Elizabeth Mittendorf, MD, PhD, Robert and Karen Hale Distinguished Chair in Surgical Oncology, director, Breast Immuno-Oncology Program, Director of Research, Breast Surgical Oncology, Dana-Farber/Brigham and Women’s Cancer Center, discusses the rationale for updating the AJCC staging system in patients with breast cancer. This system was originally developed in the 1970s but is still used today.

For decades, the staging of breast cancer has been based off the anatomic extent of the disease. This looked at the primary tumor, evidence of disease in lymph nodes, and distant metastases, in what’s known as TNM staging.

Since then, a number of different subtypes have been discovered, subtypes dictated by tumor biology, according to Mittendorf. However, the TNM staging did not account for tumor biology, which influences many treatment decisions today. Because of this, the staging system was very dated.

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Elizabeth Mittendorf, MD, PhD, discusses the rationale for updating the AJCC staging system in patients with breast cancer. This system was originally developed in the 1970s but is still used today.

Dr. Mittendorf Discusses Rationale for Updating the AJCC Staging System

Elizabeth Mittendorf, MD, PhD, Assistant Professor in the Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center, discusses the potential to target cyclin E in breast cancer.

Cyclin E is an important cell cycle regulator, Mittendorf says, and it has been discovered that it can be cleaved into low molecular weight (LMW) isoforms. These LMW isoforms are tumor-specific and cause cells to be less susceptible to inhibition and proliferate through the cell cycle more rapidly.

From a disease standpoint, LMW cyclin E is associated with a poor prognosis, meaning that it could be a target, though this is still be pursued. Mittendorf says that she views cyclin E slightly differently and says that it could be a target for immunotherapy because of its overexpression and abnormal expression in breast cancer.

This preclinical observation has been published and Mittendorf says that a decision needs to be made as to whether or not to pursue cyclin E as a therapeutic strategy.

Dr. Mittendorf on Cyclin E as a Target in Breast Cancer

Elizabeth Mittendorf, MD, PhD, Assistant Professor in the Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center, discusses the use of peptide vaccines for the treatment of breast cancer.

In her presentation at the 12th International Congress on the Future of Breast Cancer from July 18-20, 2013, in Huntington Beach, CA, Mittendorf spoke about HER2-targeted vaccine therapies.

Provenge, for the treatment of metastatic castration-resistant prostate cancer, is the only FDA-approved cancer vaccine, Mittendorf notes. Treatment with Provenge involves leukapheresis, blood manipulation, and administration into the patient. This is an intricate and very expensive process, Mittendorf says.

A peptide is a small piece of a protein, Mittendorf says, but is large enough to be recognized by the immune system. A peptide vaccine is given as a simple subdermal shot once per month for six months, followed by booster inoculations.

If the peptide vaccine approach is proven to be efficacious, it would be cost-effective and simple to produce, making it more widely used than complex vaccine constructions. On the other hand, Mittendorf notes, peptide vaccines probably will not stimulate enough of an immune response to take care of an aggressive disease, which is why they are being investigated in the adjuvant setting.

Elizabeth Mittendorf, MD, PhD, from MD Anderson Cancer Center, discusses the use of peptide vaccines for the treatment of breast cancer.

Elizabeth Mittendorf, MD, PhD

Articles

Dr. Mittendorf Discusses Rationale for Updating the AJCC Staging System

Dr. Mittendorf on Cyclin E as a Target in Breast Cancer

Dr. Mittendorf on Peptide Vaccines for Breast Cancer