Titles and Affiliations
Director of Breast Surgical Oncology
Co-Leader of Breast Site Disease Group
Medical Director, Operating Room
Professor of Surgery
University of Miami School of Medicine
Research area
Evaluating whether reducing a patient’s stress response using a non-selective beta blocker can improve treatment response during neoadjuvant chemotherapy.
Impact
An individual’s neighborhood impacts many aspects of their life, with individuals in disadvantaged neighborhoods experiencing limited access to healthcare, healthy food, clean air and water, among other factors. Despite significant advances in breast cancer screening, diagnosis, and treatment, women living in disadvantaged neighborhoods continue to have higher breast cancer mortality rates than those in more advantaged areas.
Prior work has shown that patients living in more disadvantaged areas are less likely to achieve a pathologic complete response—meaning the tumor is completely eliminated by treatment—and are more likely to show elevated sympathetic nervous system activity in their tumors and blood biomarkers. Building on these findings, this clinical trial aims to evaluate whether a non-selective beta blocker—a medication that blocks the body’s sympathetic nervous system, or “fight or flight” response—can improve treatment response in the neoadjuvant setting, which is associated with improved long-term outcomes.
This clinical trial is critical for evaluating whether reducing a patient’s stress response during neoadjuvant chemotherapy can improve pathologic complete response rates, a surrogate marker for improved survival. Higher pathologic complete response rates, in turn, reduce the need for additional surgical procedures, chemotherapy, and radiation—all of which improve patient quality of life.
What’s next
This study will evaluate the effect of propranolol, a non-selective beta blocker, on pathologic complete response rates—a surrogate for how effectively chemotherapy eradicates the tumor—as well as its potential to reduce cardiac complications in patients receiving neoadjuvant chemotherapy. Improving pathologic complete response rates is associated with improved survival and may also allow patients to undergo less extensive lymph node surgery (reducing rates of lymphedema), allow for higher rates of lumpectomy over mastectomy, and reduce the need for additional adjuvant treatments such as chemotherapy or radiation.
Biography
Susan Kesmodel, MD is a Professor of Clinical Surgery in the Division of Surgical Oncology, Department of Surgery at the University of Miami, Miller School of Medicine. Dr. Kesmodel received her medical degree from the University of Pennsylvania, Perelman School of Medicine and completed a residency in general surgery at the Hospital of the University of Pennsylvania and a fellowship in surgical oncology at MD Anderson Cancer Center.
Dr. Kesmodel specializes in the treatment of benign and malignant breast diseases and high-risk skin malignancies including melanoma. Her clinical interests include prophylactic breast surgery for high-risk patients, oncoplastic breast surgery, and optimizing local-regional treatment for patients with breast cancer. Her main research interest is in management of the axilla in both early-stage and advanced breast cancer. Dr. Kesmodel is the Director of Breast Surgical Oncology and Co-Leader of the Breast Site Disease Group for Sylvester Comprehensive Cancer Center. She participates in the development of clinical research projects examining breast cancer management and outcomes and prospective clinical research protocols to improve patient management and reduce surgical morbidity. She also collaborates with multiple basic scientists to develop translational research protocols examining novels therapies for resistant and/or aggressive breast cancer subtypes. Dr. Kesmodel also serves as the Chair for the Commission on Cancer at Sylvester Comprehensive Cancer Center.
Dr. Kesmodel has authored numerous articles on breast cancer management and outcomes. She is a member of the Society of Surgical Oncology where she serves on the Breast Disease Site Working Group, American Society of Breast Surgeons, and the American College of Surgeons. Dr. Kesmodel is committed to education and is a Vice-Chair for the Continuous Certification Assessment (CCA) for the American Board of Surgery and leads the Breast Committee where she oversees development of questions for the CCA exam.
