An alternative form of a common breast cancer drug glides on the skin instead of traveling the distance through the blood stream. It’s a more direct route to tumor cells, and it may help patients avoid obstacles along the way.
Rosalie Saviano, breast cancer survivor: “I had three different areas of cancer in my right breast.”
The diagnosis wasn’t a surprise for Rosalie Saviano. Her mother and sisters had faced the same news. Her doctor recommended a lumpectomy, but first she was offered the opportunity to participate in a small clinical trial.
Rosalie Saviano:: “I said ‘Yes, I would be willing to do that,’ and I was happy to because look at my family history and all the women this could hopefully help in the future?”
At the time, Northwestern Medicine breast cancer researcher Dr Seema Khan was testing an alternative form of tamoxifen, a drug known to help stop the spread of cancer cells. It’s commonly prescribed in a five-year course for patients like Rosalie with ductal carcinoma in situ – cancer contained in the milk ducts of the breast. And it’s often recommended as a prevention therapy for healthy women at high risk to develop breast cancer in the future.
Dr Seema Khan, Northwestern Medicine breast cancer researcher: “For women with invasive cancer, you do need the drug in the whole body. But for high risk women and women with DCIS, they only need it in the breast.”
So the idea was to introduce a topical treatment – a gel form of tamoxifen applied to the skin of the breast.
Dr. Khan: “So the thought was if you put the drug on the skin on the breast it’s really going to concentrate in the breast.”
Unlike an oral medication that circulates throughout the blood stream – the concept of the gel was to contain the medication where it was needed most – in the breast -- minimizing exposure to other areas of the body.
Dr Khan: “The side effects of tamoxifen – the one most women experience at some level – hot flashes, it feels like menopause, but it’s not really menopause it’s just the hot flashes. The other serious side effects that are very rare but are more serious, are cancer of the uterine lining and blood clots.”
In the study, half the participants received a placebo gel and an active pill. The others had an active gel and a dummy pill.
Rosalie Saviano: “You get up in the morning, take a shower, put on body cream anyway. It was no different than putting on body cream.”
It was a simple routine and Dr Khan and her team were looking for simple numbers. First, they measured the amount of cancer cells in the breast at the time of diagnosis and again six weeks later before patients underwent surgery.
Dr Khan: “Our goals were to look at whether the cell growth rate in the DCIS was decreased equally with the gel and the pill. That would tell us the gel has good possibilities of being as effective as the pill.”
The results were encouraging. The gel appeared to be as powerful as oral tamoxifen when it came to halting cancer growth. And when the researchers looked at how much medication each delivery method brought to the breast …
Dr Khan: “The drug concentrations were remarkably similar.”
In the blood stream, another promising find.
Dr Khan: “The concentration was five-fold higher in the oral group than in the gel group, so the circulating levels are low, the breast levels are high and it decreased growth rate, so those were all good things we hoped to see.”
Still, the study had limitations.
Dr Khan: “It was not long enough it was what we call proof of concept – so it tells us this is a concept that should work, it’s very encouraging information but there is still quite a bit of work ahead …
Dr Khan and her team are now investigating another form of the gel – an anti-progesterone agent they hope will show the same promise. You can learn more about this study – set to begin this fall -- by calling (312) 472-4759 OR emailing firstname.lastname@example.org
To read more about Dr Khan’s previous breast cancer gel study, go to: