Breast cancer survivors
Her2+ breast cancer
Women under 45
Women over 45
There have been multiple reports in the media of a Florida woman who had a "shot" to treat her DCIS with a promising outcome. This XRAY reviews the underlying story about this early breast cancer vaccine trial. (10/25/19)
|At a glance||Clinical trials|
|Behind the headlines||Guidelines|
|Vaccines and prevention||Questions to ask your doctor|
|What does this mean for me?||Resources and references|
the story of one patient in an early-phase breast cancer vaccine trial.
Many media outlets picked up a story about a woman with DCIS (stage 0) who participated in a clinical trial of a breast cancer vaccine. Headlines included:
Media outlets covered the story of Lee Mercker, who was recently diagnosed with ductal carcinoma in situ (DCIS). DCIS is a noninvasive form of breast cancer. This means the cancer cells formed in the milk duct but haven't spread beyond to invade other parts of the breast. Although DCIS is not life-threatening, it can turn into invasive breast cancer if it is not treated.
In most cases, DCIS is treated with breast-conserving surgery (BCS). A surgeon removes the tumor and a small amount of surrounding normal tissue. BCS is usually followed by radiation therapy. For some women, including Mercker, mastectomy is a better option for treating DCIS.
Mercker said she went to the Mayo Clinic in Jacksonville, FL to start treatment for DCIS. However, her doctor asked if she’d like to try something else first: an experimental vaccine intended to fight off early-stage breast cancer and prevent future breast cancer.
Mercker said that she jumped at the chance, and she was the first patient enrolled in the clinical trial. Over 12 weeks, she received shots of a vaccine designed to train her own immune system to find and attack her precancerous cells, similar to the way flu vaccine works.
Mastectomy or lumpectomy with radiation are standard-of-care treatments for DCIS. It is important to note that Mercker received the vaccine then had a double mastectomy. Even without the vaccine, mastectomy that removed Mercker’s breast tissue would have eliminated her DCIS. However, because she has a mastectomy, researchers were able to carefully examine her breast tissue to see if the vaccine affected her breast cancer cells.
Several studies are looking at medications and vaccines in an effort to prevent or lower the risk for cancer. Similar to the study in which Ms. Mercker participated, it is common for these clinical trials to begin enrolling people who have very early stages of cancer and plan to undergo surgery. The medication or vaccine is given before surgery; afterward, a pathologist looks closely at the removed tissue to see how the drug affected the cancerous cells.
According to clinicaltrials.gov, the current Mayo study is small, enrolling just 43 women who will be followed for a couple of years to observe the vaccine’s safety and side effects. Much larger and longer-term studies will be needed in order to show whether the vaccine ultimately prevents DCIS from becoming invasive breast cancer. Because the research is still early and the effectiveness of the vaccine is still unproven, women who participate will also receive standard-of-care treatment for DCIS.
There are several different types of breast cancer. The vaccine in this study was created to prevent breast cancers that make too much of the Her/neu protein (or HER2 for short), which plays a large role in the development of many breast cancers. If successful, this vaccine may help prevent many—but not all—breast cancers. Currently, clinical trials are testing several approaches to preventing breast cancer or recurrence.
Because the immune system helps people to fight infection and cancer, researchers are very interested in ways to harness it to treat or prevent cancer. New immunotherapy drugs are approved to treat several types of cancer, including breast cancer. Still, although the immune system is a natural part of our body’s defense against disease, like any other treatment, vaccines and immunotherapies must be thoroughly tested to prove they are safe and effective before they become standard of care.
While several headlines suggested that Mercker was “cured” by the vaccine, she did not receive it as a breast cancer treatment. While this research is promising, it is far too early to assume or to state that this is an effective way to prevent or treat breast cancer. It is misleading and dangerous for the media to promote this as a cure. Women diagnosed with DCIS should follow the recommendations of their health care team. Participating in a research study such as this one is the best way to get access to experimental agents, advance science and assure that you receive quality care.
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The National Comprehensive Cancer Network (NCCN) has guidelines for treatment of DCIS. You should talk about which option is best for you with your health care provider. NCCN DCIS 2019 treatment guidelines include:
Following surgery, the NCCN recommends that patients:
Mayo Clinic trial covered in this article:
Other breast cancer prevention trials:
The Washington Times
First Coast ABC News