New tools are transforming breast cancer treatment in Pittsburgh

Lissa Yanak had been cancer-free for four years when doctors diagnosed her — again — with the same type of cancer.

This time around, in early 2019, the triple negative breast cancer, spread to the lymph nodes above the collarbone.

Yanak and her husband didn’t know what the future held, so they headed out west and climbed Camelback Mountain in Arizona.

“That’s where I lost my hair…for the second time,” said Yanak, 32, of Pittsburgh’s South Hills.

Yanak is now cancer free. Doctors treated the deadly form of cancer with a new drug therapy developed by a UPMC researcher. Beset by debilitating nausea, Yanak was able to tolerate her cancer treatments with acupuncture, a treatment that involves inserting thin needles in the skin to treat pain and other ailments. She received the treatment for free at the nonprofit Glimmer of Hope, which recently partnered with Allegheny Health Network’s new cancer center.

While October is Breast Cancer Awareness Month, filled with pink ribbons and bows and success stories, there is still much work to be done and lives to be saved. About 90% of women survive breast cancer because of research and newly developed treatments, according to the American Cancer Society.

But for that other 10%, breast cancer is still lethal. The prospects for survival and living through treatments are hellish and uncertain.

Yanak’s story is but a small sample of the research and multiple clinical trials at Pittsburgh area hospitals for breast cancer detection, treatment and recovery.

At UPMC Hillman Cancer Center, doctors are using immunotherapy, a form of therapy that uses the body’s own immune system to fight cancer, coupled with chemotherapy to treat triple negative breast cancer like Yanak’s. The most dire five-year survival rate for triple negative is 11% if the cancer is advanced and has spread to distant parts of the body, according to the American Cancer Society.

Yanak was treated with atezolizumab, an immunotherapy coupled with chemotherapy, developed by Dr. Leisha Emens, co-leader of the Hillman Cancer Immunology and Immunotherapy program.

A physician-scientist, Emens moves easily from the laboratory to the bedside to treat patients, said Dr. Robert Ferris, director of UPMC Hillman Cancer Center.

Emens’ treatment of immunotherapy and chemotherapy helps between 20% to 30% of triple negative patients by shrinking their tumor or holding it in dormancy, Ferris said.

The frontier is now finding out why not all women benefit from immunotherapy/chemo therapy, Ferris said.

“It would be great to cure cancer with one fell swoop,” he said, “but advancements are incremental.”

More help with living through treatments

On the outside, life-saving treatments make everything good again, but not without substantial fortitude, and extra help.

“I was afraid to go places because I was sick all the time,” Yanak said.

Acupuncture, offered free twice a month, dissipated the nausea, she said. Such therapy is not covered by traditional health insurance. So a local nonprofit, Glimmer of Hope, provided the acupuncture for free. Yanak couldn’t have led a normal life going through treatment without it, she said.

The nonprofit just teamed up with the AHN to establish the Glimmer of Hope Metastatic Breast Cancer Center in AHN Cancer Institute at Allegheny General Hospital in Pittsburgh’s North Side. The center targets patients whose cancer has spread to other parts of the body.

The center offers one-stop shopping to visit a number of doctors and receive a number of medical services in one visit. It also helps ease the process for patients to qualify for clinical trials on new treatments AHN offers in conjunction with Johns Hopkins Kimmel Cancer Center.

“I would rather try to support women as they go through cancer and provide services that the foundation would pay for such as acupuncture,” said Diana Napper, who founded Glimmer of Hope Foundation in 1994.

While treatments have come a long way, metastatic breast cancer is still a disease that in most cases is not curable, said Dr. Christie Hilton, director of the Glimmer of Hope Metastatic Breast Center and medical oncology lead physician in the AHN Cancer Institute.

“These women will need to be on some form of treatment for the rest of their lives, and that comes with side effects,” she said.

Some patients don’t lose their hair and don’t look like cancer patients but face issues such as pain, hot flashes, nausea, vomiting, constipation and more, Hilton said.

“They need more help and shouldn’t have to spend their lives in waiting rooms at the doctor’s office,” Hilton said.

Napper added, “We need to be flexible and try to make the experience of being sick a better experience.”

Shorter radiation therapy for early stage breast cancer

Earlier this year, UPMC ran with the latest breakthrough research from Europe that radiation can be cut by half or more for women treated for early stage breast cancer, from stage 0 to stage II. Many more health systems are expected to follow suit.

Typically, women can expect about 20 days of radiation after surgery, sapping their energy, time and finances.

“The shorter duration of radiation will cause less side effects to breast tissue, less fatigue, less cost to the patient,” said Dr. Sushil Beriwal, deputy director of Radiation Services at UPMC Hillman Cancer Center and medical director of the department of radiation oncology at UPMC Magee-Womens Hospital.

Another part of treatment is that there is no longer one size fits all, as radiation treatments are customized to the individual.