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Rena Feinman, PhD
Associate Scientist, Department of Research
Hackensack University Medical Center
Hackensack, New Jersey
Goal: To personalize therapies that are curative even for the most challenging cases of triple negative breast cancer (TNBC).
Impact: Drs. Feinman and Montgomery are studying the composition of gut and tumor bacteria and the role it plays in how the immune system recognizes and responds to tumors. Understanding the role that certain bacteria play in outcomes in TNBC patients may lead to new strategies to improve both the quality and duration of treatment by altering the levels of these bacteria.
What’s next: The team continues to enroll patients newly diagnosed with TNBC and will conduct analyses of gut and tumor bacteria to establish correlations with immune response and outcome.
One of the most important recent discoveries in cancer research is that the composition of gut and tumor bacteria plays a critical role in how the immune system recognizes tumors and responds to them. Triple negative breast cancer (TNBC) is an aggressive disease treated primarily by chemotherapy, but many patients don’t respond to it. Drs. Feinman and Montgomery are correlating changes in the composition of the gut and intratumoral microbiome with anti-tumor immune response in newly diagnosed TNBC patients before, during, and after chemotherapy. Their work may identify markers that predict poor outcome, which could lead to the development of personalized microbial-based therapies to enhance treatment responses in TNBC patients.
Full Research Summary
Research area: Identifying innovative approaches to improve response to therapies for triple negative breast cancer (TNBC), an aggressive form of the disease.
Impact: While significant progress has been made in the understanding of TNBC, there are still no targeted therapies available to treat it. Neoadjuvant (pre-surgical) chemotherapy can improve clinical outcomes, but only 30 percent of patients with TNBC respond to neoadjuvant chemotherapy. The work by Drs. Feinman and Montgomery could lead to biomarkers of response and interventions to improve response in patients with aggressive disease.
One of the critical goals is to identify predictors of response to neoadjuvant chemotherapy so that TNBC patients destined to do poorly can be identified earlier. The discovery that differences in the makeup of the gut and tumor microbiome, which consist of tens of trillions bacteria, can influence whether or not a patient responds to chemotherapy prompted Drs. Feinman and Montgomery to ask if certain types of gut and tumor bacteria increase the efficacy of neoadjuvant chemotherapy by re-activating the patient’s immune system. They aim to identify novel microbiota-associated biomarkers that predict poor outcome and could lead to the development of personalized microbial-based therapies to harness immunotherapeutic responses in treatment-refractory TNBC.
Current investigation: The team is conducting a prospective study in which they will correlate changes in the composition of the gut microbiome with anti-tumor immune response in newly diagnosed TNBC patients before, during, and after standard neoadjuvant chemotherapy.
What they’ve learned so far: Drs. Feinman and Montgomery have found the presence of gram-positive and gram-negative bacteria in tumor biopsies of several TNBC patients prior to and after treatment with standard of care neoadjuvant chemotherapy.
What’s next: The team will add additional clinical sites to increase patient accrual for their study. They will use existing specimens from patients who were diagnosed with TNBC to determine if certain types of bacteria and gene expression profiles in patients’ tumors are associated with risk for residual disease and metastasis.
Dr. Rena Feinman is an Associate Scientist in the Department of Research and Member of the John Theurer Cancer Center at Hackensack University Medical Center. She received her PhD in the Department of Microbiology at the New York University School of Medicine and pursued her postdoctoral fellowship at Memorial Sloan Kettering Cancer Center.
While on faculty at the Myeloma Institute for Research and Therapy in Little Rock, Arkansas, Dr. Feinman’s laboratory identified NFkappaB, a master regulator of immune and inflammatory responses, as a therapeutic target and predictive factor in clinical response to dexamethasone and immunomodulatory-based therapies in multiple myeloma patients.
Until 2013, Dr. Feinman was an Assistant and Associate Professor of Surgery at Rutgers-New Jersey Medical School. Her research investigated how hypoxia-inducible factors (HIF) and toll-like receptor signaling triggered intestinal inflammation during shock and critical illness led to the development of systemic inflammatory response syndrome and multiple organ failure.
Dr Feinman’s current research examines the influence of the gut microbiome in modulating anti-tumor immune responses in high-risk multiple myeloma. In collaboration with Dr. Leslie Montgomery, Dr. Feinman is working to identify novel gut flora-associated biomarkers that predict response to chemotherapy, disease-free survival and overall survival in newly diagnosed TNBC patients.