The 38th Annual San Antonio Breast Cancer Research Symposium (SABCS) kicked off Tuesday afternoon with education sessions setting the tone for the rest of the meeting that will run through Saturday morning. BCRF is attending the meeting and will provide updates throughout the week on the latest news in breast cancer research and clinical trials.
Genetic Risk Prediction
Highlights from the education sessions included presentations from BCRF investigators, Drs. Mark Robson, Fergus Couch and Susan Domchek on the promise and challenge of genetic risk prediction. Research has uncovered hundreds of inherited gene mutations (the genes you inherit from your mom and dad) that are associated with various levels of risk for breast cancer, including rare mutations in major genes (such as BRCA 1 and BRCA 2) that significantly increase risk and more common gene alterations called “SNPs” and other gene variants of unknown clinical significance. These discoveries have fueled the development of variety of commercially available gene tests, many of which create more confusion for both clinicians and patients. There are concerted collaborative efforts underway involving academic clinical and research groups, as well as commercial companies to better understand the risk of the known variants. Cancer registries, such as PROMPT (Prospective Registry of Multi Plex Testing) were created to prospectively follow individuals who have undergone multiplex gene testing so that scientists can learn more about the significance of rare gene mutations on breast cancer risk. Collecting information from families that share a genetic mutation will also be key to quantifying the individual risk in a way that can change the course of prevention, treatment or management of a specific breast cancer.
Development and Use of Molecular Biomarkers for Cancer
In a session on biomarker development hosted by BCRF investigator Dr.Ben Ho Park, Dr. Daniel Hayes emphasized how critical biomarkers (gene or protein markers that differentiate tumor cells from normal cells) are to selecting the right treatments for each patient and reducing his or her exposure to toxic chemotherapies or to expensive targeted therapies that won’t improve their outcome. Dr. Max Diehn of Stanford University discussed advances in liquid biopsy technologies that can detect minute amounts of tumor DNA in the blood of patients. Scientists can then scan those tiny pieces of DNA for rare gene mutations, which can then serve as biomarkers for disease progression, treatment response, or the presence of residual tumor after treatment. While the emerging technologies are promising, each potential biomarker must be clinically validated through rigorous prospective clinical trials and then undergo FDA review and approval for acceptance by third party payees, e.g. health insurance companies, a lengthy and complicated process outlined by Dr. Julia Beaver of the FDA.
Management of Advanced Breast Cancer
BCRF grantee Dr. Fatima Cardoso moderated a concurrent session on the treatment of advanced, or metastatic breast cancer, sharing new guidelines from the recent Advanced Breast Cancer (ABC) 3 Conference held in Lisbon, November 5-7. The ABC guidelines, which are expected to be made public in early 2016, are intended to create a worldwide consensus in the treatment of metastatic breast cancer that is based on the latest research.
While treatment remains challenging for those with progressed disease, the latest findings point to therapies that focus on balancing treatment efficacy with better quality of life, since many patients are living longer with their disease. Individualized treatment remains a key goal for oncologists and takes into consideration the patient’s personal needs– factors influenced by past therapies, age, socio-economic and psychological factors, and availability of treatment options– in selecting the most appropriate treatment for his or her disease.
“If all cancer patients would be treated according to the current knowledge, mortality would substantially decrease,” Cardoso said.
Other highlights from the session on advanced breast cancer included a talk from Dr. Maura Dickler of Memorial Sloan-Kettering Cancer Center, who presented an analysis on optimal treatment of metastatic estrogen-receptor(ER) positive breast cancer, Dr. Alistair Ring of the Royal Marsden, UK who spoke about strategies for tailoring chemotherapy for metastatic breast cancers and Dr. Sarah Hurvitz of the University of California Los Angeles who discussed available regimens and advancements in treatment of HER2-positive metastatic breast cancer.
Controversies in the Management of DCIS
In a session hosted by BCRF grantee Seema Khan, scientists and clinicians presented scientific and clinical arguments for and against aggressive treatment of DCIS. The incidence of ductal carcinoma in situ (DCIS) has increased dramatically with advances in screening technologies. Considered pre-malignant or Stage 0, the treatment of DCIS as cancer with surgery, radiation and often systemic therapy has fueled controversies among oncologists. One thing everyone agreed on: DCIS is a marker of increased risk of breast cancer, and right now, doctors don’t know how to distinguish those that are high risk from those that are not. Identifying the molecular pathways that drive DCIS to become invasive breast cancer will be important in resolving the controversy and reducing overtreatment.
Dr. Yi Li of Baylor College of Medicine provided an overview of potential drug targets for treatment of DCIS emphasizing pathways that promote tumor cell survival and growth that may be key players in the progression to invasive breast cancer. Dr. David Euhus of Johns Hopkins University highlighted the adaptation of prediction tools such as Onco Type Dx to develop a DCIS-specific tool that can predict which DCIS are high risk for recurrence. Dr. Shelly Hwang presented an alternative strategy for management of DCIS involving the use of anti-estrogen treatments such as tamoxifen, raloxifen or aromotase inhibitors to both treat the DCIS and prevent recurrence.
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