Collaborating to Improve Care at the 2014 Breast Cancer Symposium

BCRF grantees join the conversation at the annual ASCO meeting

Last week, BCRF traveled to San Francisco to attend the 2014 Breast Cancer Symposium held by the American Society of Clinical Oncology (ASCO). Initiated in 2007, the annual session provides an opportunity for physicians and clinical investigators from around the globe to share the latest developments across all aspects of breast cancer. 

“The Breast Cancer Symposium has become a wonderful meeting that translates the latest research into routine clinical practice, so more patients can benefit more quickly from the advances made in all disciplines around the world,” said Dr. Clifford Hudis, Chairman of BCRF’s Scientific Advisory Board and ASCO’s 2013 President.

The theme of the symposium, “Enhancing Clinical Care Through Collaboration,” couldn’t have been more in sync with BCRF’s philosophy of joining forces to bring an end to breast cancer. Many BCRF grantees, in fact, participated in a number of the symposium’s meetings as both discussants and presenters.

Here are some highlights:

Risk Assessment, Screening & Prevention
The discovery of BRCA1 and BRCA2, along with other cancer-associated gene mutations, paved the way for the development of genetic tests. Despite the potential these discoveries hold, many challenges remain in interpreting the results of multi-gene tests for patient counseling and cancer therapy. At the symposium, experts emphasized the need for continued research to better understand the clinical significance of newly discovered genetic mutations and the importance of family history in assessing breast cancer risk. BCRF has long supported the work of leaders in this field including Drs. Fergus Couch, Mary-Claire King, Katherine Nathanson, Kenneth Offit, Sir Bruce Ponder, Lajos Pusztai, Chuck Perou, Jeffrey Weitzel and others.

Breast cancer screening for the general or “normal” risk, population is currently limited to mammography, a hot topic because of the risks versus benefits debate in women under 50. Dr. Stephen Feig, an expert on the subject and a research radiologist at the University of California, Irvine, emphasized the importance of continued screening for all women in San Francisco. He cited clinical trials demonstrating that up to 85 percent of women diagnosed with breast cancer—and more than 60 percent of women between ages 40-49—do not have a family history of the disease. These studies suggest that for women with a family history limited screening could result in many cancers going undetected until much later, making them potentially more difficult to treat.

The conversation continued with a discussion on anti-estrogen drugs such as Tamoxifen and Raloxifene, a class of drugs known as SERMs (Selective Estrogen Receptor Modulators), which have shown to prevent breast cancer or its recurrence in high-risk women. This strategy, called chemo-prevention, requires long-term treatment (typically five years), but many women stop their therapy prematurely because of side effects. Knowing which women will benefit from these drugs could reduce the incidence of side effects and lead to the development of alternative strategies. BCRF grantee Dr. Jack Cuzick presented data from a clinical prevention trial, supported in part by BCRF, suggesting that changes in breast density could help predict the a patient’s response to Tamoxifen. This would allow doctors to find out early whether a woman should continue the standard five-year Tamoxifen treatment.   

Immunotherapy
The immune system works by balancing on and off switches to regulate how the body responds to infection. Two proteins that turn off immune response, called CTLA-4 and PD-1/PD-L1, are often hyper-activated in tumor cells, allowing the tumor to go undetected by the immune system. The FDA recently approved immunotherapies to block these proteins after recent clinical trials showed a significant improvement in metastatic melanoma. In a session chaired by BCRF grantee Dr. Hope Rugo, Dr. Heather McArthur, who is also funded by BCRF, provided an overview of the history of cancer immunotherapy and its potential in breast cancer. Dr. McArthur is currently working with BCRF grantees Drs. Jedd Wolchok and Stephen Solomon to test a pre-surgical combination of immunotherapy to help tackle triple negative breast cancer.

Survivorship
A person’s journey with breast cancer doesn’t end with the last round of treatment; the effects of chemotherapy, radiation and surgery can impact quality of life for years. Many of the issues facing cancer survivors, including how to best manage and prevent recurrence, were topics of discussion during a session chaired by Dr. Hudis and BCRF grantee Dr. Julie Gralow. Dr. Pamela Goodwin, who is also funded by BCRF, explained that most women with breast cancer tend to be heavier than the general population at the time of diagnosis. As she expounded on obesity’s tie to an increase in metastasis and death, she noted the science underlying this link, including increases in levels of circulating insulin and estrogens as well as inflammatory markers, and emphasized the importance of physical activity.

Adding to the survivorship conversation, BCRF grantee Dr. Sharon Giordano talked bout the long-term effects of systemic chemotherapy, including chemo-induced menopause, hot flashes and other gynecological effects, as well as depression, anxiety, loss of libido and nerve damage. She made it known that preventive and therapeutic strategies are being studied in clinical trials and treatment guidelines are being revised to minimize long-term side effects.

Metastasis
Most breast cancers depend on estrogen for growth and, as a result, are referred to as estrogen receptor positive (ER+). While anti-estrogen drugs like Tamoxifen and aromatase inhibitors are effective for most ER+ breast cancers, a persistent problem is late recurrence, considered longer than five years after diagnosis. We understand very little about why tumors come back years after treatment, but resistance to anti-estrogen therapies often occurs in these relapse tumors.

During the symposium, BCRF grantees Drs. Suzanne Fuqua, Hope Rugo and Lajos Pusztai presented updates on emerging strategies and new challenges in addressing this concern. Dr. Fuqua’s research raised the possibility that the receptor for the male hormone androgen may play a role in response to anti-estrogen therapies, leading to recurrence or metastasis. Dr. Fuqua also demonstrated how mutations in the estrogen receptor gene, ESR1, play an important role in drug resistance both in metastatic and primary tumors. Dr. Rugo provided an overview of recent clinical trial results highlighting promising combination and targeted therapies for hormone-resistant breast cancers. Dr. Pusztai discussed the current challenges and future promise of tumor-profiling tests in predicting drug response and highlighted the potential of multipurpose drugs for various types of cancer based on common molecular abnormalities.

Breast-conserving Therapy
Early detection of smaller tumors and the use of pre-surgical treatment to reduce tumor size has made breast-conserving therapy (BCT) an option for many women with early stage breast cancer. BCT, a procedure that removes only the affected area of the breast, has been shown to be a safe and effective alternative to mastectomy. BCRF grantees Dr. Stuart Schnitt, a pathologist at Beth Israel Deaconess, and Dr. Bruce Haffty, a radiation oncologist at Rutgers Cancer Institute, shared their views on the challenges in preventing recurrence while preserving a woman’s natural appearance after BCT.

The 2014 Breast Cancer Symposium continued its tradition of focusing on cutting edge yet clinical relevant advances that have the patients and their families top of mind.