M.medical oncologist Nina Dabreo, M.D.An assistant professor of medicine at the NYU Long Island School of Medicine, treats patients at various stages. breast cancerShe also sees women with benign but high-risk breast disease and advises them on options for lowering their risk.
as Medical Director of the Breast Medical Oncology Program at Perlmutter Cancer Center at NYU Langone Hospital – Long IslandDr. D’Abreo is involved in creating and implementing programs that help every stage of the breast cancer treatment continuum. diagnose to survival.
He talks about how he decided to become a doctor and how the treatment of breast cancer has changed.
Medicine was not your first choice as a career. Please tell us how you became a doctor.
I grew up in Mumbai, India, and my mother was a biology teacher, so science was her specialty. She wanted to become a doctor, but she couldn’t do it for many reasons. Growing up, I was good at mathematics, science, and biology, but mathematics and physics were my strengths. rice field. But her mother wanted me to become a doctor.
In India, due to the structure of higher education, scores are important in qualifying exams. Unbeknownst to me at the time, my parents submitted an application for admission to medical school. And lo and behold, I had an interview. I promised to attend some medical school classes and see how things went. I went to engineering school, he went to medical school for three months, and soon after. After my first anatomy exam, I was hooked. There is a lot of physics involved in the human body. Pharmacology was great and physiology was what really got me. After the first three months, I took a short exam and it went well. I gave up on enrolling in engineering school and decided to pursue a career in medicine.
As a medical oncologist specializing in treating breast cancer patients, what changes in treatment have you seen during your career?
The most important advance is personalized therapy, which refines treatment to suit the individual patient’s tumor biology. We have moved away from the “one size fits all” style of treatment, a timeless history of breast cancer treatment from the era of radical mastectomy to the eventual evolution of medical oncology.Traditionally, we have many chemical treatment to all patients. While we do this for some patients for good reasons, we are now individualizing treatment and tailoring it to both the patient’s biology and clinical condition. In some cases this means adding treatment as needed and in others de-escalating. Personalized therapy continues to evolve and refine in her 14 years of practice as a medical oncologist.
Can you describe one or two particularly exciting clinical trials that you are leading?
I am a principal investigator for the NYU Langone network of two exciting collaborative group-led trials aimed at optimizing treatment modalities for HER2-positive breast cancer. This is an aggressive form of the disease, and the patient is usually given multi-drug chemotherapy in combination with her HER2-blocking antibody, back and forth. surgery. CompassHER2-pCR This is a phased palliative trial, led by the Eastern Cooperative Oncology Group, using a complete pathologic response (pCR) to one dose of chemotherapy with a HER2-targeted agent before surgery to treat patients who do not need it. Adequately minimizing the use of additional chemotherapy. that.
called the second part of that trial Compass HER2 RD, are investigating the optimization of postoperative treatment. This is for people who have not had a complete response and have residual disease (RD). These patients are usually given her HER2-targeted drug called TDM-1. The trial allows her to escalate to TDM-1 in combination with another oral HER2 blocker. These are good examples of adjusting treatment based on tumor response, not over-treating or under-treating.
Another area of my interest is using non-pharmacological approaches to improve cancer treatment. I think there is a growing interest in the idea that exercise is medicine. Exercise not only makes patients feel better, it can also improve cancer outcomes.We develop researcher-led projects in collaboration with colleagues who are experts in the field of oncological rehabilitation Perlmutter Cancer Center As with another academic center that is considering adding exercise to patients with early-stage estrogen receptor-positive breast cancer. to see if it affects So this is another way to optimize cancer treatment, but using exercise in combination with hormone therapy.
Do you have a success story with a patient you can share?
There are many success stories of professional and personal satisfaction.
Eight years ago, I treated a pregnant patient diagnosed with locally advanced HER2-positive breast cancer. At the time, she did not have adequate insurance and was having trouble finding medical care.Working with our oncology team and OB/GYN, we were able to successfully get her through. pregnancyI am in the clinic with my daughter who was born right after the treatment. Watching her child grow over the years has been such a joy to me. It shows how we were able to successfully lead this patient out of a time of crisis.
Another professionally pleasing story concerns a patient who participated in a clinical trial investigating the use of adjuvant therapy for patients with triple-negative breast cancer. This was an escalation trial in which immunotherapy was added to patients with residual disease after chemotherapy and surgery. We were one of the few sites on Long Island to offer trials when they opened.
She is from Memorial Sloan Kettering Cancer Center (MSKCC). Although this patient did not have access to the trial at MSKCC at the time, her oncologist was able to refer her and she went to us and successfully enrolled her. She has now been away for about 3 years and is doing very well. It was a huge leap of faith. The experience shows how cancer treatment can be truly collaborative. Patients can find resources and help them thanks to her network of excellent supports.
Looking ahead to the next five to ten years, what can breast cancer patients expect from new treatments?
One advance is in patients receiving long-term estrogen-driven therapy. We know some patients will be on treatment for her 10 years, but there are techniques that could help assess who among those patients really need extended treatment. One way he does this is by analyzing circulating tumor DNA and identifying markers in the blood to predict whether the cancer is likely to return. This is an evolving field. Several applications of this science are already in clinical use. for example, colon cancerand I think this can also be applied to breast cancer, further improving how long patients are treated and when to change treatments.
New antibody-drug conjugates with low toxicity and low-dose chemotherapy conjugated to targeted drugs are also on the horizon and may replace conventional chemotherapy.
An attractive area is personalized vaccines. Breast cancer is also one of the tumor types where using the patient’s own immune system in many ways, including chimeric antigen receptor (CAR) T cells, is a promising area. This is particularly relevant for cancer patients like triple-negative breast cancer, for whom there are few effective treatments.
What can the person who sees you for breast cancer treatment expect?
Despite all advances in treatment, one thing that remains constant is the individualization of cancer care. Not only is treatment individualized, but when someone comes to Perlmutter Cancer Center, they are cared for by a very personal team who are always available for contact. Nurses and medical assistants know their patients and they become part of the family. This very one-on-one approach is what patients can expect when they see us. But it’s all done in a very personalized way.
A story I shared about a patient who took my daughter to the clinic illustrates this. When she and her daughter came in, you can see that the entire team that treated her was happy to see her, and we took the extra step of integrating her entire team into patient care. rice field. We pride ourselves on being responsive and available to our patients and being able to answer patient questions in a timely manner. It is this team approach that involves personal involvement.
