of the area’s biology.
A new ovarian cancer drug has been approved for NHS use in England, offering hundreds of women with hard-to-treat disease a life-prolonging treatment.
Elahere is the first new drug for chemotherapy-resistant ovarian cancer to be approved by the NHS for more than 20 years.
Ovarian cancer is the 18th most common type of cancer globally, affecting more than 300,000 women a year.
More than three-quarters of patients are diagnosed at an advanced stage, making the disease harder to treat.
Prof Ruth Plummer, national clinical lead for cancer drugs at NHS England, said: “This represents the most significant breakthrough in NHS treatment for these hard-to-treat ovarian cancers in over two decades – and we’re delighted it will now offer hundreds of women much-needed hope of precious extra time with their loved ones.”
Standard treatment for ovarian cancer usually involves surgery and chemotherapy, but about 80 per cent of patients with advanced disease relapse and most eventually develop resistance to chemotherapy.
According to the National Institute for Health and Care Excellence, patients with folate receptor-alpha-positive platinum-resistant epithelial cancers have until now had limited options when their tumours stop responding to standard chemotherapy.
Now NICE has approved mirvetuximab soravtansine, also known as Elahere, for patients with epithelial ovarian, peritoneal or fallopian tube cancer that has become resistant to platinum-based chemotherapy and whose tumours contain the FRα protein that the drug targets.
FRα is a protein found on the surface of some cancer cells.
NHS England said up to 400 women a year in England could benefit, in what it described as a major milestone for treatment.
Mirvetuximab soravtansine is given through a drip once every three weeks.
A global clinical trial involving eight NHS hospitals found that the treatment delayed cancer progression and prolonged survival by an average of four months, compared with chemotherapy alone, with more manageable side-effects.
Cancer progression means the disease is growing, spreading or worsening.
In 37 per cent of patients, tumours shrank by at least 30 per cent, compared with 16 per cent of those given chemotherapy.
The drug, made by AbbVie, combines a “homing” antibody, which seeks out the FRα protein on the surface of cancer cells, with a cancer-killing molecule that destroys the cell from within.
Experts said the decision was a seminal moment and could significantly improve the quality of life of affected patients.
Rachel Downing, head of policy and external affairs at Target Ovarian Cancer, said: “This is a hugely important moment for women with platinum-resistant ovarian cancer and their families, who have faced limited effective treatment options for far too long. Today’s announcement offers real hope of improved quality of life.”
Victoria Clare, chief executive of the charity Ovacome, said: “Today marks a landmark moment. Being told that platinum-based chemotherapy is no longer working can bring anxiety and uncertainty, particularly when the disease is at an advanced stage, where time and options are limited.
“This recommendation is the first in over 20 years to offer the ovarian cancer community an additional choice at a critical stage, with the potential to make a real difference to patients and their families.”
Helen Knight, director of medicines evaluation at NICE, said: “We heard clearly from patients and clinicians about the very limited options available at this stage of the disease and the substantial burden that chemotherapy places on women’s lives.
“We are pleased that, following a robust process and a new commercial arrangement with AbbVie, we are now able to recommend this treatment for NHS use.”
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