New Research Unveils Key to Cancer Metastasis
- A new study shows promising results in better understanding what cancers will likely undergo metastasis (spread to other body parts) and respond to immunotherapy.
- The study conducted by researchers at Stanford University and the Arc Institute suggests that cancer cells with the protein ENPP1 can signal if the cancer will respond to immunotherapy treatment and if it’s more likely to undergo metastasis. It’s important to note that while this research shows promise, it’s still a long way from more definitive advancements in cancer treatment.
- Immunotherapy is a cancer treatment that triggers your immune system to search for and attack cancer cells, microscopic or more extensive tumors.
- Metastatic breast cancer is a condition in which cancer cells have spread from the breast to other parts of the body. Among women who are seeking medical attention for breast cancer for the first time, approximately 6 to 8% have evidence of metastatic breast cancer.
What makes certain cancers undergo metastasis or spread to other parts of the body, effectively making them harder to treat? It’s a question researchers are getting closer to answering following a new study from Stanford University and the Arc Institute. Essentially, researchers believe cancer cells with the protein ENPP1 can signal if the cancer will respond to immunotherapy treatment and if it’s more likely to undergo metastasis.
The study published in “Proceedings of the National Academy of Sciences” found that Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) “expression has been correlated with poor cancer prognosis.”
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“Breast cancer patients with low ENPP1 expression have hot tumors and respond completely to the immunotherapy drug Keytruda (generic name, pembrolizumab) with “7-y metastasis-free survival.” Conversely, patients with high levels of ENPP1 detected were less likely to respond to immunotherapy treatment and were more likely to have their cancer undergo metastasis and experience a relapse.This means patients can check for the ENPP1 protein early on through genetic testing because ENPP1 levels can be used as a biomarker.
“Our study should offer hope for everyone,” lead researcher Lingyin Li, associate professor of biochemistry at Stanford and Arc Core Investigator, told Stanford News.
RELATED: Immunotherapy and Triple Negative Breast Cancer
This study helps clinicians understand how much of a role ENPP1 levels play in cancer progression and the necessary treatment to keep the cancer at bay. It’s important to note that this study offers hope but is a long way from providing more substantial changes in overall cancer treatment at this time.
Helping Patients Understand Metastatic Breast Cancer and Your Options
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- Debt Collectors Are Hunting Half of Women with Metastatic Breast Cancer — Help Us, Please!
- Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options
- Elacestrant (Orserdu) Offers Hope for Patients With a Stubborn Form of Metastatic Breast Cancer
- FDA Approves Diagnostic Test to Identify Patients with Metastatic Breast Cancer Expressing Low Levels of HER2
How Immunotherapy Works, and Its Pros and Cons
Immunotherapy is a medicine that triggers your immune system to search for and then attack cancer cells, whether microscopic or in the form of more extensive tumors.
“Immunotherapy originally started as being an indication for patients who had stage four disease,” Dr. Anna Pavlick, a medical oncologist at Weill Cornell Medicine, tells SurvivorNet.
“In the beginning, we began trying to make vaccines to try to trick the immune system into attacking a protein that we thought was important in the cancer. These vaccines for cancer almost never worked. The problem was the cancer was using a different track of the immune system to block it from attacking,” Dr. Ronald Natale, director of the Lung Cancer Clinical Research Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center in Los Angeles, told SurvivorNet.
“Well, scientists developed treatments, antibodies that would block PD-L1 from blocking the immune system. This unleashed the immune system to resume its attack on the cancer very successfully, at least in some patients,” Dr. Natale added.
“We have now done studies looking at using immunotherapy for patients who have stage three disease. Because we know that these patients have a 50/50 chance of whether this is going to come back or not, we want to make those odds of it coming back even less. But it is not chemotherapy. It does not bring down your immune system. It does not predispose patients to infection. It does not make them lose their hair,” Dr. Pavlick continued.
While immunotherapy is effective for most patients, it has some side effects, most related to inflammation. You might experience diarrhea when your colon is inflamed or itching when your skin is inflamed. You can also have pain in your liver or pancreas if you have pancreatitis or hepatitis.
RELATED: Immunotherapy in Recurrence
WATCH: Understanding immunotherapy side effects.
Common Immunotherapy side effects include:
- Fatigue
- Nausea or stomach discomfort
- Joint pain
- Diarrhea or constipation
- Cough
- Rash
- Loss of appetite
- Changes in blood cell counts
- Fever
More severe adverse reactions include:
- Pancreatitis: Inflammation of the pancreas
- Colitis: Inflammation of the large intestine
- Pneumonitis: Inflammation of the lungs
- Hepatitis: Inflammation of the liver
- Thyroiditis: Inflammation of the thyroid gland
If you experience severe side effects, your doctor may need to temporarily or permanently stop your immunotherapy treatment.
“The side effects of immunotherapy are not, quote, forever. Depending upon the severity depends upon how we manage it. There are some patients who will get diarrhea, and we can give them treatments to calm down their diarrhea, which lasts a couple of days. It might be sporadic over a couple of weeks,” Dr. Pavlick said.
WATCH: Why immunotherapy Isn’t for Everyone
Immunotherapy doesn’t work for everyone with cancer. Dr. Vamsidhar Velcheti, the director of thoracic oncology at NYU Perlmutter Cancer Center, says that, unfortunately, it’s still difficult to predict which patients will respond well to immunotherapy treatments.
“The ways cancer generally escapes the body’s immune system is by protecting itself by producing certain proteins,” said Dr. Velcheti. “PD-L1 is one of those proteins that actually helps protect the cancer from the body’s immune system. For patients that have high levels of PD-L1, you could potentially use single-agent immunotherapy with good outcomes. The problem is that these proteins are constantly in flux.”
When Cancer Undergoes Metastasis
Stage 4 or metastatic cancer means the cancer has spread beyond its point of origin and into distant parts of the body. While the cancer is often more challenging to treat at this advanced stage, treatment options still exist. In metastatic breast cancer, for example, current treatment options include hormone therapy, chemotherapy, and targeted drugs. Sometimes, surgery and/or radiation are considered. With advanced disease, treatment aims to keep you as stable as possible, slow the tumor growth, and improve your quality of life.
For women with HER2-positive breast cancer, meaning they have high levels of a protein called HER2 on the surface of their cancer cells, targeted treatments are available. Women diagnosed with triple-negative breast cancer have found hope with chemotherapy and immunotherapy.
WATCH: How Immunotherapy is used to treat advanced triple-negative breast cancer.
For postmenopausal women with hormone-receptor-positive and HER2-negative breast cancers, a newer class of drugs called CDK4/6 inhibitors are available. These drugs have been shown to improve survival in some women with metastatic cancer.
These CDK4/CD6 drugs decrease the amount of estrogen that can be taken into a cancer cell, slowing the rate at which that cancer cell can expand.
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