Metastatic Breast Cancer and the Listeria-Based Cancer Vaccines
Literature Review
Breast cancer denotes the commonest cancer in females and accounts for about sixteen percent of all cases of cancer. Nearly 200,000 instances of breast cancer are diagnosed every year in the United States. The widely studied risk aspects of breast cancer encompass race, age and gender. The incidences of the disease and the rate of death usually augment with age where women from 45 years of age and above carry the greatest risk. In the developed nations, continued developments have led to a considerable decrease in death rate, which is mostly attributable to improvements in diagnosis and treatment approaches. In discussions regarding breast cancer, the secondary literature by Chopra and Kamal affirms that there were over two million survivors in the United States in 2006 (1-15). The study also states that the lasting impacts of breast cancer, in addition to its treatment, have negative and positive influences on recovery and the quality of life for the survivors.
Fig. 1: The influences of the quality of life in breast cancer survivors (Chopra and Kamal 3)
The quality of life for the survivors differs with the stage of diagnosis, recovery after the initial treatment, and the first reappearance of the disease (Chopra and Kamal 1-15). In seeking to shed light on the causes, treatment, management, and prevention of the metastatic breast cancer, tumor immunology, and the Listeria-based cancer vaccines, the applicability of three instruments (Quality of Life Index-Cancer Version, Quality of Life-Cancer Survivors, and Quality of Life in Adult Cancer Survivors Scale) was assessed. Assessment of four domains of the quality of life (psychological, physical, spiritual and social) established that Quality of Life in Adult Cancer Survivors Scale offers the best outcome. This research paper will build upon the study and synthesize the notions to offer valuable insights into the distinctive concerns and requirements of breast cancer survivors with the purpose of assisting physicians and researchers to apply the most effective approach to the improvement of the quality of care.
Metastatic (also referred to as secondary) breast cancer arises where cells from the primary tumor metastasize to other sections of the body such as the lungs and liver resulting in the diagnosis of metastatic/advanced breast cancer. Studies in this field establish that the diagnosis of metastatic breast cancer is usually more worrying when judged against the diagnosis of primary tumor because it implies that cancer cannot be cured.
There exist gaps in available research about the experiences of women with advanced breast cancer as compared to studies of females suffering from primary breast cancer. The secondary literature by Warren sought to discuss the prevailing themes concerning metastatic breast cancer and identified poor psychological performance, uncertainty, and lack of control as the major issues influencing women with advanced breast cancer (564-574). The identified themes show that having metastatic breast cancer is a challenging experience, which is swayed by numerous factors, most of which have not been studied, unlike the aspects that influence women with primary breast cancer. This research paper will apply the study and synthesize the offered insights to bridge the existing gap and provide implications for the treatment of patients with metastatic cancer. Nonetheless, it is evident that the factors that influence metastatic breast cancer require further study since the women suffering from the condition necessitate greater support than presently available and enhanced treatment to ensure that they triumph over the disease.
Since breast cancer greatly affects women across the globe with about 40% of them proceeding to advanced (metastatic) condition, aggressive treatments and studies in this field have been carried out to date. Irrespective of the enhanced research and treatment, the eradication of metastases or remaining tumor cells following surgery has in most cases been unfinished, which is attributable to chemo resistance. Therefore, unlike the primary tumor, the residual tumor cells act as the key contributors to the morbidity and death rate of breast cancer. In this regard, further studies should seek to establish treatments that eradicate distant metastases fully to provide the best assurance in the facilitation of the care for metastatic breast cancer. Through the synthesis of the ideas provided in the secondary literature by Kim et al., this research paper will seek to offer treatments that focus on the elimination of breast cancer metastases (741-749). Significant concepts from previous studies have demonstrated that pcDNA3.1-Mage-b DNA vaccines provide successful vaccination against the metastases. The future of this technology will be the enhancement of the effectiveness of Mage-b vaccines via facilitated delivery with the application of Listeria monocytogenes (an intracellular pathogen, which mainly affects antigen-presenting cells, for instance, dendritic cells and macrophages). On this note, Listeria monocytogenes will act as a striking vaccine transmitter as proteins generated by the bacterium may occur as small peptides through processes producing CD4 and CD8 T-cell reactions to antigens.
The application of chemotherapy in the treatment of metastatic breast cancer has for a long time been an issue of controversy. The idea in previous studies that chemotherapy does not influence the progression of breast cancer has been disapproved by the outcomes of treatment approaches in the developed nations (Agodirin et al. 337-344). Significant discoveries in the field of breast cancer have established alternatives for the treatment of metastatic cancer that encompass surgery, after which chemotherapy or any other form of averred adjuvant is offered. However, such options have not yielded approving outcomes for metastatic breast cancer. This research paper builds upon the primary literature by Singh et al. and synthesizes the ideas to establish vaccines with favorable outcomes on metastases (1945-1954). The effectiveness of the vaccines for metastatic breast cancer is strongly lessened by immune repression in the tumor thus posing a fundamental obstruction to the success of immunotherapy. Studies have examined the possibility of the natural killer T-cells overcoming the immune restraint and enhancing immunization against metastases. In one study, mice having metastatic breast cancer were clinically treated with Listeria-based cancer vaccines and the impacts on toxicity, metastases, tumor mass, and immune reactions established (Singh et al. 1945-1954). Successive treatments of mice having metastatic breast cancer with the application of Listeria-based vaccines were effective in the reduction of metastases though they led to serious liver toxicity. Health professionals could enhance this treatment approach using Listeria-based vaccines strengthened by the application of a-galactosylceramide, which yields a nearly total eradication of metastases devoid of toxicity. In this regard, direct application of a-galactosylceramide into Listeria-based vaccines provides an effective non-toxic approach in the care of patients with metastatic breast cancer.
Important works in the field of breast cancer establish that the continued increase of the elderly population around the world will make metastatic breast cancer persist at a progressively high rate and cause of death at an increasing frequency. Regardless of the recent developments over time with respect to the prevention and treatment of metastatic breast cancer, it remains a great cause of death, particularly to the elderly, and co morbid conditions rarify further care. In cases where cancer progresses to the metastatic phase, it usually requires unrelenting treatment and the available alternatives are not many. Though immunotherapy could be the most promising treatment alternative for the prevention and cure of metastatic breast cancer in the elderly people, it is less successful to them when judged against the younger patients because of the impassiveness of the T-cells mainly within the tumor. In the primary literature by Chandra et al., both old and young mice with metastatic breast cancer were treated with Listeria-based cancer vaccines (once ahead of and two times following the growth of tumor) and evaluated for metastases and primary tumor, with regard to the response of the NK and T-cells (2281-2290). Listeria-infected Myeloid-derived suppressor cells conveyed Listeria primarily to the environment of metastases and primary tumor cells. This way, immunotherapy with Listeria considerably decreased the quantity of Myeloid-derived suppressor cells in the blood and primary tumor, changed the residual suppressor cells into immune stimulators and facilitated the response of T-cells in the young and elderly patients. Though previous studies in this field affirm that immunotherapy is not successful in the elderly when judged against the young patients, future technology should seek to establish Listeria-based treatment that is similarly effective against metastatic breast cancer for all patients irrespective of their age.
Similar to other forms of malignancy, immunotherapy is seen to provide the anticipation of a valuable approach in the treatment of metastatic breast cancer. However, important works in the field assert that the success of the treatment approaches for metastatic breast cancer relies on the comprehension of the mechanisms concerning self-tolerance that has to be conquered for the achievement of excellent outcomes of care. Significant discoveries have centered on facilitating the understanding of tumor cells and the host constituents to create an efficient immune reaction and the regulating aspects. In their primary literature, Gorczynski, Erin, and Zhu affirm that lasting cure of metastatic breast cancer in mice, even when the condition has metastasized to the liver and lungs, is achievable through the combination of surgical therapy and immunotherapy (325-334). Health professionals should build on this idea to offer effective treatment of metastatic breast cancer with Listeria-based cancer vaccines.
The implications in the field of metastatic breast cancer establish that holistic suffering (the experience of isolation, vulnerability, despair and worthlessness) present unbearable difficulties for the patients. Though countless treatment approaches have been recommended for its lessening, there has not been a comparison of their success. The development of the means of assuaging holistic suffering should form the basis of further studies. The available research on spiritual and religious approaches for the treatment of metastatic breast cancer identifies gaps in knowledge, which is attributable to the inadequacy of studies assessing the influence of such interventions to prove their worth. The secondary literature by Best et al. demonstrates that though studies are at an early phase of the religious interventions for the treatment of metastatic breast cancer, there are numerous promising opportunities for therapies to mitigate the holistic suffering of the patients. Even with the application of Listeria-based vaccines, the future of the technology in the treatment of metastatic breast cancer should incorporate spiritual welfare, hope, and worthiness to positively and considerably influence the treatment modalities
Works Cited
Agodirin, Olayide, Samuel Olatoke, Ganiyu Rahman, Moses Adeoti, Gafar Oyeyemi, Abiola Durojaiye, and John Agboola. “How effective is the treatment of locally advanced and metastatic breast cancer in developing centers?: A retrospective review.” Ethiopian Journal of Health Sciences 25.4 (2015): 337-344.
Best, Megan, Lynley Aldridge, Phyllis Butow, Ian Olver, Melanie Price, and Fleur Webster. “Treatment of holistic suffering in cancer: A systematic literature review.” Palliative Medicine 29.10 (2015): 885-898.
Chandra, Dinesh, Arthee Jahangir, Wilber Quispe-Tintaya, Mark Einstein, and Claudia Gravekamp. “Myeloid-derived suppressor cells have a central role in attenuated Listeria monocytogenes-based immunotherapy against metastatic breast cancer in young and old mice.” British Journal of Cancer 108.11 (2013): 2281-2290.
Chopra, Ishveen, and Khalid Kamal. “A systematic review of quality of life instruments in long-term breast cancer survivors.” Health and Quality of Life Outcomes 10.14 (2012): 1-15.
Gorczynski, Reginald, Nuray Erin, and Fang Zhu. “Serum‐derived exosomes from mice with highly metastatic breast cancer transfer increased metastatic capacity to a poorly metastatic tumor.” Cancer Medicine 5.2 (2015): 325-334.
Kim, Hee, Francisco Castro, Diana Gonzalez, Paulo Maciag Yvonne Paterson, and Claudia Gravekamp. “Mage-b vaccine delivered by recombinant Listeria monocytogenes is highly effective against breast cancer metastases.” British journal of cancer 99.5 (2008): 741-749.
Singh, Manisha, Wilber Quispe-Tintaya, Dinesh, Chandra, Arthee Jahangir, Manjunatha Venkataswamy, Tony Ng, Shalu Sharma-Kharkwal, and Claudia Gravekamp. “Direct incorporation of the NKT-cell activator α-galactosylceramide into a recombinant Listeria monocytogenes improves breast cancer vaccine efficacy.” British journal of cancer 111.10 (2014): 1945-1954.
Warren, Myron. “Uncertainty, lack of control and emotional functioning in women with metastatic breast cancer: A review and secondary analysis of the literature using the critical appraisal technique.” European journal of cancer care 19.5 (2010): 564-574.
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