The San Antonoio Breast Cancer Symposium 2017 [transcript] [audio]

Guest: Dr. Neelima Denduluri

Presenter: Neal Howard

Guest Bio:  Dr. Neelima Denduluri earned her medical degree from the Louisiana State University Medical Center, where she served as President of the American Medical Student Association. Upon graduation, she received the “Exemplar of Desirable Attitudes of the Physician Towards His Patients” award, which is bestowed upon one graduating senior. Dr. Denduluri is highly involved in the local community by participating in community outreach, speaking to support groups, and volunteering at the Arlington Free Clinic since 1999. She has consistently been named as a Top Doctor in Northern Virginia Magazine and Washingtonian magazine, and she has been featured in both local and national media for her expertise in breast cancer. In addition to her passion for patient care, Dr. Denduluri’s dedication to the advancement of medicine has led her to take on multiple leadership roles, including: Associate Chair of the US Oncology Breast Cancer Research Committee; Chair of the American Society of Clinical Oncology (ASCO) Clinical Practice Guidelines Committee; and Cancer Committee Chairman at Virginia Hospital Center. Dr. Denduluri also currently serves as an associate and principal investigator on many clinical trials and is a steering committee member for NAPBC accreditation for the Reinsch Pierce Family Center for Breast Health.

Segment Overview: Dr. Neelima Denduluri, MD, talks about the latest news from the San Antonio Breast Cancer Symposium (SABCS) Dec 2017, her perspective on recent developments and what she sees as potential game changers for the future of breast cancer treatment.

Transcript

Neal Howard: Welcome to Health Professional Radio. I’m your host, Neal Howard. Glad that you could join us on the program today. Our guest is Dr. Neelima Denduluri. She’s here to talk with us about some of the latest news that came from San Antonio Breast Cancer Symposium. She’s the Associate Chair of Breast Cancer Research at the US Oncology Network. Thank you for joining us today, Dr. Denduluri.

Dr. Neelima Denduluri: Thank you for having me.

N: Beyond being the Associate Chair of Breast Cancer Research there at the Oncology Network. What led you to breast cancer research?

D: So interestingly, I grew up in a village in India until I was 6 or 7 and used to go back every summer and shadowed my grandfather who was a community doctor. That really awakened my eyes at a very early age to the health and equities with how my family lived with the surrounding village. Then I went to medical school in college in Louisiana, also a place where I think there are a lot of health and equities and a lot of women health issues that needed to be addressed. I have a wonderful mentor at LSU that opened my eyes to breast cancer research when I was 19-20. It’s become a long passion for me to incorporate women’s health research and make sure that everyone has the great healthcare no matter where they live.

N: I did mention the San Antonio Breast Cancer Symposium. What did you see coming out of the symposium as eye-opening? Or maybe as a potential game-changer in the breast cancer research arena?

D: Interestingly, we’re increasingly dividing breast cancer into subtypes HER2, triple negative, estrogen-receptor positive or buzzwords that we see. But even within the categories, we’re subtyping them further. For example, for negative breast cancer has always been looked at as a tough disease to treat but now we’ve made some advances saying, “These are the people that need more chemotherapy. “ This population is more likely than other breast cancer subtypes to be associated with the genetically associated cancer. There is a class of … for example, PARP inhibitors which seem to improve outcomes for women who develop breast cancer as a result of having inherited the gene from their mom or dad. I would say more targeted therapy, more personalized therapy. Additionally, there are new drugs being developed for each subtype of breast cancer. What really struck me, to be honest, but San Antonio is that some of the old lessons are being revisited. For example, women with estrogen-receptor positive breast cancer which means that the breast cancer feeds off as estrogen or progesterone and that’s a vast majority of women diagnosed with breast cancer. It’s really important that we support them for their anti-estrogen therapy. I really like that things like acupuncture, yoga were looked at as possible ways to help these women tolerate the side effects of this anti-estrogen therapies.

N: Would you say that that was the most significant thing that struck you at the symposium?

D: I think that the overall focus on wellness was very striking to me. This …, while we want people to stay on this drug because it is very important to reduce the risk of cancer coming back or once that they are on cancer therapy we want to reduce the growth as it’s a chronic disease. We also find the way to support them to tolerate them better. Also, as I always like to say, one other thing that struck me is that wellness, in general, is very important … For example, menopausal women that lost 5% of their body weight had a significant reduction in their breast cancer and developing breast cancer. The other thing that is interesting going back to overall supporting one in, is one thing that comes up with a lot of young women that I have the privilege to see is that they’re worried about fertility. There is a very nice conglomeration of trials that were presented that show that suppressing women’s ovaries are putting them to sleep during chemotherapy may enhance their chances of becoming pregnant later and preserving their ovarian functions. I think that it gives people hope because a lot of times when we see young women with breast cancer wherein somewhat of a … situation where we really want to get started on therapy very quickly with something like chemotherapy. And chemotherapy has side effects like premature ovarian failure and fertility. And so while we ideally like to send them to a reproductive endocrinologist for them to save eggs or embryos, sometimes we don’t have time for that or it could cause prohibitive. To be able to offer them a shot that puts their ovaries to sleep that may give them the hope for fertility later was really nice to see.

N: Does this deactivation as it were the ovaries, does it wake itself back up or does it have to be deactivated through a chemical process as well or activated again through a chemical process?

D: That’s a really good question. That’s why we give the shots because it’s reversible. It’s reversible ovarian ablation.

N: You mentioned that some old things have been revisited. That being said, where do you see the future of breast cancer diagnosis and treatment in view of some of these things that you saw at the symposium?

D: I think that we definitely need to make sure that women with estrogen-receptor positive breast cancer stay on their anti-estrogen therapies. Some give them more aggressive estrogen therapy but I think that we need to make sure that women who were diagnosed with breast cancer that have significant family histories or young or have several subtypes of breast cancer, they definitely need genetic counseling and testing. As far as the future, I think really personalizing therapy is becoming more and more important. Making sure that women have access to clinical trials that they can take advantage of the new agent that is being developed. Also, making sure that we support them with the toxicities of the therapies that happen.

N: There are some benefits I’m sure being treated for breast cancer in the community setting. What are some of those benefits that you can tell us about?

D: I always think it’s important for women to get cutting-edge care plus the home. Many of the women and even male breast cancer patients that I see, they have very busy lives for them to go an hour and a half, two hours and traffic to quote-unquote ”major institution” is a real disruption of their life. A lot of my patients walk to our clinic and receive their therapy or it’s easier for their friends and family to support them. I think that as long as there is cutting edge care, I think the convenience and the personalization of community care where everyone knows your name is a real bonus when they’re going through a really difficult time.

N: Being in a community setting, I guess friendships and other personal relationships are forged which also when support.

D: Absolutely. I personally practice right outside of DC in Northern Virginia, very metropolitan suburb, that it is very nice to be able to meet the people I treat – families and things like that at the grocery store or restaurant. I think that it really fosters the sense of community. Additionally, sometimes I know the child, teachers of the women that I treat. A lot of that helps with of course maintain confidentiality but it really helps to know the setting that the patients that I see in the clinic, what kind of lives they have outside of the office room that I see them in.

N: Where can we go online and get some more information and maybe view some of these treatment options and some of this new information that has been presented at the symposium?

D: Sabcs.org is the conference website. Additionally, there is a hashtag on Twitter, breast cancer social media (#bcsm) and a lot of the new drugs, a lot of the new findings from the trials are very well outlined there.

N: I appreciate you coming in, Dr. Neelima Denduluri. Thank you and I’m hoping we’ll talk in the future.

D: Thank you for having me.

N: You’ve been listening to Health Professional Radio. I’m your host, Neal Howard. Transcripts and audio of the program are available at hpr.fm and healthprofessionalradio.com.au. Subscribe to this podcast on iTunes, listen in and download a SoundCloud and be sure and visit our affiliates page at hpr.fm and healthprofessionalradio.com.au.

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