Breast Cancer Clinical Trials at Dartmouth Cancer Center

Clinical trials play a crucial role in advancing cancer treatment and care. Dartmouth Cancer Center, renowned for its comprehensive breast cancer research, offers nearly 20 clinical trials in this area alone, addressing needs from surgical innovations to testing new drugs.

For surgeons

Oncology surgeon Richard J. Barth, Jr., MD, wanted to help find a more accurate method of performing breast cancer lumpectomies to reduce the need for a second surgery. Recognizing that the issue was about placement and imagery led to an innovation called the Breast Cancer Locator (BCL). Years later, the BCL is now in a large clinical trial with surgeons from cancer centers around the country to evaluate the tool’s safety and effectiveness in subjects with non-palpable invasive breast cancer or ductal carcinoma in situ (DCIS).

Industry-sponsored

While some clinical trials are designed and initiated at Dartmouth Cancer Center (called “investigator-initiated trials”), Dartmouth Cancer Center also engages in industry-sponsored trials, such as one led by Linda Vahdat, MD, in partnership with Pfizer. This trial focuses on a new medicine for ER+/HER2- recurrent or metastatic breast cancer, aiming to compare its performance with the standard drug, fulvestrant.

Who are PHOEBE, GERTRUDE and ESTHER?

A whole series of interventional clinical trials explore the effectiveness of combining or adding drugs to standard treatments across various subcategories of breast cancer. These trials are commonly known by women’s names, taken from letters in the registered name of the trial.

“Phase II Study of Estradiol Therapy to Target ER + Metastatic Breast Cancer” is referred to as, you guessed it, the “ESTHER trial.” The ESTHER trial investigates the potential of estradiol, a naturally occurring estrogen hormone, in treating ER+ breast cancer in postmenopausal patients.

And don’t forget DEBRA

Radiation therapy has been widely used to treat breast cancer for many years. That doesn’t mean experts know everything. They are still learning. And learning is done through clinical trials. Radiation oncologist and clinical researcher Lesley Jarvis, MD, PhD, is leading “De-Escalation of Breast Radiation Trial for Hormone Sensitive, HER-2 Negative, Oncotype Recurrence Score 18 Breast Cancer (DEBRA).” This trial examines the possibility of reducing radiation exposure in patients with low-risk, hormone receptor-positive, early-stage breast cancer by evaluating the efficacy of hormonal therapy alone after surgery, compared to the usual combination of surgery, radiation and hormonal therapy.

Not always about treatment

While new treatments cannot reach patients without clinical trials, trials like the one led by Courtney Stevens, PhD, look into enhancing self-care among breast cancer survivors. This particular study aims to promote physical activity through a novel smartwatch app, “PHITbit,” designed to encourage exercise based on survivors’ feelings towards physical activity.

For more details on active clinical trials at Dartmouth Cancer Center, including these and many others, visit cancer.dartmouth.edu.

From the Lab: The Close-up on How it Works

Tetrathiomolybdate (TM) is a copper chelation (bonding) compound used to treat Wilson’s disease, a hereditary copper metabolism disorder. Preclinical (animal) studies of breast cancer and studies of human patients with breast cancer showed that depleting copper decreases the availability of the infrastructure that’s necessary for tumor growth and spread.

TM prevents the creation of the local neighborhoods that cancer cells need to mobilize and create in order to grow and spread. This includes effects on bone marrow cells called HPCs (hematopoietic progenitor cells), which prepare sites in distant organs to receive migrating cancer cells. These bone marrow cells also recruit other cells called EPCs (endothelial progenitor cells) that activate an “angiogenic switch” that establishes blood vessels at the new site to feed the cancer cells.

Early research showed that immediately before cancer recurrence, levels of both HPCs and EPCs spike. However, copper is critical to mobilizing these cells, suggesting that copper depletion should be studied. Copper is also used to produce the fuel that allows cancer cells to travel to other sites, and it helps to create a welcoming environment for cancer cells by remodeling the collagen microenvironment.

Copper depletion appears to inhibit the production, release and mobilization of EPCs from the bone marrow, leading to a suppressed angiogenic switch and promotion of tumor dormancy.