We discuss the key moments at the San Antonio Breast Cancer Symposium, the world's largest breast cancer conference.
Last week, as the UK was hit by a so-called “weather-bomb”, some Brits were 5,000 miles away, donning short sleeve shirts in an attempt to stay cool in 100% humidity at the world’s largest breast cancer conference.
Breakthrough out in force
The San Antonio Breast Cancer Symposium is arguably the most important conference of the year for the field. This year’s event saw 7,500 delegates from more than 90 different countries.
And the Brits were out in force. Dr Nick Turner, from the Breakthrough Toby Robins Breast Cancer Research Centre at the ICR, was part of the planning committee and one of only two people from outside the USA to be given this honour. Invited speakers from the UK included some of the most influential people in breast cancer research. We were particularly excited to hear talks from Breakthrough-funded scientists Professors Andrew Tutt, Mike Dixon and Mitch Dowsett and Drs Arran Turnbull and Lesley-Ann Martin.
Tuesday was all about education. Experts in areas such as drug development, breast surgery, treatments for specific types of breast cancer, prevention and patient care delivered clear overviews of the progress and future of their field. A highlight of the day was Professor Mitch Dowsett from the Breakthrough Toby Robins Breast Cancer Research Centre and the Royal Marsden Hospital leading a session of talks sharing best practice in the treatment of ER-positive breast cancer patients.
This type of breast cancer has some very good treatment options such as tamoxifen and aromatase inhibitors. However, many patients’ tumours develop resistance to these treatments over time, which can lead to the cancer coming back (recurrence). Mitch explained that we need to be able to predict which patients are likely to recur early on in their treatment programme so that clinicians have the opportunity to intervene before recurrence.
Treating patients prior to surgery (known as neo-adjuvant treatment) and looking for genetic and molecular changes associated with recurrence could be a powerful predictive tool. Mitch said that biomarkers can be discovered which, within two weeks of starting treatment, can predict the risk of future recurrence. Analysis of patients in clinical trials have shown this to be the case for women treated with tamoxifen and aromatase inhibitors.
Also talking in Mitch’s session was Professor David Cameron, who recently took part in our debate on treatments for secondary breast cancer. He stated that there is a shortfall in knowledge with how we choose which patients receive neo-adjuvant treatment and which don’t. To address this, David proposed that we need to start asking the right questions. Can we identify patients for whom neo-adjuvant treatment offers nothing? Can we improve how we select treatments for each patient? Currently, neo-adjuvant treatments are selected based on the size of the tumour, rather than on its biological characteristics, and something needs to be done to address this.
Breast cancer treatments are getting better
Wednesday held some exciting talks about the current state of drug development for breast cancer, as well as the challenges on the horizon. In a session aimed at patients, Professor Carlos Arteaga from Vanderbilt University said that treatments have been getting better and less toxic due to an explosion in new targeted therapies. Many are not yet approved for use but it highlights how rapidly we have started to get a grip on the complexities of the disease. The main reason these drugs fail in clinical trials, he said, is not that the drugs are bad, but that the drugs aren’t being used on the right people. It’s imperative, then, that we identify biomarkers which can be used to more accurately select patients for a particular drug.
Breakthrough scientist wins Brinker Award
Mitch Dowsett was in the spotlight again to receive the Brinker Award for Scientific Distinction. This prize is awarded for service to clinical research and it’s a great achievement that Mitch is receiving the award even though he is not a clinician.
Mitch has always been interested in the biology and therapy of ER-positive breast cancer, and said he’s proud to have been involved in the development of aromatase inhibitors, one of the most successful breast cancer treatments to date.
After talking through the history of aromatase inhibitors (a story for another day!) he reiterated what he spoke about on Tuesday - that the focus needs to turn towards biomarker discovery as a way to improve how patients are treated with drugs such as tamoxifen and aromatase inhibitors.
Tackling the hard-to-treat breast cancers
On Thursday we saw Professor Andrew Tutt take to the stage to present the first analysis of the Breakthrough and Cancer Research UK funded Triple Negative Trial. This clinical trial set out to test which of two chemotherapy drugs (carboplatin and docetaxel) is more effective at treating patients with triple negative breast cancer (TNBC) once it has spread. The top line message from Andrew was that there was no difference in survival for patients treated with either drug. However, their analysis revealed that carboplatin gave a significant benefit in a sub-set of patients who tested positive for a faulty BRCA gene. Andrew suggested that this finding gives reason for BRCA testing in all TNBC patients because it could help guide treatment choice.
Tamoxifen can prevent breast cancer
The IBIS-1 trial was a long term prevention trial to see if tamoxifen could prevent women getting the disease if they are at high risk (a family history or several close relatives with breast cancer). The trial has previously shown that tamoxifen could prevent breast cancer in this set of women and new data presented by Professor Jack Cuzick now shows that the “reduction in breast cancer incidence remains strong and unabated for 20 years”.
This tells us that tamoxifen will continue to reduce breast cancer risk for many years – which is very good news for those women who are benefitting from the drug in this way. These findings also show that the impact of tamoxifen is greater in pre-menopausal women, which is exciting as this group have fewer options than women post-menopause. We believe these findings should help all women at a higher risk of developing breast cancer to reach an informed decision about what, if any, preventative measures they may wish to take to manage their risk.
Back home to sleep
So at the end of a long, humid week, it felt pretty good to be flying homeward bound for some proper winter weather and a good night’s sleep. This year at the conference we were treated to some fascinating science, telling the story of the future of breast cancer research and revealing just how much progress has been made. We are proud to say that Breakthrough-funded research was a prominent feature and look forward to more ground-breaking research being revealed next year.