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Interesting Progress on the mTOR Signaling Pathway and ER-Positive Breast Cancer By Dr. Robert D.

Stebbins

As a former Palo Alto medical practitioner, I focused on the clinical care of patients with oncologic and hematologic diseases, including leukemia and breast cancer. Patients with the latter condition can take heart in a new drug for estrogen receptor (ER)-positive breast cancer that is currently attracting significant attention in the medical community.

Approximately three-fourths of all breast cancers are classified as ER-positive, meaning that they grow in response to estrogen. Hormonal therapies are standard for this type of cancer, with breast cancer tumors responding in about 60 percent of cases under current treatment protocol. The drug tamoxifen is frequently taken by patients for several years after the initial ER-positive breast cancer treatment, effectively blocking breast cancer cells estrogen receptors and also inhibiting estrogen from binding to them. The aromatase inhibitor class of drugs halts estrogen production in post-menopausal women; however, it cannot be taken by pre-menopausal patients.

The newly developed drug everolimus (Afinitor, Zortress), combined with existing exemestane therapy, has been shown in a recent study to extend progression-free survival among patients by four months. Everolimus works by targeting the mTOR signaling pathway, which is one of the many factors involved in determining cell differentiation and growth patterns. Along with phosphatidylinositol (PI) 3-kinases, mTOR appears to be one of the important regulating proteins in breast cancer cell growth and division. A recent study at the Dana-Farber Cancer Institute in Boston involved patients with ERpositive breast cancer who had undergone numerous estrogen inhibitor treatments in the past. Non-control patients were given the mTOR inhibitor everolimus in combination with standard exemestane therapies. While the new treatment successfully delayed cancer progression among many patients, response rates were less affected and some side effects such as mouth sores and diarrhea were observed. The study does seem to be a proof of pathway in demonstrating the mTOR and PI 3-kinases as critical research areas in lengthening progression-free survival rates among ER-positive breast cancer patients. About the Author: Robert Dean Stebbins, MD, treated patients at a private practice in Palo Alto, California, for more than 20 years, also serving as Founding President and Chairman of the Board with the Private Physicians Group at Stanford, Inc.

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