Nearly 200 BCRF researchers joined hundreds of donors and supporters for the Annual Symposium at the Waldorf Astoria on October 27. Every year, BCRF convenes this informational forum immediately prior to the Awards Luncheon to offer an opportunity for BCRF supporters to ask questions directly to a panel of selected experts from the BCRF community of scientists.
Medical research, particularly the field of breast cancer, has been marked by many exciting advances in the last two decades. As the pace of technology and discovery continues to quicken, it is easy to be swept up in the momentum. The theme of the 2016 Symposium, “Breast Cancer: Where are we now? Where are we going?” was intended to take pause to reflect on what we’ve achieved, but also to think about both the promise and challenges of the future in breast cancer research and ultimately patient outcomes.
This year’s symposium panelists were 2016 Jill Rose awardee, Dr. Charles Perou and radiation oncologist, Dr. Silvia Formenti. BCRF’s Scientific Director, Dr. Larry Norton and Chair of the BCRF Scientific Advisory Board, Dr. Judy Garber moderated the discussion and researchers in the audience participated by responding to questions in their area of expertise.
From one disease to many: recognizing the complexity of breast cancer
It wasn’t that long ago that breast cancer was thought as a singular disease where every woman diagnosed would receive the same standard surgery and chemotherapy. Today the story is much different. Because of groundbreaking research by BCRF investigator Charles Perou and many others, we know there are at least five or six molecularly distinct subtypes of breast cancer. Within those subtypes there is enormous variability between patients– and even within a single tumor– that can affect patient outcomes.
As with any intellectual pursuit, the more we learn, the more we realize we don’t know. While it may be tempting to become discouraged by this demoralizing truth, particularly in regards to finding a cure (or cures) for breast cancer, Dr. Norton emphasized that the inherent complexity of breast cancer is actually an opportunity.
“It allows us [scientists]”, he said, “to make new discoveries that link pieces of the puzzle together.”
One puzzle, many players: Personalizing care, risk assessment, prevention and treatment
Understanding how inherited gene mutations affect risk is a crucial element to unraveling the mysteries behind breast cancer. This includes how mutations that occur in the tumor cells during cancer progression affect tumor behavior, and how these two seemingly distinct phenomena converge to affect breast cancer outcomes.
Dr. Garber highlighted how work in this area continues to evolve and provide new clues to personalize both prevention and treatment for each patient. Answers to these questions are being pursued through collaborative efforts of BCRF investigators and involve clinicians, geneticists, biologists, bioinformaticians and mathematicians.
Personalized or precision medicine, while not a new idea, has gained traction with the support of the National Cancer Moonshot Initiative. The overarching goal of the Cancer Moonshot is to harness the vast amounts of information siloed in medical records and other national databases to better understand and predict risk and deliver the most appropriate cancer care for each individual.
There are many challenges to achieving the goals of the Cancer Moonshot, not the least of which is communicating this information to patients. Dame Lesley Fallowfield, emphasized the need of clinicians to learn how to discuss treatment options and risk of recurrence in a way that empowers patients rather than frightening them, particularly at a time when they have received the devastating news of a cancer diagnosis.
Fifty years of Immunotherapy: Are we there yet?
Scientists have known for more than a century that the human immune system can attack and kill cancer cells, but harnessing this inborn capacity has been illusive in the fight against most cancers.
Though 50 years of research has not yielded an immunotherapy cure, it laid the groundwork for the tremendous progress of the last decade and new promising agents that could change the future of cancer treatment and even prevention.
The renewed excitement around immunotherapy is fueled by the success of a class of drugs called checkpoint inhibitors. In certain cancers, particularly: lung, melanoma and triple negative or HER2-positive breast cancers, checkpoint inhibitors look promising in early clinical studies.
These drugs work by making tumor cells “visible” to specialized immune cells called T-cell that can then attack and kill them. Since the T-cell can “remember” what the tumor cells looked like, the thought is that this approach may ultimately prevent tumors from coming back; much like a vaccine can prevent disease.
However, BCRF researcher Dr. Leisha Emens pointed out that response to current immune therapies has been limited to less than 20 percent of patients.
“It’s an exciting time,” she said, “but there is still a lot we need to learn about how to use these therapies.”
Most scientists agree that the future of immune-oncology will be in devising ways to enhance the immune response to make these therapies more effective. Towards this goal, we have learned that many standard therapies, including some chemotherapies and radiation activate the immune system and are being tested in combination with immune targeting agents. Targeting multiple immune pathways is another strategy to enhance response.
Dr. Silvia Formenti described efforts to use targeted radiation therapy to activate the immune system around the tumor, making it more sensitive to checkpoint inhibitors. Other efforts such as cryoablation– the freezing of tumors–and vaccines are being tested clinically for their effectiveness at sensitizing tumors to immunotherapy.
Feeling in control when nothing seems to be
Questions from the audience requested clarity on two somewhat confusing recommendations: the benefit vs. risk of moderate alcohol consumption and the use of nutritional or herbal supplements during cancer therapy.
Dr. Walter Willett addressed the first question by explaining that the benefits of moderate alcohol consumption, particularly red wine, to reduce the risk of cardiovascular disease should be weighed against the scientific evidence showing that even a few drinks a week can increase the risk of breast cancer by as much as 15-20 percent.
“The cardiovascular benefit [of red wine],” he said, “is greater for men than woman.”
While it seems somewhat counter-intuitive that doctors would discourage the use of nutritional supplements during cancer therapy, Dr. Joyce Slingerland explained that it is very difficult to predict how supplements might interact with or counter the effects of chemotherapy, so abstaining from use at least during therapy is currently the best advice.
Dr. Hope Rugo added that because supplements are unregulated, there is no way of knowing the actual formations, adding to the uncertainty of the effect they may have during therapy. She acknowledged, however that taking supplements may provide a sense of control for patients who feel they have lost control of their lives and their health after their breast cancer diagnosis. All patients diagnosed with cancer should discuss any supplements they use with their doctors.
Where are we going?
In closing, each panelist was asked to describe their vision of the future for breast cancer. Dr. Garber envisioned a world where we can better identify and protect people at risk by utilizing new technologies to harness the vast amounts of data being collected in medical records and clinical trials. Dr. Perou believes that current technologies will continue to improve and new technologies will be developed that together will advance precision medicine. Dr. Formenti envisioned a future where we solve the mysteries of immunotherapies so that they are both more effective in treating cancers and will prevent or reduce the risk of metastasis or recurrence.
The Annual Symposium and Luncheon are a highlight of the year for BCRF staff and supporters alike. For those who attend the events they are a unique opportunity to meet the scientists at the vanguard of breast cancer research and advances in clinical care. For BCRF program staff, the October events provide valuable face time with the scientists we work with throughout the year. For the scientists, the they are a special occasion to catch up with old friends and colleagues, to forge new collaborations, and to celebrate the uniqueness of BCRF, as both a funder and a family.
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