The recent San Antonio Breast Cancer Symposium (SABCS) highlighted many new advances in breast cancer research, but New Zealanders want to know when we'll benefit from these new approaches to breast cancer treatment. 

 

BCAC chair, Libby Burgess attended SABCS and was invited to participate as a patient representative on an expert panel including world-leading oncologists and breast surgeons. 

She gives us her assesssment of the major research advances announced at SABCS and her view on when we'll see these treatments in New Zealand. 

 

Research Highlights:

  • T-DM1

The new drug T-DM1.  It is very effective in treating advanced HER2-positive breast cancer, including in patients who have previously had Herceptin. T-DM1 uses Herceptin to target a toxic chemotherapy drug to HER2-positive tumours and this precise targeting avoids the harmful side-effects of damage to normal cells. USA advocates and oncologists have pressured the FDA to fast-track approval and this is likely to be granted in February. Pertuzumab is also effective – it targets a different HER2 receptor and adds effectiveness.  Both these drugs were named by ASCO in their short list of major advances in cancer treatment for 2012.  Read more here.

  • Shorter radiation treatment programmes

The results from the UK START trials. These showed that fewer stronger doses of radiotherapy (40-Gy in 15 fractions over three weeks) were at least as safe and effective as longer courses involving more treatments (50-Gy in 25 fractions over five weeks). The shorter course tended to damage remaining normal tissue less than the longer one. Interestingly, those with the more aggressive disease tended to have the best response to the shorter course of higher doses. NZ and the US use the standard longer course. BCAC will communicate with NZ radiation oncologists to lobby for change on this standard. Read more here

  • Herceptin

New data on Herceptin duration (HERA 24 v 12 months; PHARE 12 v 6 months) has further established 12 months as the standard of care internationally. Read more here.

  • Triple negative breast cancer research

Characterisation of triple negative breast cancer sub-types and development of effective treatments is a high priority research area.  Each of the different sub-types needs different targeted therapies and research on these is still in an early stage of discovery.  Patients and advocates are driving progress forward, with good engagement from researchers.  There is strong motivation for drug companies to participate in this research push as the potential exists to make significant profits if effective treatments are found. 

 

  •  Tamoxifen

The ATLAS trial reported that women with ER positive breast cancer who were treated with tamoxifen for 10 years had lower rates of recurrence and death than those treated for 5 years. Benefits were likely to be greatest in those with higher risk breast cancer (positive nodes, larger tumours) given their greater chance of recurrence. The results are particularly relevant for pre-menopausal women as aromatase inhibitors don’t work for these women. The MA-17 trial shows better outcomes in post-menopausal women who switched to letrozole after 5 years on tamoxifen than for those who stayed on tamoxifen for 10 years.  Read more here.


When will these treatments become available in New Zealand?

Libby says SABCS provided many results that will improve the effectiveness of breast cancer treatments.  Lack of funding in New Zealand for evidence-based medicines will remain an issue limiting our access.   Our drug funding agency PHARMAC is notoriously slow at providing access to medicines that have been shown to improve breast cancer survival and are funded in other countries.  BCAC is working with others in the New Zealand health sector to improve the timeliness, transparency and accuracy of PHARMAC’s processes.  


Breast cancer advocates

Each year the Alamo Breast Cancer Foundation (ABCF) offers travel grants for advocates from within and beyond the USA to attend SABCS. Libby says the knowledge and passion of the advocates at SABCS is impressive. She commented that the strong collaborative relationships between well-organised advocacy groups and leading researchers and clinicians is powerful in ensuring provision of substantial government funding for breast cancer research.  Her observations on advocacy at SABCS include:

  • It was evident throughout the event that women with metastatic and/or triple negative disease were very frustrated with the lack of curative treatments. These groups provide an increasingly powerful voice in driving the research agenda and seeking early access to effective treatments. There are a number of well-educated, well-organised active advocacy organisations in the US e.g. www.metavivor.org; www.advancedbreastcancercommunity.org ; www.lbbreast cancer.org  (living beyond breast cancer); www.tnbreast cancerfoundation.org ; National Breast Cancer Coalition (www.breastcancerdeadline2020.org ).

 

  • There is a strong push to speed up the process of research and approval so that effective safe medicines are available to patients sooner. Some take as long as 20 years to get to market. Current drug development was described as slow, inefficient and expensive. We may be able to do better at choosing drugs that hit the target and are safe by: studying them as early in the disease as possible; choosing study endpoints that are good predictors of benefit; choosing good randomised designs that allow earlier selection of those that should be moved forward; increasing the proportion of eligible patients who are given the opportunity to enrol in trials; and encouraging researchers and pharmaceutical companies to take a co-ordinated collaborative approach.
  • A hot issue in the US is that women with dense breasts have been found to have a higher risk of developing breast cancer. Women argue they have a right to be informed of this risk, leading to an increase in requests for screening ultrasound scans – at a significant cost. Some US states have legislated to ensure ultrasound is an integral part of screening and that insurance companies pay for this. Some argue the extra screening is unnecessary so there is much debate.


If you’re interested in breast cancer research and think you might like to attend SABCS, get in touch with us.