Norman Wolmark, MD

Identifying factors that are responsible for late distant metastatic recurrence of invasive lobular carcinoma.

Impact

Invasive lobular carcinoma (ILC) is the second most common type of breast cancer after the more common invasive ductal carcinoma (IDC). ILC has unique features compared to IDC, including metastatic spread to unusual sites such as the stomach and the ovaries, and a propensity for late distant metastatic recurrences, sometimes even 15-20 years after initial diagnosis. However, there is very little clinical research being exclusively conducted in ILC and thus the reasons for these characteristics are not well understood. Clinical trials almost always group ILC and IDC together, which has led to a knowledge gap in our understanding of long-term outcomes of patients with ILC. Dr. Wolmark is leading research by the National Surgical Adjuvant Breast and Bowel Project (NSABP) to uncover drivers of late distant metastatic recurrences in patients with ILC.

What’s next

Long-term work by Dr. Wolmark and the NSABP has enabled the analysis of clinical data to compare long-term survival between patients with ILC and IDC from four large NSABP clinical trials of chemotherapy regimens for the treatment of early-stage breast cancer. An earlier study confirmed that patients with ILC were more likely to experience late breast cancer recurrences beyond the first five years from diagnosis than patients with IDC. Their current project is to identify factors that are specifically associated with late, distant metastatic recurrences of ILC by sequencing patient tumor specimens and creating a genetic signature that could help identify patients who are at risk for late recurrences. Being able to identify this set of patients would allow for personalized treatment, which may be able to prevent late recurrences and save lives.