The American Society of Clinical Oncology (ASCO) recently released its tenth Annual Report: “Clinical Cancer Advances 2015,” highlighting advances in cancer care and emerging trends in technology expected to have a significant impact on the management of cancer.
The report is intended to inform both the public and the professional community about the status of the cancer field. As Dr. Clifford Hudis, Immediate Past President of ASCO and Chairman of the BCRF’s Scientific Advisory Board, explains, “There has been some discussion about whether the investment in cancer research has been worth it, whether we’re making progress or not, and this report is a way of clearing addressing these concerns by documenting key advances.”
What do advances in leukemia mean for breast cancer?
For the first time, ASCO highlighted its Advance of the Year: the treatment of chronic lymphocytic leukemia (CLL). Four new drugs, two immunotherapy-based treatments and two targeted drugs, have resulted in a dramatic improvement in management of CLL. BCRF asked Dr. Hudis to comment on the significance of these treatment advances for breast cancer.
Dr.Hudis: The relevance of these new therapies to breast cancer is not in the specific proteins they target or whether they will be effective against breast cancer; it’s more general. There is an intense effort to unlock the secrets of the genome, the alterations in the genes of tumors that cause them to behave as cancers, and to use that information to developed highly targeted drugs that hopefully will improve treatments in all cancers. The two targeted drugs in CLL are examples of that. But it is worth remembering that tamoxifen, which targets the estrogen receptor, was the first targeted therapy in breast cancer and we now have others, like trastuzumab (Herceptin®) and pertuzumab (Perjeta®) that target the HER2 protein, and the list of potential targets and active drugs will continue to grow as our understanding of the breast tumor genome expands. In this way the advances in CLL both mirror and predict what we expect in breast and other cancers.
Similarly, the modern immunotherapy story started with melanoma, where new drugs that enhance the immune response proved more effective than traditional treatments. We continue to build on that experience in other cancers. The immunotherapies that were successful in reversing the trend in CLL work by targeting unique antigens on the tumor and we are asking if there are unique antigens that can be targeted in breast cancer and whether we can increase the exposure of those antigens and use immune modulating drugs to enhance the body’s natural immune defense against tumors.
Note: In 2014-15 BCRF invested over $5 million in 24 projects led by 30 investigators studying new ways to harness the immune system to fight breast cancer.
The significance of the advances in the treatment of CLL is that they highlight the fact that the science can transcend the specific disease type and that discoveries in one malignancy may inform treatment and research in another.
The report is a comprehensive overview of significant progress across cancer types so did not focus only on breast cancer, but Dr. Hudis noted that they highlighted new research data on the prevention of breast cancer. The IBIS II study involved over 4000 high- risk, post-menopausal women who received anastrozole (an aromatase inhibitor) for five years. In a press conference at the 2014 San Antonio Breast Cancer Symposium in December, the study’s lead investigator, Dr. Jack Cuzick, reported that anastrozole reduced breast cancer risk by 50 percent.
Dr. Hudis: We’ve known for years that tamoxifen and raloxifene (selective estrogen receptor modulators or SERMS that are frequently described as anti-estrogen drugs) can prevent breast cancer. Now we have a second confirmation that an aromatase inhibitor is also an effective chemo-preventive strategy for women after menopause. Together, four reported studies make it pretty clear that we can prevent some types of breast cancer. That’s very important, because prevention can be the best cure and it suggests that we may be able to prevent more cancers in the future.
A decade in review and future perspective
The report emphasizes that the last decade of research has yielded unprecedented advances, many of which can be linked to information obtained as a result of The Cancer Genome Atlas (TCGA), launched by the National Institutes of Health in 2005. The impact of the TCGA and other large scale tumor profiling studies on the path to new targeted therapies and more personalized medicine cannot be overstated. In the last decade we’ve seen the emergence of a host of new targeted therapies based on the discoveries being made in understanding tumor genomics.
The report also listed the most important trends that ASCO believes will reshape cancer care in the next decade, including identifying and killing cancer stem cells, improved genomics technology, liquid biopsies and nanotechnology. BCRF asked Dr. Hudis to comment on the impact of these emerging fields on breast cancer.
Dr. Hudis: The technical advances are not necessarily disease specific. There increasingly will be advances that are scientifically based and that cross traditional disease boundaries.
In spite of the general applicability, however, scientific advances do not do away with the need to understand the historical aspect of specific diseases and to provide context-sensitive options for treatment. To achieve this goal, physicians and researchers are going to have to maintain and enhance their disease knowledge even as they learn more molecular biology. In the end, they will have to apply these findings to individual patients.
Entering the era of precision medicine
Understanding the cancer genome– the genetic abnormalities that make a cell behave like cancer– is the foundation of precision (or personalized) medicine. The goal of precision medicine is to match treatments to patients based on the genetic makeup of the cancer as well as patient-specific factors such as lifestyle and other individual characteristics. Large scale molecular profiling of hundreds of different tumors over the last decade has provided a wealth of knowledge that can be used to predict what drugs a patient is mostly likely to respond to and to identify new therapeutic targets.
In his 2015 State-of-the-Union address, President Obama announced a federally- funded Precision Medicine Initiative aimed at accelerating progress in this area. In a speech that followed, Mr. Obama pledged $215 million to power a new model of patient-oriented research to accelerate biomedical discoveries and advance the development and deployment of new tools, knowledge and therapies to guide personalized treatments in cancer and other diseases.
Dr. Larry Norton, BCRF’s Scientific Director, lauded President Obama’s commitment, emphasizing that BCRF has been at the forefront of advancing precision medicine, highlighting the Evelyn H. Lauder Founder’s Fund as an example. “I am fully confident,” Dr. Norton said, “that the Founder’s Fund and the AURORA projects will help make precision medicine for breast cancer possible by advancing our understanding about the molecular biology, not just the genomics, of metastatic disease.”
President’s Obama’s pledge comes at a time when federal investment in research has stagnated. ASCO President Dr. Peter Yu notes that much of the progress highlighted in this and past ASCO reports would not have been possible without significant investments in research from the U.S. National Institutes of Health and National Cancer Institute. In the past decade, a decline in federally funded research has resulted in a 23% loss of purchasing power. “The practical implication of this,” notes Dr. Yu, “is that promising research is going unfunded, new studies are being scaled back, fewer patients have opportunities to participate in clinical trials and future meaningful advances against cancer may be few and far between– unless the nation renews its commitments to fighting cancer.”
BCRF is proud of its sustained commitment to breast cancer research and for its role in moving discoveries and innovations forward. Dr. Hudis sums up the impact of BCRF simply:
There are no clinically important advances in breast cancer that haven’t had some support from BCRF. We’ve been fortunate in being able to identify the most promising and innovative projects and investigators early and therefore help support them in making these advances.
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