Q&A With Dr. Martine Piccart-Gebhart

BCRF sat down with Dr. Martine Piccart-Gebhart to discuss her current work and interest in breast cancer research. Read on to learn more.

Q: Tell us about yourself as a scientist and how you became interested in breast cancer research.

A: My father, whom I admired very much, was a gynecologist, so I became interested in medicine very early. Then, when I was a teenager, my uncle developed colon cancer. I visited him at Jules Bordet Institute, where I now work, and an inexplicable feeling came over me when I walked into the hospital. Later on, I made these same trips to visit my mother, who developed breast cancer during the second year of my training in oncology. Her illness was a great motivation for me to become more interested in breast cancer.

Q: Describe your BCRF-funded research project. What are some laboratory and/or clinical experiences that inspired your work? What are your primary goals for this research?

A: I have devoted a lot of time and effort into the founding and activities of the Breast International Group (BIG), an international consortium of research groups outside the US. The genesis of the group was the huge problem faced by European researchers, a problem which did not exist in the US until very recently. That is, there is virtually no government funding for clinical trials, making us European researchers highly dependent on the pharmaceutical industry.

In addition, we researchers want to answer questions that are of high interest to patients and clinicians, but not to drug companies. For instance, we wanted to launch a trial called MINDACT, studying chemotherapy over-treatment, because there are patients who could gain the same level of therapeutic benefits from endocrine therapy alone without adding chemotherapy. It was very difficult to get funding for this study. Although we did get a significant grant from the European Union, it was not enough to cover the entire trial. Fortunately, Dr. Larry Norton was familiar with BIG and the frustrations that our research community faced. BCRF support helped to set up the biobanking facility for the MINDACT trial, which is testing the clinical utility of the Mammaprint 70-gene signature. Since then, BCRF has become a recurrent funding source for academic BIG projects that would not otherwise be able to proceed.

The availability of BCRF funding made me think about enhancing collaboration between BIG and the US research network through the North American Breast Cancer Group (NABCG, formerly known as The Breast Cancer Intergroup). When I was training in the US, I saw how US researchers work together and the "power" they achieved together. While European organizations, like the EORTC, were doing excellent clinical research, the US groups took collaboration to another level.

At the beginning, the BIG and NABCG collaboration was quite modest. BIG and NABCG researchers met for an hour at the annual ASCO meeting to exchange ideas. Then, collaborations increased. BCRF, again, made this possible because no one wanted industry to fund these high-level strategy meetings.

Q: Are there specific scientific developments and/or technologies that have made your work possible? What additional advancements can help to enhance your progress?

A: It's an incredibly exciting time in breast cancer research. Our basic (laboratory) scientists have done a superb job in dissecting the mechanisms behind cancer cell survival, proliferation, and invasion/metastasis. Also, we are witnessing the development of powerful high-throughput technologies, which can give us the entire genome information of an individual and his/her tumor.

However, if we want all these advances and knowledge to benefit our patients, we will need to fundamentally revolutionize the way we conduct research. Personalized medicine is our goal, but it is one that I believe is still in the future. One of the reasons is that our translational research programs – bringing insights and progress made in the laboratory to the patient's bedside – have lacked ambition and are inefficient. For example, in the current process, we look at the possible significance of one gene in tumor behavior, but a tumor relies on a complex signaling network! Also, the publication process is extremely slow.

The next step is for us is to make the best of the precious tumor samples that our patients generously give us. We need to start sharing these samples and data much sooner, especially now that the technology can give so much data on a single tumor.

The human genome was sequenced quickly because of the fantastic collaboration among all the scientists. This kind of teamwork is the only way for us to move away from the very empirical way we practice today towards something that can be really called personalized oncology.

Q: What direction(s)/trends do you see emerging in breast cancer research in the next ten years?

A: Wider and stronger collaboration will become even more important in the future than in the last three decades. New technologies are helping us better understand the complexity of breast cancer. We now know that "breast cancer" is five or six different diseases. As a result, we should no longer design studies for all breast cancer patients but for subpopulations of them. Because these studies will apply to small percentages of women sharing certain common profiles in their tumors, joining forces will be even more critical to progress.

The second thing is that we will need to do a much better job in designing studies. We need to be more ambitious in terms of what we want to achieve: not just look at the particular characteristics of each tumor, but also analyze the blood of our patients, look at their circulating tumor cells and analyze their genetic background. Translational research programs will become more complex and more ambitious. Again, this means more collaboration because ambitious translational research is expensive, so all of us will need to share expertise.

Q: What other projects are you currently working on?

A: Currently, BIG has two important initiatives. We continue running large clinical trials that are going to make important new drugs available to patients. We completed two large trials for the Human Epidermal growth factor Receptor 2 positive (HER2+) breast cancer subtype. Now, we are busy working on a third study, also on new anti-HER2 agent. These large trials aim to improve patient outcome and to help determine who would benefit the most from the new intervention, so we spend a lot of efforts in designing good translational research programs.

Q: How close are we to preventing and curing all forms of breast cancer?

A: I wish I could say that we are close. The form of breast cancer that we are not too far from "curing" is the HER2+ subtype, for which we have witnessed the development of six or seven new drugs, two or three of which are very advanced. The first results of the use of two anti-HER2 drugs given in combination, which were reported at the December 2010 San Antonio conference, are very, very promising because in some patients the tumor disappeared after receiving the two anti-HER2 drugs even before chemotherapy.

This is fascinating! So, I think that if we do the right things, design the right trials, and collaborate together, it may be possible over the next decade to cure 99% of the HER2+ cases. For the other subtypes, we still have major challenges ahead, so I'm a bit less optimistic.

Q: In your opinion, how has BCRF impacted breast cancer research?

A: What I like about BCRF is its desire to support innovation. BCRF does not do just what others do. This openness encourages innovation and "new thinking," which is so important to progress. Also, BCRF's reporting requirements, unlike other organizations', are extremely reasonable. Some organizations require us to produce a 150-page document, which is counterproductive since you have to stop research for one month just to write a report! On top of that, the way we are treated is unique to BCRF. We have a gathering once a year where we get to interact on many levels and meet the donors who support our work. It's something I've never experienced anywhere else.

Read more about Dr. Piccart-Gebhart's current research project funded by BCRF.