Fellow, Department of Medical Oncology and Hematology
MedStar Washington Hospital Center/Georgetown University
HER2-positive (HER2+) breast cancer cells have more HER2 receptor (a protein on the surface of cells) than normal breast cells. Approximately 30% of patients with breast cancer are of the HER2+ subtype. Before HER2 targeted therapies (i.e. treatments that directly block the receptor HER2) were developed, patients with HER2 positive breast cancer had a very aggressive form of disease. With the use of trastuzumab, an anticancer drug that directly targets the receptor HER2, and more recently, lapatinib, pertuzumab and ado-trastuzumab emtansine, patients are able to live longer and have better control of their disease. Unfortunately the use of HER2 targeted therapies can increase the risk of heart problems and for this reason these treatments were only studied and approved for patients with normal heart function. Dr. Lynce plans to give HER2 targeted therapies (trastuzumab, pertuzumab and ado-trastuzumab emtansine) to patients with HER2 positive breast cancer and mildly decreased heart function. As part of the initial study assessment, patients will be evaluated by a cardiologist and will receive appropriate medications to strengthen the heart. Dr. Lynce will perform frequent monitoring of the heart function with a test called echocardiogram that will provide a detailed “picture” of the heart. She will draw blood along with routine blood tests to try to learn how to predict who will develop heart problems. At the beginning of the study, Dr. Lynce will also collectblood samples to be analyzed in order to try to understand why some patients develop heart problems after being treated with HER2 targeted therapies while other do not. The study will take a maximum of twelve months and patients will be monitored for six additional months."
Dr. Lynce reports that the study has received full IRB approval, is open for patient enrollment since September 2013 and has accrued five patients through early January 2014. The research team accrued three patients in the adjuvant setting, all being treated with trastuzumab, and two patients in the metastatic setting, one receiving trastuzumab and the other receiving pertuzumab and trastuzumab. For each patient the researchers are collecting blood samples at different time points for future research analysis. So far there have been no cardiac events and patients are doing well. Dr. Lyncewas selected to present the study design in the form of a poster at San Antonio Breast Cancer Symposium 2013.
Dr. Filipa Lynce is a second year medical oncology and hematology fellow at MedStar Washington Hospital Center. She obtained her medical degree at Universidade Nova de Lisboa in her home country, Portugal. Dr. Lynce started her fellowship in medical oncology at the Portuguese Institute of Oncology and from the beginning felt a connection to patients diagnosed with breast cancer and intellectually challenged by the disease.
Two years later, Dr. Lynce felt the urge to change her career path to continue her medical training in the United States. She started a residency program in Internal Medicine at MedStar Georgetown University/MedStar Washington Hospital Center, Washington, DC and graduated in 2011. Dr. Lynce’s peers recognized her as the Best Intern in 2008-2009 and the Best Resident in 2010-2011. She continued her training in medical oncology at MedStar under the mentorship of fellow BCRF grantee, Dr. Sandra Swain. MedStar has one of the strongest cardiology departments in the country and a program in Cardio-Oncology fully dedicated to oncology patients. MedStar has developed a clinical trial to evaluate the cardiac safety of HER2 targeted therapies in patients with mildly reduced cardiac function while on optimized cardiac medications. The MedStar group will also analyze cardiac strain analysis, ultra-sensitive troponins and single nucleotide polymorphisms (SNPs) to discover better ways of predicting cardiotoxicity in breast cancer patients. Furthermore, Dr. Lynce had the opportunity to present her protocol at the Methods in Clinical Cancer Research Workshop jointly hosted by the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) in 2012 and received invaluable scientific input from BCRF grantees, Drs. George Sledge and Edith Perez.