From the Duke Cancer Institute archives. Content may be out of date.
Stacey Phipps and her daughter, Kerry, lit the virtual Tree of Hope at the Duke Cancer Patient Support Programʼs 31st annual Tree of Hope Lighting Ceremony. The December 2021 virtual event kicked off Duke Cancer Instituteʼs celebration of the 50th anniversary of its designation as a comprehensive cancer center by the National Cancer Institute (NCI).
When Phipps was diagnosed with breast cancer in fall 2020, she went to several treatment centers for second and third opinions, but the personal treatment she received at Duke stood out.
“In some places I just felt like I was a patient, but at Duke I felt like I was a person,” she said. For instance, her Duke Raleigh oncologist, Vijay G. Paryani, MD, asked about her husband and daughter by name, and he asked about her career. “He was really interested in my life outside of cancer, and I could feel that,” Phipps said.
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He [Dr. Paryani] was really interested in my life outside of cancer, and I could feel that.
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Stacey Phipps
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Patient
“When I was diagnosed with breast cancer, my immediate thought was about my daughter, Kerry, and what would happen to her if something happened to me,” Phipps said.
The family participated in a Duke program designed for families facing cancer, called KidsCan! Children and teens can talk with people their own age about their parentsʼ cancer, and parents can talk to each other about what itʼs like to be a parent while undergoing cancer treatment.
“When I finished treatment at Duke, it sounds funny to say, but I was sad that I wasnʼt going to see my care team for a while," Phipps said. “I really felt that everyone really cared about me, and I missed them in an odd way.”
“Iʼm just so blessed to live in a place where I have such good care available to me," she said. “I find my hope by looking at this 8-year-old next to me."
Triple-negative breast cancer (TNBC) has long been considered one of the most aggressive and least understood forms of breast cancer. Defined by the absence of three key markers—estrogen receptor, progesterone receptor, and HER2 overexpression—TNBC represents a heterogeneous group of tumors that, until now, have largely been treated the same way.Researchers at the Duke Cancer Institute, led by Maggie DiNome, MD, surgical oncologist with the DCI breast oncology program, are working to change that.While TNBC tumors are classified as HER2-negative, many exhibit low levels of HER2 expression. Recent Duke studies reveal that this distinction is clinically significant.The analysis of a large national database showed that TNBC tumors with HER2-low expression respond less effectively to chemotherapy compared to those with no HER2 expression at all. This finding prompted deeper investigation into the molecular differences between these subtypes.The team discovered that HER2-low TNBC tumors exhibit an immune-evasive profile. These tumors and their surrounding microenvironment show reduced immune cell presence and hypermethylation of genes critical for immune recognition. This matters because the current standard of care for early-stage TNBC includes chemotherapy combined with immunotherapy yet over a third of patients do not respond to this combination therapy.“HER2-low tumors create an environment in and around the tumor that evades the immune system better than HER2-zero tumors,” DiNome said.Preliminary multicenter data suggest that patients with HER2-low tumors have a lower pathologic complete response rate to chemo-immunotherapy compared to those with HER2-zero. These findings could transform how clinicians approach TNBC treatment.“Not all patients respond to immunotherapy, and immunotherapies are not without pretty significant risk,” DiNome said. “If we can define the patient set that might not respond, we can save them from the morbidity of that treatment.”This research also opens the door to new strategies, such as combining immunotherapy with antibody-drug conjugates like trastuzumab deruxtecan, which has shown promise in HER2-low tumors.The DCI team is pursuing grant funding to explore mechanisms driving immune evasion and to test synergistic therapies that could improve outcomes for HER2-low patients. They are also investigating the role of epigenetic regulation and external factors, such as comorbidities, stress, and lifestyle, in shaping the immune environment.
Triple-negative breast cancer (TNBC) has long been considered one of the most aggressive and least understood forms of breast cancer. Defined by the absence of three key markers—estrogen receptor, progesterone receptor, and HER2 overexpression—TNBC represents a heterogeneous group of tumors that, until now, have largely been treated the same way.Researchers at the Duke Cancer Institute, led by Maggie DiNome, MD, surgical oncologist with the DCI breast oncology program, are working to change that.While TNBC tumors are classified as HER2-negative, many exhibit low levels of HER2 expression. Recent Duke studies reveal that this distinction is clinically significant.The analysis of a large national database showed that TNBC tumors with HER2-low expression respond less effectively to chemotherapy compared to those with no HER2 expression at all. This finding prompted deeper investigation into the molecular differences between these subtypes.The team discovered that HER2-low TNBC tumors exhibit an immune-evasive profile. These tumors and their surrounding microenvironment show reduced immune cell presence and hypermethylation of genes critical for immune recognition. This matters because the current standard of care for early-stage TNBC includes chemotherapy combined with immunotherapy yet over a third of patients do not respond to this combination therapy.“HER2-low tumors create an environment in and around the tumor that evades the immune system better than HER2-zero tumors,” DiNome said.Preliminary multicenter data suggest that patients with HER2-low tumors have a lower pathologic complete response rate to chemo-immunotherapy compared to those with HER2-zero. These findings could transform how clinicians approach TNBC treatment.“Not all patients respond to immunotherapy, and immunotherapies are not without pretty significant risk,” DiNome said. “If we can define the patient set that might not respond, we can save them from the morbidity of that treatment.”This research also opens the door to new strategies, such as combining immunotherapy with antibody-drug conjugates like trastuzumab deruxtecan, which has shown promise in HER2-low tumors.The DCI team is pursuing grant funding to explore mechanisms driving immune evasion and to test synergistic therapies that could improve outcomes for HER2-low patients. They are also investigating the role of epigenetic regulation and external factors, such as comorbidities, stress, and lifestyle, in shaping the immune environment.
