An update on the status of Dr. Zhou's TNBC project.
Earlier this year I had the pleasure of sitting down with the super smart structural and chemical biologist Dr. Ming Ming Zhou, to discuss Triple Negative Breast Cancer and his quest to develop a targeted therapy to treat the disease.
For those of you who don't know (and I meet them quite often) breast cancer has several subsets one of which, Triple Negative Breast Cancer or TNBC refers to breast cancer that does not express the genes for ER (estrogen), PR (progesterone) or HER2 (human epidermal growth factor) receptors. Normally if you are positive for one of the hormones I mentioned, then your doctors will have a very specific treatment plan, unique to the the hormone your overproducing, suppressing it. With TNBC there are currently no approved hormonal therapies, making TNBC really hard to treat. We're pretty much left with chemotherapy or a clinical trail.
The good news is researchers such as Dr. Zhou are actively addressing this disparity and chipping away, trying to come up with a treatment plan that works.
Without getting to complicated (because TNBC is super mysterious with multiple layers) I'll just break down the highlights of the conversation and hopefully shed some light on where Dr. Zhou's team is in regards to a timeline on the research project.
So right away I wanted to know if the research Dr. Zhou was conducting was going to address all forms of TNBC or focus on one of the subsets (yeah, that's right TNBC has subsets too. A quick Google search of BLC - basal like carcinoma, which make up to 80% of TNBC cases will lead to a slew of super complicated, wordy based articles) Dr. Zhou's response: His teams research is broad based (yay) and is focused on creating therapy that will treat TNBC across the board and not specific to one subset.
Here is the basic pie chart of Triple Negative Breast Cancer Subsets provided by Clinical Cancer Research AA Journals.
A wave of relief rolled over me, and of course once I heard this, my super toothy grin emerges. I wonder out loud how Dr. Zhou's team is going to attempt to figure this out. Dr. Zhou simply answered "Find the root cause"! He explained that even with the extremely complicated subsets, all TNBC's share a commonality. In addition finding out what causes the over expression of cytokeratins (proteins) and addressing that aspect bid key. It's the over expression of proteins that can cause cells to get out of whack, multiply quickly and become dangerous.
So where what's up with the research? Dr. Zhou replied that his team is still in the pre-clinical trail phase (just working with animals) and putting together the immense amount of data needed to present to the FDA in order to get permission to move forward into a Phase 1 (where his team will test the treatment on a small group of people to evaluate the safety). Dr. Zhou reminded me that gathering, presenting and proving that a compound is ready for testing is not an easy task.
So, in the meantime, I'm wondering should patients when initially informed that a biopsy is needed, request that if the test comes back as TNBC that a definitive answer on what subset it is be given to patients at the onset of diagnosis? Dr. Zhou smiled and indicated that this clarifying information depends on the patient. I paused and thought about it for a while. Would that have made a difference in the way I approached my treatment? Would knowing this information, despite the fact that there are currently no approved hormonal treatments for other's diagnosed with TNBC be helpful in the overall treatment plan? Would I have went straight to apply for a clinical trail or immunotherapy forgoing chemotherapy if conclusively what my TNBC subset was?
Alright, suppose I want to know (my TNBC subset) past treatment, where would I even begin to find this information? Dr. Zhou recommended starting with the physician that treated the cancer. The answers may even be in the pathology reports (post biopsy & post surgical).
In addition I wanted to know about the disparity in representation in clinical trials for TNBC in women of color. Is it something in our genes that should be specifically addressed? Or was I off base and it's more of a socio economic factor that is responsible for the higher percentage of TNBC in communities of color. I wanted to know his opinion, on what the deal was (although TNBC is effects all races, women of color lead the percentage of those affected & dying). Now before anyone gets up in arms over my observation, it's public knowledge. Any web search TNBC article will usually have this information in the first or second paragraph. Hey, it could be possible that a study regarding African Americans & Latina could lead to the very breakthrough TNBC needs? The elusive answer may be in our genes., securing a treatment for everyone. Again, Dr. Zhou directed me back to having the conversation with the my oncologist, the believing that the conversation should begin there.
Okay, I see his point of view. It reinforces my firm belief in having a really good informed oncologist who treats their patients on a case by case basis, who is willing to introduce the subject of clinical trails to their patients combined with the level of trust a patient has in the medical system (but that's another long subject for another post).
As I gazed out the window of Dr. Zhou's office, with the spectacular view of Manhattan, The East River, Brooklyn & Queens I could see him observing me, quietly. I believe he knew, what my next question would be and before I could answer he took it upon himself to give a few words of advice.
Dr. Zhou reminded me that the last time we spoke, he recommended keeping my life on a regular schedule. Eating, exercise and sleeping should basically happen on a scheduled routine basis. But in addition he expanded on some basic facts.
Dr. Zhou recommended that my diet be made up of foods that were non inflammatory. In order to assist the "helper" cells that give out marching orders to attack and kill the bad cells, I should be consuming healthy amounts on non inflammatory foods. Here is a really simple article with pictures on five grouping examples on non inflammatory foods from Oprah.com
Dr. Zhou recommended decreasing the amount of stress that I am exposed to everyday and that a positive attitude is really important. Dr. Zhou noted that in other large urban populated parts of the world TNBC is on the rise and alluded to lifestyle and outside pathogens playing a role in the possible contributions to the mystery of this complicated disease. Those little jewels of information bolstered my confirmation, that changes regarding diet & incorporating exercise, meditation, laughter and love in my regime will help me keep this disease in remission.