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Innovations in Oncology 2020

How research advances are transforming breast cancer treatment

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Professor Andrew Tutt

Director of the Breast Cancer Now Toby Robins Research Centre at The Institute of Cancer Research, London

Breast cancer is not one single disease – it is different from one patient to the next. Research continues to make significant discoveries to identify these differences, whilst helping patients assess their risk of developing breast cancer and finding the most appropriate treatment for each individual.

As a result of new research, people diagnosed with breast cancer now live longer than in the past and receive treatments that are “kinder and smarter.” These treatments are more effective at targeting the specific biology of the disease, whilst having fewer side effects.

Tracking cancer using liquid biopsies

The rapidly evolving field of liquid biopsies is a key area of breast cancer research that could revolutionise treatment. Until recently, the effectiveness of a cancer treatment could only be monitored by removing parts, or biopsies, of a tumour and scans involving radiation.

Liquid biopsies involve looking for cancer cells or cancer DNA in the blood. This approach is not only simpler for the patient but also has huge promise as a way of monitoring breast cancer and how it responds to treatment – helping guide clinical decisions and ensuring that we stay one step ahead of cancer.

Although still being evaluated in the laboratory and the clinic, these liquid biopsy tests are likely to be introduced more widely in cancer management. The hope is that, in future, liquid biopsies will replace invasive tissue biopsies in some circumstances.

Bringing new drugs to the clinic and understanding drug resistance

The ICR and The Royal Marsden NHS Foundation Trust played a key role in the development of PARP inhibitors, now used in the treatment of ovarian, prostate and pancreatic cancers. These drugs are now set to be game changing for people diagnosed with breast cancer who have a mutation in a “BRCA” gene.

These genetically targeted drugs work by stopping cancer cells from being able to repair their damaged DNA. In the past five years, the drug carboplatin, which also kills breast cancer cells with a BRCA gene mutation has also been established as an effective treatment for breast cancer.

The hope is that, in future, liquid biopsies will replace invasive tissue biopsies in some circumstances.

The ICR and Royal Marsden have also played a key role in developing hormonal drugs called aromatase inhibitors that are used to treat breast cancer in post-menopausal women and tests that show who can have these drugs and avoid chemotherapy. Aromatase inhibitors stop production of the hormone, oestrogen, and often provide an effective treatment that avoids the use of chemotherapy.

There is also a pressing need to improve our understanding of the mechanisms breast tumours use to become resistant to treatment. At theICR, we have uncovered how resistance to aromatase inhibitors, CDK4/6 inhibitors and PARP inhibitors develops. We are working to find out how to target this resistance.

Improving radiotherapy regimens

The effectiveness of radiotherapy, which is often used to prevent breast cancers returning after surgery, is also being improved by researchers. Despite what many people think, this type of treatment is very precise and often does not come with significant side effects.

After a decade of research, two UK clinical trials have demonstrated that a lower total dose of radiotherapy delivered in fewer but larger doses is both as safe and effective while being more convenient for patients than giving multiple small doses of radiotherapy. Findings from these trials have supported changes in how breast cancer is treated that are already helping relieve pressures on the NHS.

It is clear that recent years have led to pioneering discoveries and I am hopeful that, with further research and collaboration, the future will bring even more advances.

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