Medical oncologist Nina D’Abreo, MD, an assistant professor in the Department of Medicine at NYU Long Island School of Medicine, treats people with varying stages of breast cancer. She also sees and counsels women with benign but high-risk breast disease, regarding options to lower their risk.
As medical director of the Breast Medical Oncology Program at Perlmutter Cancer Center at NYU Langone Hospital—Long Island, Dr. D’Abreo is involved in the creation and implementation of programs that can help at every stage of the continuum of breast cancer care—from diagnosis to survivorship.
She discusses how she decided to become a doctor, how treatment for breast cancer has changed, and more.
Medicine was not your first choice as a career. Can you describe what led you to become a physician?
I grew up in Mumbai, India, and my mother was a biology teacher, so science was her thing. She had wanted to become a physician, and for many reasons that wasn’t feasible. Growing up, I was good at math, science, and biology, but math and physics were my strong suit. I thought eventually I would study engineering and work in an information technology–based job. My mother, however, wanted me to become a physician, and I was adamant that I wouldn’t do that.
In India, the way higher education is structured, scores matter in qualifying exams. And I had scores that qualified me to get into one of the very prestigious medical schools there. Unknown to me at the time, my parents put in an application for medical school, for which, lo and behold, I got an interview. I promised them I would attend a few medical school classes and see how it would go. I attended engineering school for three months and medical school right after, just to see what it was like. After the first anatomy exam, I was hooked. There is a lot of physics involved with the human body. Pharmacology was fantastic, and physiology was really what drew me in. So, after the first three months, we had a short exam and I did well on that. I gave up my admission to engineering school and decided to go with medicine.
As a medical oncologist who specializes in treating people with breast cancer, what are some of the changes in treatment that you have seen during your career?
The most important advance is personalizing therapy, in which we refine treatment to suit an individual patient’s tumor biology. We have moved away from the “one-size-fits-all” style of treatment, which has been the history of breast cancer treatment through the ages, from the times of radical mastectomies to, finally, when medical oncology evolved. Traditionally, we gave a lot of chemotherapy to all patients. We still do this for some patients for the right reasons, but now we are personalizing therapy and tailoring it to fit both the patient’s biology and their clinical condition. This means that in some cases we add treatment when required and in some cases, we de-escalate. Personalized treatment has evolved in the 14 years that I have been in practice as a medical oncologist, and it continues to be refined.
Can you describe one or two clinical trials you are leading that are particularly exciting?
I am the principal investigator in the NYU Langone network for two exciting cooperative group-led trials looking to optimize how we treat HER2-positive breast cancer. This is an aggressive form of the disease, for which we typically give patients multi-agent chemotherapy in combination with HER2-blocking antibodies before or after surgery. CompassHER2-pCR is a de-escalation trial led by the Eastern Cooperative Oncology Group that is using pathological complete response (pCR) to a single chemotherapy with HER2-targeted drugs given before surgery, to appropriately minimize the use of additional chemotherapy for patients who don’t need it.
The second part of that trial, called CompassHER2 RD, is looking at optimizing treatment after surgery. This is for people who do not achieve a complete response and have residual disease (RD). Typically these patients would receive a HER2-targeted drug called TDM-1. In this trial, they can be escalated to TDM-1 in combination with another oral HER2-blocking drug. These are great examples of tailoring therapy based on tumor response so we don’t over- or under-treat anyone.
Another area that I am intrigued by is using non-pharmacological approaches to improve cancer care. I think there is a growing interest in the idea that “exercise is medicine.” Not only can exercise make patients feel better, it can also improve cancer outcomes. We are developing an investigator-initiated project in collaboration with colleagues who are experts in the field of oncological rehabilitation at Perlmutter Cancer Center as well as another academic center, looking at adding exercise for patients with early-stage estrogen receptor–positive breast cancer. These patients will receive a short course of exercise before surgery to see whether that will ultimately impact their cancer outcomes. So this is another way of optimizing cancer therapy, but using exercise—a nontoxic, non-pharmacological intervention—in combination with hormonal therapy.
Are there success stories with patients that you can share?
There are many success stories that are gratifying both professionally and personally.
Eight years ago, I treated a pregnant patient who was diagnosed with locally advanced HER2-positive breast cancer. At the time, she was underinsured and had trouble finding medical care. With our medical oncology team and our gynecologist we were able to successfully get her through her pregnancy. We now see her with her daughter, who was born right after the treatment, in the clinic. Watching her child grow over the years is extremely gratifying to me. For us, each follow-up visit is a sign of how far we’ve come and how we were able to, as a team, bring this patient successfully through a time of crisis.
Another story that’s professionally gratifying concerns a patient who participated in a clinical trial that looked at using adjuvant therapy, which is treatment after surgery, in patients with triple-negative breast cancer. This was an escalation trial in which immunotherapy was added for patients who had residual disease after receiving chemotherapy and surgery. We were one of the few sites on Long Island offering the trial when it opened.
She came to us from Memorial Sloan Kettering Cancer Center (MSKCC). Even though this patient didn’t have access to the trial at the time at MSKCC, her oncologist was able to direct her and she traveled to us and was successfully enrolled. She is now about three years out and is doing very, very well. It may not sound like a big deal, but it was a big leap of faith for this patient to leave MSKCC and come to us for treatment. That experience illustrated how oncology care is truly collaborative. Patients are able to find resources, and we are able to assist them thanks to an excellent network of support.
Looking ahead to the next 5 to 10 years, what can people with breast cancer expect in terms of new treatments?
One advance is in patients who receive estrogen-driven therapy for long durations. We know that some patients receive therapy for 10 years, but there are technologies that might help us assess who among those patients really needs extended therapy. One way to do this is by analyzing circulating tumor DNA and identifying markers in the blood that can then predict whether the cancer is likely to recur. This is an evolving field. There are some applications of this science already in the clinic, for example, in colon cancer, and I think this will also be applicable to breast cancer to further refine how long we treat patients and when to change therapy.
Newer antibody–drug conjugates that are less toxic and use smaller doses of chemotherapy bound to a targeted drug are also on the horizon and may replace traditional chemotherapy.
A fascinating 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 an area of promise. This is particularly relevant in patients with cancers like triple-negative breast cancer, where there are fewer effective treatments.
When a person sees you for breast cancer care, what can they expect?
The one thing that has remained constant, regardless of all the advancements in treatment, is that we are still personalizing cancer care. It’s not just that the treatments are personalized, but when someone comes to Perlmutter Cancer Center, they will be cared for by a very personal team, one that they can contact at any time. Our physicians, nurse practitioners, nurses, and medical assistants know the patient, and they become part of a family. This very one-on-one approach is what patients can expect when they see us. Like any other major cancer center, we have the ability to offer technology and cutting-edge trials, but it’s all done in a very personalized fashion.
The story that I shared about the patient who brings her daughter to clinic visits illustrates this. Patients become part of the family here. When she and her daughter come in, you can see that the entire team that treated her is happy to see her. We take that extra step of integrating the entire team in the patient’s care. We are responsive and available to patients, and we take great pride in making sure that the patients’ queries are answered in a timely fashion. While people can receive the same treatment anywhere, it’s this team approach with personal involvement that sets us apart.