What Is Happening in the World of Breast Cancer Research? A Doctor Explains
With October marking the annual event of Breast Cancer Awareness Month, it’s a good time to chat about all things breast health. This is your official reminder to implement regular self-checks of your breasts, and if you can, help remind your loved ones to do the same.
Breast cancer is an extremely common disease — it’s Australia’s most diagnosed cancer — so research into treating and curing breast cancer is incredibly important. To find out where breast cancer research is at and how we can help further these studies, we turned to Dr Nick Zdenkowski of Breast Cancer Trials.
POPSUGAR Australia: It’s a big question, but can you please tell us a little bit about where breast cancer research is currently at?
Dr Nick Zdenkowski: Thanks to breast cancer research, many more women (and men) are alive today after a diagnosis of breast cancer compared with 40 years ago. After discovering that breast cancers are not all the same, we have a much greater understanding of how the many different types of breast cancer behave.
This has led to targeting of treatment to the individual tumour type to give the best possible outcome for that person. The flip side is that not all patients need every treatment, and we are now learning about who can be spared the potential long-term negative side effects of chemotherapy, radiotherapy and radical surgery.
We still have a long way to go before we can confidently say that every patient will be cured and we will continue to work towards that goal. Dare I say, ideally, we would prevent all breast cancer, sparing those people who are at risk from needing any cancer treatment at all!
PS: What are the team at Breast Cancer Trials working on at the moment?
NZ: We at Breast Cancer Trials — www.breastcancertrials.org.au — are always working on several important research topics. Immunotherapy continues to be a hot topic in breast cancer. We have seen international research that promises to be a game-changer through the addition of immunotherapy to standard treatment for early-stage and metastatic breast cancer.
This is particularly true for the high-risk ‘triple-negative’ breast cancer type, which has previously lacked a ‘target’ and therefore had a particularly poor prognosis. The BCT Neo-N trial aims to find out if we can give an immunotherapy drug with chemo to harness a person’s own immune system against their cancer and spare them from needing some of the harsher chemotherapy that would usually be used. It is a neoadjuvant trial, meaning that these patients with early-stage breast cancer are given chemo before surgery to remove their cancer.
Another fascinating study is called BRCA-P, which aims to find out if we can prevent breast cancer from occurring in the first place. It is targeting women who are at very high risk of breast cancer because they have a BRCA1 gene mutation. This international trial, co-led by one of our Breast Cancer Trials researchers, is repurposing a drug called denosumab that is widely used for osteoporosis, and we have strong scientific research that indicates it may stop even pre-cancerous cells in their tracks.
Of course, the good prognosis associated with many breast cancers is due to many trials like this that BCT researchers, doctors and patients have contributed to. Ongoing research is needed to stop cancers from coming back, to maintain quality of life and to prolong life.
PS: Has there been any noteworthy developments in the last few years that have impacted how breast cancer is treated?
NZ: New and practice-changing breast cancer treatments have certainly come about over the past few years. One new development is the use of tumour genomic testing to see which patients really need chemotherapy and who can be reliably spared from that treatment and its short and long-term side effects. Breast Cancer Trials is leveraging that technology in the EXPERT trial to find out if some patients with early-stage breast cancer can be spared from the radiotherapy that would usually be prescribed after breast-conserving surgery.
More patients are having chemotherapy before surgery for early-stage breast cancer, rather than the traditional approach of surgery first and then chemotherapy. Having chemo first allows us to understand how well the cancer has responded to treatment and tailor that treatment (to give more/different if needed, or less if not needed).
A breakthrough has been seen in giving additional chemo after surgery to those with poor prognosis cancers that did not shrink with standard chemotherapy, saving more lives. Breast Cancer Trials has used this ‘neoadjuvant’ type treatment in several trials. It can all get complicated for patients to understand which is why I have worked with Breast Cancer Trials to develop an online patient support and education tool for women with early-stage breast cancer considering chemotherapy then surgery (www.myneoguide.com).
The standard of care has changed for women with hormone-responsive metastatic breast cancer with the availability of a new type of drug called a CDK4/6 inhibitor. These drugs are now routinely prescribed to Australian patients with advanced breast cancer as a result of trials that Breast Cancer Trials have worked on. People with this common subtype of breast cancer can often now feel like they have an illness where they can enjoy years of quality life (when previously they were looking at chemotherapy for the short number of months that they had left).
There are new medications that trials have shown to be beneficial, that are now going through the official approvals and reimbursement processes before being available in Australia.
PS: When new developments are discovered, for example, the recent finding that the use of aspirin may help fight aggressive breast cancer, what does it take for something like this to be officially recommended?
NZ: It takes many years between the discovery of a new medication and it being available for routine use in the clinic. It is very important to ensure that any new treatment (or an existing treatment used in a different way) is safe and effective before it is released. First, it must be tested in the laboratory and then it will move through phases of trials with increasing numbers of patients to demonstrate safety and then effectiveness.
Along the way, many treatments do not get past those steps, despite great promise. Stories in the media about drug discovery in a laboratory can give a sense of excitement, tinged by frustration by the realisation that it will be years before the average oncologist can prescribe it, if it even manages to get that far.
Drugs that are currently available for specific conditions, such as aspirin for heart disease, should not be used for another condition until they have been shown in clinical trials to be effective. The side effects must be weighed up against the possible benefits. Independent collaborative trials groups such as Breast Cancer Trials can play an instrumental role in the repurposing of drugs that are available in generic form where there may not be a drug company that is willing to fund the research.
It is the responsibility of researchers to only bring those treatments that have strong evidence of a benefit through to routine clinical care. Official recommendation requires the agreement of experts in the field, along with the government TGA. The PBS is there to make the best drugs affordable to the average Australian.
PS: Is there anything the general population can do to help with research? Is donations the best way?
NZ: Well, money is always needed for the next life-changing discovery! But apart from that, it is incredibly useful for people to understand that research is a critically necessary part of health care. We will all need health care in our lives and to benefit from that health care we stand on the shoulders of those people who have volunteered in research studies in the past.
You never know when you or a loved one will be in need and may have the opportunity to participate in a clinical trial that has the potential to improve the lives of those in the future. You can seek out those trials, by asking your healthcare team, and by investigating reputable websites such as www.breastcancertrials.org.au, www.clintrialrefer.org.au and www.anzctr.org.au.
There are many charitable organisations out there and it is important to know where your donated money goes. Advocating for breast cancer research directly through Breast Cancer Trials has the potential to change lives around the world now and for decades to come.
For more information, or to make a much needed and appreciated donation, head to the Breast Cancer Trials website.
To get involved further, you can also take part in the 3 Course Challenge on Saturday, October 16. By challenging yourself to cook a three-course Indian feast, you can help Breast Cancer Trials find new and improved treatments for breast cancer. For more information on the 3 Course Challenge, which includes an interactive live-streamed cooking class with internationally renowned chef Sarah Todd, head here.