Breast cancer research news from AACR President Nancy Davidson
Dr Nancy Davidson - AACR President, Philadelphia, USA
We had an opportunity to hear about four really terrific studies today. The first is a long awaited report from a trial that’s called MINDACT. This trial has been going on for over a decade and its goal is to try to use a genomic signature, so a genomic analysis of tumour, in addition to or instead of the clinical parameters that we usually use to decide who should get chemotherapy and who should not get chemotherapy for early stage breast cancer. So the short version of this very complex trial is it looks like this particular signature, which is called a 70-gene signature or a MammaPrint, can help to identify individuals who clinically might be felt to be at high risk by a standard algorithm called Adjuvant! Online. So clinically by that Adjuvant! Online they are felt to be at high risk and maybe should get chemotherapy but the genomic signature suggests that they’re really low risk. So these women might potentially be able to be spared the chemotherapy. A very exciting result, this is one of the largest trials we’ve ever seen of a genomic signature like this looked at in such a rigorous fashion. Dr Piccart let us know that she thinks that this will actually help to change practice in Europe because this will help to make these tests more readily available with rigorous evidence to back them up.
The second trial we heard was in the setting of treatment of early stage breast cancer and it was specifically looking at a trial called the ISPY trial which is ongoing in the United States and which is serving as a platform to try to test new agents, new targeted drugs early in breast cancer with the goal of trying to sort out which ones might be active and which ones won’t be active so that the active ones can be propelled forward for larger, more definitive trials, and the inactive or the toxic drugs can be tossed off and not be evaluated further.
So this particular presentation today was about a combination of drugs for the HER2 type of breast cancer and it suggested that a new combination, the TDM1 and trastuzumab combination, was better than our more common trastuzumab plus paclitaxel combination. The results were what they expected to see in terms of what we call pathologic complete response, that is absence of breast cancer at the time of surgery. That means that they will now take this combination forward in testing in larger trials in earlier stages of breast cancer. So a nice way of looking at short term clinical trials to try to inform the design of larger, more definitive trials.
Then finally we heard two really nice presentations that are pertinent to lots of women because they’re about risk of developing breast cancer. One of them was for the general population of women using data from the Nurses’ Health Study which are studies of several hundred thousand women in the United States who have been followed over decades and where we can look at what’s happened to them and think about their health outcomes related to elements of their general health. So this particular focus was on trying to use elements of a genomic risk score, mammographic density, which is frequently being measured by mammography in this country at the time of screening mammography, and clinical factors to try to help refine risk of developing breast cancer for the individual woman. Then that would help her, we would hope, to think about whether she should think about prevention strategies like tamoxifen or an aromatase inhibitor. Perhaps with time it might also help to think about how you might refine screening recommendations for those women.
The last presentation speaks to a really important problem that we’re beginning to have which is the problem of cancer survivorship. It’s not a bad thing to have more cancer survivors and this particular study focussed on kids who got treated during childhood and, as a consequence of the treatment of their first cancer from which they survived and thrived, in some cases they become more at risk for a second cancer. So this particular study focussed on girls who had gotten treatment for childhood cancer and then they might be at risk for developing breast cancer because of radiation to the chest at the time of the treatment of their first cancer. What they showed was that there are two areas in the genome, two SNPs, where they think that changes in those SNPs might make those girls particularly prone to that risk of radiation related breast cancer in the future. If this could be confirmed then it might be possible, theoretically, to look for these SNPs at the time that you’re making the decision about the treatment of the first childhood cancer and perhaps using this to help figure out how to make that treatment the most optimal. So a wonderful span of studies for us to talk about.
What do you think the key themes are this year at AACR?
Our themes as an organisation are, of course, that great science ultimately translates into great medicine and that’s a pervasive theme here. As you know, a lot of the excitement right now in cancer and in all of medicine has to do with precision medicine, precision cancer medicine. So what was exciting about this session this morning was that we looked at the possibility of precision cancer medicine not only for treatment of known breast cancers but also we’re beginning to think about how we might be able to use these approaches to estimate risk. That’s extremely important.
How has this developed as a theme?
It’s been growing all along. You’re right that we are at a time where some of the amazing science that’s been going on is actually now being able to come in to clinical practice or into clinical testing. So there’s a lot of excitement around that, that some of these investments that we’ve made in things like sequencing the human genome and sequencing the tumour genome are now bearing fruit and we can begin to think how that laboratory research is going to be able to have an impact on clinical care. To me that’s a huge statement, a huge reason that all of us should be supporting biomedical research through our federal agencies, nationally, internationally, through our philanthropies. There is no question that investing in research is really good for people’s lives.
What would you like to see in the future for AACR?
Our patients are at the centre of everything we do, whether you’re a basic laboratory researcher or whether you’re a clinical researcher everybody keeps in mind what the ultimate endgame is which is to try to reduce the burden of cancer, preventing and curing cancer wherever possible. So that’s extremely important. I’m hoping in 2020, for example, that we would be able to talk about the fact that cancer mortality continues to drop. I would like to hope that we would be able to talk about an ever increasing commitment to prevention and to screening because, of course, the best cancer is no cancer. So it would be really nice to think that we would have an impact there. I would also like to hope that we would see that the dissemination of all of these findings, all this work that we’re talking about, the test that Dr Piccart just talked about, it would be nice to think that these things would be readily available across the globe to individuals who have need of them. So disseminating and reducing disparities of access would be huge.
We’re very excited about the work that’s being done in cancer generally and the work that’s being presented at the AACR this week. This morning we had a chance to hear four first class breast cancer trials spanning all the way from risk assessment to treatment of active disease of a particular part of breast cancer, the HER2 positive type. For me personally it was very exciting to hear the results of the MINDACT trial, this has been in the making for such a long period of time and it’s always tremendous to see how the efforts of thousands and thousands and thousands of investigators and many thousands of patients have come together now to give us an answer, to give us a place where we can think about applying this forward to our patients in the future.