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Carol J. Fabian, MD
Professor of Internal Medicine
Director, Breast Cancer Prevention and Survivorship Centers
Morris Family Endowed Chair in Cancer Prevention
University of Kansas Medical Center
Kansas City, Kansas
Goal: To develop strategies to prevent breast cancer in moderate- to high-risk women and to improve health and quality of life for breast cancer survivors.
Impact: Dr. Fabian is studying the medication Duavee®, which is approved for relief of hot flashes and prevention of osteoporosis, to determine if it might have a role in breast cancer prevention. If so, the drug could be a safe alternative to current hormone-based chemoprevention in women at risk of breast cancer.
What’s next: She and her team will continue their investigations of Duavee® and its potential use as a chemopreventive in women at high risk of developing breast cancer.
Hormone replacement therapy (HRT) is the most effective way to reduce the vasomotor symptoms of menopause (hot flashes, flushing and night sweats), but there is concern that HRT might increase the risk of developing breast cancer, particularly in women with a higher than average risk. In her BCRF studies, Dr. Fabian has found that a drug that is a safer alternative to HRT in women with a high risk of breast cancer may also reduce the risk of breast cancer, potentially providing an alternative to current hormone-based chemoprevention.
Full Research Summary
Research area: Identifying ways to prevent breast cancer in moderate- to high-risk women and improving the health and quality of life of breast cancer survivors.
Impact: Chemoprevention drugs (i.e. tamoxifen or aromatase inhibitors) dramatically reduce the risk of developing breast cancer, but many women will discontinue their use due to side effects that can initiate or worsen menopausal symptoms. Dr. Fabian is testing what may be a safe alternative for breast cancer chemoprevention.
Current investigation: She and her team are evaluating Duavee® (a combination of conjugated estrogen and bazedoxifene), which is FDA-approved for relief of hot flashes and prevention of osteoporosis. They aim to determine if Duavee® may be a safe and effective option for women at high risk of breast cancer who can’t tolerate current endocrine-based chemopreventives. This year they will assess changes in blood-based and imaging biomarkers to confirm their pilot studies.
What she’s learned so far: Dr Fabian’s studies have shown that women who took Duavee® had a reduction in breast density as well as breast tissue proliferation (increase cell division), and a reduction in blood levels of hormones known to promote breast cancer growth. These observations suggest that Duavee® might be helpful for breast cancer prevention.
What’s next: Based on the results of the pilot study, Dr. Fabian and her colleagues plan to launch a multi-institution, Phase II NCI-sponsored randomized clinical trial of Duavee® versus placebo to assess its effects on risk-associated biomarkers. With the support of BCRF, they will further assess Duavee’s mechanism of action and biomarkers of response in advance of the trial.
Carol Fabian received her MD, internal medicine and oncology training from the University of Kansas School of Medicine in Kansas City, Kansas. Dr. Fabian joined the faculty at the University of Kansas Medical Center in 1977 and currently holds the rank of Professor. She serves as the Director of the Breast Cancer Prevention and Survivorship Centers. These centers are heavily involved in translational research in addition to providing clinical services. She leads the Cancer Prevention Research Program within the University of Kansas Cancer Center and holds the Morris Family Endowed Chair in Cancer Prevention.
Dr. Fabian pioneered the use of random periareolar fine needle aspiration to acquire breast epithelial cells for refinement of breast cancer risk assessment. The technique is also used for evaluation of biomarkers to monitor response in early phase breast cancer prevention clinical trials: 1) weight loss in combination with omega-3 fatty acid supplementation; 2) a flaxseed lignin derivative; and 3) an aromatase inhibitor in postmenopausal women taking hormone replacement. She is also involved in clinical studies to promote health and quality of life for breast cancer survivors and serves as a Co-Chair for the Cancer Survivorship Committee of SWOG.