As a radiation oncologist, Naamit K. Gerber, MD, associate professor in the Department of Radiation Oncology at NYU Grossman School of Medicine, provides the latest and most advanced treatments to people who have breast cancer and lymphoma. Dr. Gerber is co-director of the Breast Cancer and Hematologic Malignancies Disease Management Groups at NYU Langone Health’s Perlmutter Cancer Center, and her research focuses on developing new agents and procedures to minimize the side effects of radiation and ways to reduce radiation exposure for women with early-stage breast cancer.
Dr. Gerber discusses her work to minimize side effects of radiation, recent advances in the treatment of breast cancer, and more.
What are some of the ways you and your colleagues are working to minimize the side effects of radiation to treat cancer?
Radiation therapy is very effective in reducing the risks of breast cancer returning, but it is not without side effects and, particularly, long-term side effects. Patients with breast cancer can, thankfully, live a long time, so the long-term side effects from radiation are very relevant. Reducing these side effects is important for survivors in terms of their long-term quality of life.
We are conducting a phase 2 clinical trial at Perlmutter Cancer Center, called the ReDCoAT Study, to determine whether a topical caffeine cream can lower the risk of complications in women who need radiation therapy after having a mastectomy with breast reconstruction. The rates of reconstruction failure after a mastectomy are higher in women who have radiation versus those who don’t require radiation, and the risks of other reconstruction complications are also higher in the setting of radiation. Caffeine blocks adenosine, a naturally occurring molecule involved in tissue repair, which can also lead to scarring and fibrosis. Our hope is that this cream might potentially lower the risk of reconstruction complications in women who have received radiation as radiation increases the risk of fibrosis. Fibrosis is one of the processes behind implant loss and suboptimal cosmetic results as well as other reconstruction complications such as impaired wound healing and capsular contracture, hardening of the tissue capsule that surrounds the implant, which can cause chronic pain and distort the shape of the breast.
Why is this important for patients?
This is very important because our patients who have mastectomies followed by radiation go through so much to treat the breast cancer—surgery, radiation, and often chemotherapy as well. The least we can do is try to minimize those complications that are caused by our own therapies. One of the most common side effects of postmastectomy radiation is reconstruction complications. The goal of this study is to hopefully lessen the risk of radiation’s effect on the reconstructive outcomes. This is true for women who have unilateral mastectomies in whom they are hoping to achieve some symmetry with the intact breast as well as for women who have a prophylactic mastectomy of the uninvolved breast in whom the radiation to only one side can result in asymmetry. We hope that this study will introduce new options for patients to improve long-term outcomes.
What has been your experience with the patients you have treated at Perlmutter Cancer Center?
The most common thing I hear from my patients after they have finished radiation is that it was so much easier and more pleasant than they were expecting. I constantly hear from patients how friendly and warm everyone has been, from the nurses to the front desk staff. Some of my patients who are finishing a four- or five-week course of radiation will tell me that they are sad that they won’t be returning because our department has become something of a safe haven for them. And although no one wants to need radiation treatment, patients tell me what a positive experience it is despite their concerns, fears, and expectations.
I recently treated, along with Dr. Deborah Axelrod (professor in the Department of Surgery, director of clinical breast surgery and services, and medical director of community cancer education and outreach at Perlmutter Cancer Center), a 106-year-old woman with breast cancer. And this patient was just incredibly inspiring. She is the oldest person I ever met, and she was so optimistic and upbeat despite going through this experience of breast cancer. Her life experience is so vast, and it was amazing to interact with her and her daughter and get to know them a little bit. It was really a privilege to treat her.
What are some of the advances that have been implemented in the last five years at Perlmutter Cancer Center to better treat patients?
The past five years have seen many advances at Perlmutter Cancer Center for people with breast cancer. We introduced a technique called deep inspiration breath hold, or DIBH, in which patients are treated while taking a deep breath in. This expands the lung volume, which allows for better sparing of the heart and lungs in patients who need breast radiation. We also have a very robust accelerated partial breast program, in which we are able to treat selected patients with early-stage breast cancer with more targeted radiation, as opposed to treating the whole breast. The smaller treatment field allows us to also accelerate the treatment, and patients complete their entire course of radiation in just one week. Historically, breast radiation was given over five to six weeks, and more recently it was reduced to three to four weeks. The one week of partial breast radiation has been a great option for our patients.
Generally, the Department of Radiation Oncology has combined cutting-edge clinical trials with very patient-focused care, so we have a lot of options for patients. We have multiple clinical trials open for people with both early-stage and more advanced breast cancer, some of which involve shortening or omitting radiation entirely. We never lose sight of the fact that, first and foremost, our goal is to optimize the treatment of each individual patient.
You are a member of the breast committee of NRG Oncology, a nonprofit organization dedicated to clinical research. How has your involvement helped to improve the care of patients at Perlmutter Cancer Center?
In NRG Oncology, I serve on a committee that reviews new trial ideas for people with breast cancer, and we try to determine which trials are best suited for national accrual. That experience has been very helpful for me in terms of both participating in the trials and also designing my own trials as it gives me a better sense of what the clinical trial landscape looks like more globally.
I also serve as a senior editor for Practical Radiation Oncology. In addition to serving as one of the breast cancer editors, I also started a new column called “Morbidity and Mortality,” which features a unique case each issue that discusses a specific complication caused by radiation. This has been a great opportunity to work with radiation oncologists around the country to write up and publish unique cases for which published data and management guidelines are missing.