Rita S. Mehta
Health Sciences Professor, Medicine
|fulvestrant, carboplatin, dose dense, weekly paclitaxel, Targeted/Individualized Therapeutic Options, Clinical and Translational Research|
M.B.B.S. Merit Scholarship(1977-82)
Hope Foundation/Ortho Biotech Young Investigator Workshop Award for SWOG(2001)
Avon Scholar (2001-03)
Orange County Physician of Excellence(2006-09, 2014-2016)
Castle Connolly's Top Doctors™ (2012-2016)
Super Doctors (2008/9; 2013-2016)
Dr. Mehta demonstrated that adding fulvestrant to anastrozole improves progression-free and overall survival in advanced hormone receptor-positive breast cancer by 20% and 19%, respectively, as compared to anastrozole alone in a large 700-patient randomized trial (SWOG-S0226, NEJM 2012)-an unprecedented result in first-line hormonal modulation therapy of breast cancer. This improvement was particularly impressive in endocrine-naïve population with about a 26% improvement in survival outcomes. These impressive results with the use of fulvestrant were indeed confirmed in 2 studies (FIRST and FALCON)of mostly endocrine-naïve population (LANCET 2017). Collectively, these trials demonstrate that the natural history of hormone receptor-positive advanced breast cancer can be changed by improving overall survival-"the gold standard". And while this is only a small step, it is a crucial "first step" in improving outcomes for our patients, with even better treatments expected in the future.
She also demonstrated a high rate of pathologic complete response linked to a high rate of 3-year progression-free and overall survival in triple-negative breast cancer, with the use of chemotherapy specific dose-dense and weekly chemotherapy regimens, and with the use of carboplatin in high risk triple-negative breast cancer (JCO 2008, www.cancer.gov/cancer topics/pdq/treatment/breast/.../page8). This high survival also extended to patients with BRCA-associated breast cancer (ASCO 2011). Similarly, she showed a high rate of pathologic complete response and associated high survival in HER-2 positive large and inflammatory breast cancer, with the use of trastuzumab in neo-adjuvant setting. This association of high survival to high pathologic complete response rates was strong (SABCS 2004-2009, Cancer 2008, Annals of Oncology 2008, ASCO 2010). Recent large trials have supported this early adoption of highly effective treatments; and also supported pathologic complete response as a robust intermediate endpoint of survival in high-grade tumors. These include HER2-positive, triple-negative and highly-proliferating hormone receptor-positive breast cancers. Recent FDA approval of pertuzumab in neo-adjuvant treatment in breast cancer is a testament of the benefit of using intermediate end-point in directing early approval of promising drugs.
Targeted/Individualized Therapeutic Options– In an era that is fast witnessing an increasing chemotherapeutic choice for cancers in general, individualized patient directed treatment with improved outcome has become a reality. Development of genomic profiles to predict clinical outcome in an individual patient is now achievable. To this end, Dr. Mehta participated in TailoRx and S1007 studies, which are prospectively evaluating these strategies. She also showed that an intermediate endpoint of chemoprevention can be modulated significantly with the use of anastrozole prior to breast cancer surgery (ASCO June 2013). Supporting this concept, a large multicenter trial confirmed the chemo-preventive potential of anastrozole (Lancet, December 2013). She is also the institutional PI of Kathryn Trial (phase III) which randomizes patients with residual disease following neo-adjuvant (preoperative chemotherapy)to either Ado-trastuzumab or trastuzumab.
Clinical and Translational Research – Dr. Mehta is one of the key contributors to clinical research activities within the Cancer Center at UCI. Her main focus has been on the development of hypothesis-driven, investigator-initiated trials in the area of breast cancer. Currently, Dr. Mehta is the UCI principal investigator for all NSABP breast cancer treatment trials and Lead Researcher of Southwest Oncology Group hormonal trial in advanced breast cancer-S0226. She directs clinical research office in managing all breast cancer protocols.
Fulvestrant decreases anastrozole drug concentrations when taken concurrently by patients with metastatic breast cancer treated on SWOG study S0226. Hertz DL, Barlow WE, Kidwell KM, Albain KS, Vandenberg TA, Dakhil SR, Tirumali NR, Livingston RB, Gralow J, Hayes DF, Hortobagyi GN, Mehta RS, Rae JM. Br J Clin Pharmacol. 2016 Jun;81(6):1134-41. doi: 10.1111/bcp.12904. Epub 2016 Apr 8.
Rugo HS, Rumble RB, Macrae E, Barton DL, Connolly HK, Dickler MN, Fallowfield L, Fowble B, Ingle JN, Jahanzeb M, Johnston SR, Korde LA, Khatcheressian JL, Mehta RS, Muss HB, Burstein HJ. Endocrine Therapy for Hormone Receptor-Positive Metastatic Breast Cancer: American Society of Clinical Oncology Guideline. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2016. Epub 2016/05/25. doi: 10.1200/jco.2016.67.1487. PubMed PMID: 27217461.
Tran PN, Zhuang L, Nangia CI, Mehta RS. Dramatic Response to Carboplatin, Paclitaxel, and Radiation in a Patient With Malignant Myoepithelioma of the Breast. The oncologist. 2016. Epub 2016/07/31. doi: 10.1634/theoncologist.2016-0092. PubMed PMID: 27473043
Tromberg BJ, Zhang Z, Leproux A, O'Sullivan TD, Cerussi AE, Carpenter PM, Mehta RS, Roblyer D, Yang W, Paulsen KD, Pogue BW, Jiang S, Kaufman PA, Yodh AG, Chung SH, Schnall M, Snyder BS, Hylton N, Boas DA, Carp SA, Isakof SJ, Mankoff D; ACRIN 6691 investigators. Predicting Responses to Neoadjuvant Chemotherapy in Breast Cancer: ACRIN 6691 Trial of Diffuse Optical Spectroscopic Imaging. Cancer Res. 2016 Aug 15.
Tran PH, Mehta RS; Treatment of pregnancy associated metastatic hormone and Her-2 receptor positive inflammatory breast cancer: A real challenge. Cancer Treatment and Research Communications Volume 9, 2016, Pages 121–123
Neoadjuvant plus adjuvant bevacizumab in early breast cancer (NSABP B-40 [NRG Oncology]): secondary outcomes of a phase 3, randomised controlled trial.Bear HD, Tang G, Rastogi P, Geyer CE Jr, Liu Q, Robidoux A, Baez-Diaz L, Brufsky AM, Mehta RS et al.Lancet Oncol. 2015 Sep;16(9):1037-48.
Mehta RS, Barlow WE, Albain, KS, Vandenberg, TA, Dakhil, SR., Tirumali, NR., Lew DL, Hayes, DF., Gralow, JR,. Livingston, RB., and Hortobagyi, GN. Combination Anastrozole and Fulvestrant in Metastatic Breast Cancer. N Engl J Med 2012 Aug; 367:435-444.www.nejm.org/doi/full/10.1056/NEJMoa1201622
Ueda S, Roblyer D, Cerussi A, Durkin A, Leproux A, Santoro Y, Xu S, O'Sullivan TD, Hsiang D, Mehta R, Butler J, Tromberg BJ. Baseline tumor oxygen saturation correlates with a pathologic complete response in breast cancer patients undergoing neoadjuvant chemotherapy. Cancer Res. 2012 Sep 1;72(17):4318-28. Epub 2012 Jul 9.
Mehta RS, Barlow WE, and Hortobagyi GN. Anastrozole and Fulvestrant in Metastatic Breast Cancer. N Engl J Med 2012; 367:1662-1664:October 25, 2012. (Invited Letter)
Shieh MP, Mehta RS. Oligohydramnios associated with administration of weekly paclitaxel for triple-negative breast cancer during pregnancy.Ann Oncol. 2011 Sep;22(9):2151-2. Epub 2011 Jul 28
Roblyer D, Ueda S, Cerussi A, Tanamai W, Durkin A, Mehta R, Hsiang D, Butler JA, McLaren C, Chen WP, Tromberg B. Optical imaging of breast cancer oxyhemoglobin flare correlates with neoadjuvant chemotherapy response one day after starting treatment. Proc Natl Acad Sci U S A. 2011 Aug 30;108(35):14626-31. Epub 2011 Aug 18.
Chen JH, Bahri S, Mehta RS, Kuzucan A, Yu HJ, Carpenter PM, Feig SA, Lin M, Hsiang DJ, Lane KT, Butler JA, Nalcioglu O, Su MY. Breast Cancer: Evaluation of Response to Neoadjuvant Chemotherapy with 3.0-T MR Imaging. Radiology. 2011 Aug 30.
Lin M, Chen JH, Mehta RS, Bahri S, Chan S, Nalcioglu O, Su MY. Spatial shrinkage/expansion patterns between breast density measured in two MRI scans evaluated by non-rigid registration. Phys Med Biol. 2011 Sep 21;56(18):5865-75. Epub 2011 Aug 18.
Cerussi AE, Tanamai VW, Hsiang D, Butler J, Mehta RS, and Tromberg BJ. Diffuse optical spectroscopic imaging correlates with final pathological response in breast cancer neoadjuvant chemotherapy. Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences (2011) 369: 4512
Chang DH, Chen JH, Lin M, Bahri S, Yu HJ, Mehta RS, Nie K, Hsiang DJ, Nalcioglu O, Su MY. Comparison of breast density measured on MR images acquired using fat-suppressed versus nonfat-suppressed sequences.Med Phys. 2011 Nov;38(11):5961.
Bear HD, Tang G, Rastogi P, Geyer CE Jr, Robidoux A, Atkins JN, Baez-Diaz L, Brufsky AM, Mehta RS et al. Bevacizumab added to neoadjuvant chemotherapy for breast cancer. N Engl J Med. 2012 Jan 26;366(4):310-20.www.nejm.org/doi/full/10.1056/NEJMoa1111097
Hsiang D, Yamamoto M, Mehta RS, Su MY, Baick CH, Lane KT, Butler JA. Predicting Nodal Status Using Dynamic Contrast Enhanced MRI and Breast Pathology in Patients with Locally Advanced Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy With and Without Sequential Trastuzumab. Archives of Surgery. 2007 Sep; 142(9):855-861.
Yamamoto M, Mehta RS, Bacik CH, Su MY, Lane K, Butler J, Hsiang, DJ. The Predictive Value of Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer Patients Who Have Undergone Neoadjuvant Chemotherapy. The American Surgeon. 2007 Oct; 73/10:977-980(4).
Chen JH, Carpenter, PM, Mehta RS, Nalcioglu O and Su, M-Y. Pathological Axillary Lymph Node Status in HER-2 Receptor Positive and Negative Breast Cancers. Ann Surg Oncol. 2008 Mar;15(3):941-2. Epub 2007 Nov 15.
Agrawal G, Chen JH, Baick CH, Hsiang SD, Mehta RS, Nalcioglu O, and Su, M-Y MR Imaging Features of Breast Cancer: A Correlation Study with HER-2 Receptor. Ann Oncol. 2007 Nov;18(11):1903-4.
Chen JH, Carpenter, PM, Mehta RS, Nalcioglu O and Su, M-Y. Triple Negative Breast Cancer: MR Imaging Features in 29 Patients. Ann Oncol. 2007 Dec;18(12):2042-3. Epub 2007 Nov 20.
Chen JH, Mehta RS, Carpenter, PM, Nalcioglu O, and Su, M-Y. MRI in Predicting Pathological Response of Triple Negative Breast Cancer Following Neoadjuvant Chemotherapy. J Clin Oncol. 2007 Dec 10;25(35):5667-9.
Chen JH, Feig B, Agrawal G, Yu H, Carpenter PM, Mehta RS, Nalcioglu O, Su
MY. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy.Cancer. 2008 Jan 1;112(1):17-26.
Mehta RS. HER2 and response to paclitaxel in node-positive breast cancer. N Engl J Med. 2008 Jan 10;358(2):197-8; author reply 198.
Mehta RS; Schubbert T: Re: HER2 status and efficacy of adjuvant anthracyclines in early breast cancer: a pooled analysis of randomized trials. J Natl Cancer Inst. 2008 May 7;100(9):680; author reply 680-1. Epub 2008 Apr 29
Mehta RS: Hormone receptor, grade, human epidermal growth factor receptor 2, and topoisomerase II as predictors of response to chemotherapy. J Clin Oncol. 2008 May 20;26(15):2596; author reply 2596-7.
Baek HM, Chen JH, Yu HJ, Mehta R, Nalcioglu O, Su MY: Detection of choline signal in human breast lesions with chemical-shift imaging. J Magn Reson Imaging. 2008 May;27(5):1114-21.
Mehta RS. Dose-dense and/or metronomic schedules of specific chemotherapies consolidate the chemosensitivity of triple-negative breast cancer: a step toward reversing triple-negative paradox. J Clin Oncol. 2008 Jul 1; 26(19):3286-8; author reply 3288.
Mehta RS, Schubbert T, Wong K. Trastuzumab in inflammatory breast cancer.
Ann Oncol. 2008 Oct;19(10):1815-7.
Mehta RS, Schubbert T, Marshall J, Carpenter PM. Rational and successful use of carboplatin and albumin-bound paclitaxel in a patient with recurrent metaplastic carcinoma who presented with multi-organ tumor emboli. Clin Breast Cancer. 2009 Feb;9(1):56-9.
Zell JA, Tsang WY, Taylor TH, Mehta RS, Anton-Culver H Prognostic impact of human epidermal growth factor-like receptor 2 and hormone receptor status in inflammatory breast cancer (IBC): analysis of 2,014 IBC patient cases from the California Cancer Registry. Breast Cancer Res. 2009 Feb 19;11(1).
Chen JH, Feig BA, Hsiang DJ, Butler JA, Mehta RS, Bahri S, Nalcioglu O, Su MY. Impact of MRI-evaluated neoadjuvant chemotherapy response on change of surgical recommendation in breast cancer. Ann Surg. 2009 Mar;249(3):448-54.
Raj KP, Sanati H, Mehta RS, Zell JA. Need for a new treatment strategy: leptomeningeal carcinomatosis from gastric cancer. Anticancer Drugs. 2009 Apr;20(4):301-4.
Bahri S, Chen JH, Mehta RS, Carpenter PM, Nie K, Kwon SY, Yu HJ, Nalcioglu O, Su MY. Residual breast cancer diagnosed by MRI in patients receiving neoadjuvant chemotherapy with and without bevacizumab.Ann Surg Oncol. 2009 Jun;16(6):1619-28.
Mehta RS and Su M-Y: Continued Exploration of Bevacizumab in Breast Cancer. Ann Surg Oncol 2010 February; 17(2): INVITED LETTER
Chen JH, Mehta RS, Nalcioglu O, Su MY MR imaging evaluation of non-inflammatory breast cancer with skin involvement following neoadjuvant chemotherapy” (DOI 10.1245/s10434-010-0974-7) RS Mehta had an equal contribution as the first author, JH Chen. online February 24, 2010.
|Grant||Prediction of Neoadjuvant Chemo Pathological Response Using MRI Markers. Co-Investigator. (PI Su, L) R0-1 NCI, NIH, % Effort – 17%, 10/07-10/12: $3,070,694.00.|
American Society for Clinical Oncology
Orange County Oncology Association
National Surgical Adjuvant Breast and Bowel Project
Southwest Oncology Research Group (SWOG)
SWOG 0226 (SABCS Dec 2011; NEJM 2012 2004—curr
Medical Director of the Breast Center
|Research Centers||Chao Family Comprehensive Cancer Center|
|Breast Cancer Research Group|
|Southwest Oncology Group|
|Link to this profile||http://www.faculty.uci.edu/profile.cfm?faculty_id=5537|