Building new standards of care for every patient with breast cancer

Breast cancer is still the world’s most commonly diagnosed type of cancer, which means we still have much more work to do. The field of research and development is constantly pivoting to better meet the needs of people with breast cancer, and we are committed to writing the next chapter for tackling with every type of breast cancer.

Dr Maura Dickler, Vice President of Global Product Development in breast and gynaecologic cancers at Roche and Steve Tuplin, Global Franchise Head of breast and gynaecologic cancers at Roche, reflect on progress in breast cancer to date and discuss how care may look for patients of the future, as well as Roche’s role in leading this change.

Maura: During my time as a clinician, I had the privilege of witnessing a paradigm shift in the way HER2-positive metastatic breast cancer and early breast cancer are treated. Pivotal insights in understanding the relationship between certain types of cancer and certain genes, exemplified by the identification of the HER2 gene in the 1980s, completely revolutionised the way that breast cancer treatment was developed.

Steve: Certainly, and as a company, we were able to change the natural history of HER2-positive disease and we’ve been pushing standards of care ever since, pioneering the science to bring clarity to complex disease pathways and to identify and develop innovative solutions for the many subtypes of breast cancer. Of course we ultimately hope to cure people with certain early-stage breast cancer – our innovations in HER2-positive disease have done that three times, each time raising the bar even higher and helping ever more patients towards cure – but we know that there is still much more to do. Despite improvements in breast cancer care, this year we saw it become the leading form of cancer worldwide and the fifth leading cause of cancer death, with yearly death toll expected to rise to one million by 2040. The burden of breast cancer on society is huge.

Maura: Those really are stark statistics, but an important reminder of our continued collective responsibility to tackle breast cancer head on. I truly believe personalisation will be key to unlocking the burden of breast cancer, which is at the core of Roche’s approach. Our ever-increasing knowledge of the biology of breast cancer, shared through forums such as SABCS, enables us to better select patients who may benefit most from a given therapy, or combinations of therapies, and rapidly act on proof-of-concept signals that could lead to the pivotal trials of the future.

Steve: Yes and we are doing this across all subtypes of breast cancer: to raise the standards of care even further in HER2-positive disease, to set new standards of care in hormone-receptor positive disease, as well as improve the outlook for patients with triple negative breast cancer, where inherent heterogeneity means patient and therapy selection is all the more important. We are also working with partners and executing trials to change the standards of care for people with breast cancer, and we are at the forefront of designing trials for all breast cancer subtypes, with the aim of improved efficacy and tolerability for all.

Maura: This 360-degree approach is what makes me so impassioned to work at Roche; the concept of integrated, patient centric care determines everything we do. In hormone receptor-positive breast cancer, the most common type of breast cancer with high unmet needs in terms of adherence to treatment and overcoming resistance, we’ve become the first company to evaluate an oral SERD in the early-stage, adjuvant setting. Plus, in addition to our aim of innovating a more effective and tolerable therapy, we developed an oral SERD to help overcome the burden of monthly visits to the doctor’s office associated with the current standard of care – something I believe is extremely valuable for patients.

Steve: I’m glad you mentioned that, as I think it’s important for patients to be able to input not only on the type of treatment they receive, but how and where they receive it. This was critical at the start of the COVID-19 pandemic, when we rapidly pivoted to mitigate its impact across our clinical trials by creating more fluid protocols that allowed patients to benefit from fewer face-to-face visits, minimising disruption to their lives and importantly risk from COVID-19. Both inside and outside of the clinical trial setting, delivering flexible, patient centric care is just as important to us as delivering precision care.

Maura: Indeed – for our development programme, we always seek input from patients on study protocols and have patients represented within the steering committees for our studies, to ensure we take a ‘patient first’ approach. This drives us to integrate novel formulations early on in our development programmes, such as subcutaneous administration (injections under the skin) and, in the future, on body delivery systems.

Steve: It’s really an exciting time to be working on breast cancer, particularly at Roche where we have such a rich history in this area and continuously strive to set new standards of care. Tremendous leaps forward have resulted in many millions of people surviving breast cancer, but we must continue to be bold in our collective endeavour to ensure people with every form of breast cancer receive the best care possible. As always, we do this by being led by the science, making bold decisions and by acknowledging that we cannot do this alone.

Maura: Most definitely. After all, there is an exciting world of external insights and innovation to partner with and learn from beyond our four walls.