資料來源：https://dailybruin.com/2016/10/05/breast-cancer-drug-found-at-ucla-leads-shift-toward-personalized-care/

October is the only month devoted to breast cancer awareness, but researchers at UCLA have breast cancer on their mind year-round.

Increasingly, researchers and clinicians at UCLA are shifting towards personalized medicine to improve patient prognoses.

Sara Hurvitz, an oncologist at the Ronald Reagan UCLA Medical Center, said the drug palbociclib, which was clinically tested and proven to treat breast cancer at UCLA, is at the forefront of therapies specialized to target specific kinds of breast cancer.

Palbociclib is particularly effective in women with hormone-receptor positive breast cancer, the type that affects approximately two-thirds of women with breast cancer, she said.

“I put several patients in the clinical trial for this drug back in 2009,” Hurvitz said. “One of the patients had very advanced incurable breast cancer, and she hasn’t had her breast cancer return in 6.5 years.”

She said palbociclib boosts the median length of time the cancer remains dormant by 10 months, in comparison to patients using the conventional treatment: antiestrogen therapy.

She said the FDA approved the drug in 2015 due to its positive results.

Though the drug was a success, Hurvitz said she thinks breast cancer research is often stalled by inadequate funding, which is why researchers often turn to philanthropic support to accrue the necessary funds. She added conflicting motivations with pharmaceutical companies often hinder efficient research.

“When working with the pharmaceutical industry, sometimes the scientific aspects of the study are not necessarily preserved, and marketing aspects and financial aspects are (prioritized).” she said. “Not all the clinical questions you want to ask are being answered because of differing motivations.

Parvin Peddi, an oncologist at Ronald Reagan UCLA Medical Center, said UCLA is also testing cold caps, chilled helmets women can wear during treatment, to improve the psychological health of patients undergoing chemotherapy for breast cancer.

She said the cold caps prevent the chemotherapy drugs from reaching the hair follicle and causing hair loss, a side effect that is often psychologically devastating for patients.

The caps are available for purchase but most types are not yet FDA approved. As a result, their price is loftier because insurance does not cover the cost.

Peddi said lack of patient accessibility to clinical trials presents a major barrier to breast cancer research and denies patients the opportunity to test novel treatments. Peddi said breast cancer patients in smaller communities or who are not enrolled in large research-driven medical programs like those at UCLA are at a disadvantage because they have minimal access to clinical trials.

“Everybody should have the opportunity (to participate in clinical trials) because that’s how you move the field forward,” Peddi said.

Peddi said she thinks the biggest barrier to advancements in the field of breast cancer research is doctor and patient reluctance to renounce old therapies.

“Some therapies are already so established that it’s hard to get people to change their mindset and try different therapies that may actually be better,” Peddi said. “(For example), cancer doctors are reluctant to enroll people in clinical trials (featuring novel drugs).”

But she said she’s confident the field is moving in the right direction.

“In the next few years, we’re going to distance ourselves from blind chemotherapy and shift towards personalized cancer care,” Peddi said. “We’re going to say ‘this is the breast cancer you have, it’s dependent on factors A,B,C; I’ll give you drugs for these particular factors, not give you same drug I give everyone else.’”

Polly Roberts, a professor of world arts and cultures/dance and a breast cancer survivor, said palbociclib did not work for her, but the shifting movement towards personalized care helped her cope with her stage 4 cancer.

“When I asked (my oncologist) what my prognosis was, she refused to give it to me,” Roberts said. “She said ‘you are not a statistic – you are an individual.’”

She added her oncologist initially said she would normally be hesitant to allow patients with stage 4 cancer – the most advanced phase – to re-enter their career. However, she allowed Roberts to return to UCLA to teach because she recognized that doing so would help Roberts cope with her illness.

“When I walked back into the classroom that fall quarter, it was like rebirth,” Roberts said, “My students were my support system. Almost everyone knows or has had a loved one with cancer, so students just get it.”

Roberts said she thinks integrative medicine, which emphasizes mental health in addition to conventional treatments and was pioneered by the Simms/Mann-UCLA Center for Integrative Oncology, is one of the major advances in breast cancer therapy.

Acupuncture, nutrition and psychotherapy are common techniques used in integrative medicine. She added this form of treatment was critical in helping her cope with her breast cancer.

Roberts said she thinks that with a growing emphasis on integrative medicine and sophisticated personalized care, UCLA oncologists are moving in the right direction.

“It’s an important time in breast cancer research, and I want to be here to see it,” she said.