Driving "state of the art" forward in breast cancer treatment: An interview
This week, an expected 7,500 breast cancer clinicians and researchers from 90 countries will converge on San Antonio, Texas, for the 38th Annual San Antonio Breast Cancer Symposium (SABCS), the world’s largest breast cancer congress. SABCS serves as a forum for the sharing of information on developments in clinical, translational or basic research in breast cancer, and is the result of a partnership between the Cancer Therapy & Research Center at UT Health Science Center, San Antonio, the American Association for Cancer Research, and the Baylor College of Medicine. The shared mission of these organisations is to advance progress against breast cancer.
Here, we ask Padraic Ward, Breast Cancer Franchise Head, and Dr Andreas Chlistalla, Disease Area Head, Breast and Gynaecologic Malignancies in Global Medical Affairs, for their personal perspectives on general progress achieved in breast cancer treatment, and what the future holds.
How far are we from curing breast cancer?
Andreas Chlistalla: Good first question. I think we have made real progress, but still have a way to go. If you diagnose breast cancer early then with treatment before and/or after surgery you can have a good chance of preventing the disease from returning or reaching an advanced and ultimately incurable stage. However, with advanced breast cancer – cancer that has spread throughout the body – it is more difficult. Importantly it is treatable, and the aim of treatment at this stage is to control tumour growth and maintain patients' quality of life. We may not be close to finding a cure in advanced breast cancer, but there has certainly been great progress in controlling tumour growth.
Padraic Ward: Andreas touches on an important point. We may not have found a cure for advanced breast cancer yet, but that shouldn’t be perceived as a lack of progress in this area. Huge steps forward have been made in terms of helping people with advanced breast cancer not only live longer, but ensuring the quality of life they have is as good as it can be. This is important progress for people with this disease.
What have been the biggest recent advances in breast cancer?
Padraic Ward: Ninety percent of women diagnosed early with breast cancer are now alive five years after their diagnosis and the death rates from breast cancer have dropped by more than a third since the 1980s. For me, that’s real progress. A number of advances have contributed to this progress – better screening, better, more accurate diagnosis, improved surgical techniques, and continuing to develop better, more effective treatments.
Andreas Chlistalla: For me, the biggest advance has been in our knowledge – we just keep learning more and more about breast cancer. For example, it is now clear that breast cancer is not just one disease, but a really complex set of quite distinctly different diseases. This knowledge has enabled us to really understand tumour biology and helps us identify, diagnose and treat breast cancer more effectively.
Another area where big progress has been made is the increasing use and acceptance of innovative clinical trial endpoints to help get new medicines to patients more rapidly. Today, overall survival (OS) is seen as the “gold standard” by which breast cancer medicines are judged. However, as treatment provides greater efficacy benefit and moves to earlier lines of therapy we need to rely on other endpoints to avoid trials requiring ever increasing – and frankly unviable – amounts of time and effort to be completed. Examples include pathological complete response (pCR) in early breast cancer, and progression-free survival (PFS) in advanced breast cancer, respectively.
How is Roche contributing to advances in breast cancer?
Padraic Ward: Our biggest contribution has been in the area of HER2-positive breast cancer – an area we’ve been involved in for over 30 years, since the discovery of the HER2 gene. In that time, we’ve translated research into three medicines which have made a huge impact worldwide. We’ve also contributed to advances in HER2-negative cancer through our anti-angiogenesis research.
Andreas Chlistalla: I think one of our key contributions is our commitment to research – we have the largest clinical trial programme in breast cancer currently involved with or supporting a large number of trials across many countries. Despite all of our advances in treatment in the past years, there remains a considerable unmet need for new therapies, and as a leader in oncology Roche is committed to helping drive progress forward.
What are you excited about at SABCS this year?
Andreas Chlistalla: For me there are several exciting areas. There will be data from a National Surgical Adjuvant Breast and Bowel Project (NSABP) study on anti-angiogenic treatment concepts in the neo-adjuvant setting, and also a raft of presentations that look at going beyond the HER2 pathway and that will help us understand the potential of targeting pathways such as PI3K – a really interesting area of research. We will also be presenting some preliminary cancer immunotherapy data. We have seen some promising results with cancer immunotherapies in other cancers such as bladder cancer, lung cancer and melanoma, but this will be the first time that data in breast cancer will be presented.
Padraic Ward: SABCS is one of my favourite congresses – it is big, but because it is solely focused on breast cancer you can go to pretty much every session if you want. We are excited to be presenting data from across our development and clinical breast cancer portfolio, which is an important area of research for us. We continue to explore various signalling pathways to understand their role in driving tumour growth, as well as ways of blocking these pathways that might lead to further benefits for patients with cancer.
Beyond SABCS, what does the future hold for breast cancer and for Roche in this area?
Padraic Ward: More progress! There have been some real advances in breast cancer, but there is still much work to be done. We want to reduce the number of people with early breast cancer progressing to the advanced stage and we want to help those people diagnosed with advanced cancer live longer and better lives. We have an expanding portfolio of pipeline and marketed drugs in breast cancer at Roche, one that we are really excited about. For example, the acquisition of Seragon earlier this year added investigational oral selective estrogen receptor degraders, or SERDs, to our portfolio. We hope that our research will yield exciting results in many different types of breast cancer including HER2-negative disease.
Andreas Chlistalla: I’m excited at the pace and progress of the research. There are so many interesting avenues of research that hold promise for improving outcomes further for people with breast cancer, such as PI3K inhibition, the SERDs and immunotherapy. It is genuinely a very exciting time to be involved with breast cancer research. At Roche, we will continue to focus on the patient; we will continue to follow the science. We are committed to research into new medicines as well as the most effective use of current medicines, whether that is in different settings or stages of disease or by combining medicines to attack breast cancer on multiple fronts.