Dr. Cindy Matsen, a doctor at the Huntsman Cancer Institute at the University of Utah, talks about treating breast cancer with a non-invasive procedure.
Interview conducted by Ivanhoe Broadcast News in 2023.
Is it a new technology or just a new way of doing things?
Matsen: It’s more of a new way of targeting an older technology, if that makes sense.
Actually does. Help us explain it. How does it work?
Matsen: So ablation basically means killing tissue without removing it, and there’s a couple of different ways it can be done. It’s usually either with heat or cold. So you either freeze tissue or you burn tissue how you can think about it. So there’s been lots of different ways that has been done over time. This particular technology uses high frequency ultrasound to heat up the tissue. So it’s a heat ablation, but it targets the ultrasound using MRI guidance, which is a new way of getting more precise around how to do the ablation. And for the breast, MRI is actually our most sensitive test for looking at breast tissue. So it gives us the advantage of being able to target tumors more accurately and precisely. So Dr. Allison Payne, who is a PhD that developed the system, she has worked really hard on making this extremely precise. So we can actually- in this trial, we’re only ablating half of the tumor, but it’s so precise that she can do that.
And that’s something you couldn’t do before?
Matsen: They could do it, but it was less accurate or less precise. So the MRI just allows for more precision in terms of how to target the ablation.
I remember someone telling me about brain tumors, that they do the MRI just to make sure they got everything out. Do they do the same thing with this?
Matsen: That’s not where we’re at yet. So this is actually more of what we would call like a Phase 1 trial, where it’s really looking at safety and not necessarily efficacy. So we’re not looking at how effective the ablation is, per se, we’re looking at how well the equipment works and how comfortable it is for people to undergo the procedure. And that’s the first step that you do when you’re developing different kinds of treatments. And so, this particular one does have some efficacy outcomes, but those are the secondary things that we’re looking at and that’s why we’re only ablating half of the tumor right now. Because one of the things that there’s a concern about is the loss of information that you might get if you ablate it and don’t take it out. So this is not a sort- this is not a trial where surgery is not done, surgery is still done. So this is ablating half the tumor and then removing it with surgery so they can compare the half that was a bladed to the half that wasn’t. And also, the main outcome is seeing how well people tolerate it, how comfortable are they, how much pain might they have during this procedure. And so that’s the primary thing we’re looking at right now. Is the comfort level essentially of the patient.
That’s the immediate side effects, right?
Matsen: Yeah, exactly. So looking at what they call tolerability.
So you’re saying this is a technology mostly about precision, why is that important?
Matsen: Well, in the end, you don’t want to affect normal tissue that you don’t need to affect. You want to leave as much normal healthy tissue intact as possible. And one of the things that is a challenge in breast cancer, is that the tumors often have like little arms or little tendrils that come out from them. And that’s true for a lot of cancers. In breast cancer surgery, what we’re doing lympectomies, we’re always trying to get a clear margin or a healthy edge of- or an edge of normal tissue, essentially, around the tumor. And so that means we have to take out a little bit extra beyond where the edge is. And in ablation, the same thing applies, like you’re trying to ablate the whole thing, but try to get a little bit of an edge, but you don’t want to go too far because that defeats the purpose. You’re trying to preserve as much healthy breast tissue as possible. And so you’re trying to be really accurate and precise in terms of how far out you need to go, so that you can preserve as much healthy breast tissue as you can. And it’s the same thing as when you were talking about brain surgery, same thing. They’re trying not to go too far out, so that you’re not affecting healthy tissue.
How have people responded to it so far?
Matsen: So people are very excited. But what they’re excited about, I think, is where we’ll get to eventually. Where we’re at right now, people still have to have surgery. What people are excited about is this possibility that, in the future, this technology will be precise enough and effective enough, that you could actually use it instead of surgery. But we’re not there yet. And so people are very excited about the eventual application of it, and the patients that are participating right now are really excited about being part of that process to help people in the future. It really isn’t changing their care. They’re still having surgery, they’re still doing the standard things that we do. But they’re providing really great information so that people in the future can have different care.
How long are the studies going to go on?
Matsen: Years. This particular study is probably just- we estimate about a year, for this particular study. But then there’s always the next phase. And so you’re always looking to do the next thing. And developing these kinds of technologies always takes years, because there’s a lot of data that you have to gather. But there’s also regulatory processes that you have to go through to get approval, to make sure that things are safe and effective before you start using them in a big population. So that does take years.
Is this for any type of or breast cancer or just like this particular?
Matsen: Eventually, it could be for any breast cancer. In this trial, we’re restricting it a little bit to cancers that are less aggressive. And where they’re big enough that you can ablate them, but small enough that you’re not going to have any damage to the skin. That’s one of the things that’s hard with ablation technologies, is that they still do have effects on the tissue around them. And so you want to make sure that it’s far enough away from things like the skin that you’re not going to have skin damage. And so there are some, what I would call anatomic criteria around how they can be applied, but in terms of the types of cancer in the breast that it could be applied to, that could be very broad. It’s just the anatomic considerations around the size of the tumor, how close it is to the skin or to the muscle, making sure that it’s in an area where we could ablate it effectively, but not damage other tissue.
Do you think that, in the future, this could be used for other things, or do you think it’s going to change the way things are done?
Matsen: Well, this particular device is designed for the breast, that’s the main thing about it. It’s really designed for all the breast. So this is going to be applicable for the breast, but a range of different kinds of tumors that you could have in the breast, including benign things. So there are benign tumors that can happen in the breast as well that we still remove with surgery in most cases. But ablative technologies are, I think, going to be very applicable for those things where there’s no issue with leaving it there after it’s ablated. The issue with cancer is that you have to make sure that you’ve ablated it effectively enough that you can still leave that tissue there without removing it. But this is specifically for breast. There are lots of ablation technologies that are used for other types of cancers like the liver in particular. There’s ablation that’s already used for a lot of those.
With this technology, is it the difference between, like you said, they don’t have to do surgery if this goes through, they would have to do surgery, so they wouldn’t have to go under anesthesia or it just coming out?
Matsen: Yeah. I don’t know how long it’ll take eventually. Right now, it takes about an hour. They still have some light sedation just because it’s not necessarily comfortable to lay in that position for an hour. So there is some light sedation so that they can feel more comfortable. And it’s like when women get breast biopsies where they use numbing solution for the breast and still use some pain medications. But it’s not the same as like general anesthesia. So the risks are a little bit lower there, but it’s got to be for women who can tolerate laying on the device for an hour. And so that’s going to be not appealing to some people. And yet for some people it’s going to be great. So, it’s not that this is going to be something that applies for every single breast cancer patient, but there’s going to be, I think, a select population of breast cancer patients that it’s going to be great for.
Good to have options.
Matsen: Yeah, absolutely. And that’s the thing that we actually love in breast cancer care, is that it’s one of the few cancers where we have a lot of different options for how we can approach treating the cancer even from like the surgery and ablation perspective. We have multiple things that we can do, and so we have lots of different options for people, which I think is really empowering.
Is there anything else that you want to talk about?
Matsen: One of the exciting things, actually, that Dr. Payne is working on, that I hope will have some good results, is looking at how ablation may actually activate the immune system to help attack cancer cells in the breast. That would be really exciting. If beyond just killing the tumor, it actually can activate the immune system to kill cancer cells and actually it’s like immunotherapy. So it could actually have broader impacts than just killing the tumor itself. So that would be really exciting if we can get some data around that kind of effect.
I went through chemotherapy 10 years ago for Lymph Hodgkin, and I remember, at the time, my doctors saying, “I really hope in 20 years, if you look back at how we used to treat cancer patients and say, ‘My gosh’,”.
Matsen: Well, we do that all the time, actually. Even now, when I look back at how we approached breast cancer surgery in the ’80s and even into the ’90s, it was a lot different. The history of breast cancer surgery has really been figuring out how much we have to do and learning that we can do less. There’s still some people where that’s not possible. And that’s, I think, one of the hard things about cancer is that, as you know, it’s not just one disease. It’s thousands of different diseases. So everyone’s situation is different. But one of the things that has happened over time is that we do have so many more options. And I think it’s absolutely true that we always look back at the decades before us and go what? I can’t believe we do that for a while. But that’s part of learning how to improve care, and that’s really what these kinds of trials are about, is how can you figure out how to do things in a better way? How can you figure out how to provide more options for people and be more personalized in terms of how we’re going to approach care for each person.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Avery Shrader Nicole Winkler
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