Ms Shavaun Wells is a proud Tungurrung woman. The concept of improving Indigenous health, wellbeing, and quality of life resonates with Shavaun and has influenced the roles, research, and studies that she has undertaken.

Shavaun is a Senior Fieldwork Officer on the Kulay Kalingka study, a National Cohort Study aiming to understand Aboriginal and Torres Strait Islander people’s beliefs and attitudes about cancer, engagement with cancer screening programs, and experiences with cancer diagnosis, care and treatment to improve experiences and outcomes. And we spoke with her about the importance of this research.

“I’ve been working as an aboriginal health worker for the last nine years, and I fell into to research. All the women who have passed in my family have passed from breast cancer, so it was more of a passion piece of work to do than an actual job. And I’m currently leading the Kulay Kalingka study.”

“We launched the Kulay Kalingka study last July in Condobolin and we wanted to launch it in a community instead of a university. We launched the video when we were there, so we filmed a video on the day of the launch, which was great to see.”

“Kulay Kalingka translates to “net bag in the water” in Ngiyampaa (Wongaibon) language. Woven net bags have been used by rainforest Bama (peoples) to process highly toxic foods, whereby foods are placed in net bags and run through a slow-moving stream to leach out their toxins and make them safe over time.”

“So the artist who designed our amazing graphics, his name is Bernie Singleton. His wife had stage four ovarian cancer when he was designing this. He’s an Aboriginal man, and he had this idea of designing a net bag to put her in the net bag and let the toxins drain from her body like Aboriginal people would do with fish back in the day to drain out any toxins.”

“We heard his story, and we just went, that’s what we’re doing. So, we did some work with Condobolin, but we had this one lady there and she had five kids. She had to travel five hours to Sydney to undertake a breast screen. She was diagnosed with cancer, so she had to find a babysitter for her five kids.”

“She had to hire a car to get to Sydney to get a treatment. She hit a kangaroo on the way back, she didn’t have the proper insurance, and then was sort of $20,000 in debt from trying to receive her diagnosis, and then she stopped undertaking any treatment after that. And we’ve had so many men say to us ‘I drove to the hospital, but I didn’t know where to park, so I just left’.”

“So, we collect data through surveys. We were really worried about causing Aboriginal people distress when they were talking about their cancer journey, but it was the opposite effect. People were saying, I’ve never had a platform to tell you, or to tell anyone what is going on with my cancer and what I didn’t like, what I did like and what the barriers were for me.”

“So, people have sort of found it a really nice way to get their journey outwards. And we just collect surveys, but we’ve had probably 15 people come to us and say I want to tell you about my journey not just tick boxes.”

“So, we’re just speaking to a 19-year-old Aboriginal man on the Gold Coast who had this cancer that he described as being the size of a Red Bull tin. He was 19 when he had his first diagnosis, and it was Christmas Eve, so everything was closed for a while.”

“We’re just speaking to all these people, because people can tick boxes and we can sort of decipher their story, but to hear their story and to see their photos is just so powerful. So it’s actually sounds like an awful study trying to find out cancer experiences, but people with cancer seem to be empowered by sharing their experience.”

What are some important cultural considerations when providing breast cancer care to Aboriginal and Torres Strait Islander women?

“We’ve found that Aboriginal and Torres Strait Islander women diagnosed with breast cancer were more likely than other Aboriginal and Torres Strait Islander women diagnosed with other cancers to hear the news from an Aboriginal and Torres Strait Islander health worker.”

“Among all women with cancer, only one in three participants felt that the information they received about their cancer at the time of their diagnosis was designed for Aboriginal and Torres Strait Islander people. We also found that it was important where one in three women with breast cancer had family attend their appointments.”

“Aboriginal and Torres Strait Islander women with cancer commonly identified the following factors as important to them during their cancer treatment:

• They really wanted to ensure that family were able to attend their appointments.
• Being culturally safe during their treatment
• Having access to someone who understands their culture
• Having a doctor that they feel comfortable with
• Having an Aboriginal and Torres Strait Islander person to talk to who can support them.”

“The participants of the study were asked whether certain factors delayed any access to their treatment. The most reported factors that hinder timely treatment were location of the treatment centre, cost of the treatment, navigating the healthcare system, racism in the healthcare system was quite prominent and lack of childcare services.”

How can healthcare workers better engage with Aboriginal and Torres Strait Islander communities to improve treatment outcomes?

“When we’ve been speaking with the Aboriginal and Torres Strait Islander women a lot of women have identified that screening services aren’t always close to them.”

“We’ve spoken to quite a lot of women over the age of 40 who are eligible for breast screening but aren’t reminded again to sort of undertake that screening within two years. The system only sends out automatic reminders when they turn 50.”

“We’ve also found that a lot of Aboriginal and Torres Strait Islander people are scared of a diagnosis. So, producing materials that are designed for Aboriginal and Torres Strait Islander people would be a good start.”

What support networks or resources are available to Aboriginal and Torres Strait Islander women diagnosed with breast cancer?

“The Kulay Kalingka study is a national cohort study, so we’ve been able to sort of find some areas that may have cancer navigators or an appropriate McGrath Cancer Nurse, who can point them in the right direction. We found that one in four Aboriginal and Torres Strait Islander women who are on their cancer journey are also caring for someone else on their cancer journey and putting their own needs secondary.”

“So, the idea of a holistic support service that isn’t just directed at the cancer patient, but the family that surrounds that woman or that man with breast cancer would break down some barriers. In some locations, and some quite remote locations, we’ve found Aboriginal and Torres Strait Islander I guess health workers who might’ve been on their own cancer journey, or their family has been on their own journey and therefore they offer to train doctors.”

“It mostly applies in Aboriginal medical services where Aboriginal health workers and GPs or doctors might be working together, and it might be an indirect learning.”

What are your hopes for the future of breast cancer research?

“I guess that the breast cancer journey and awareness become more of a proactive step and not a reactive step, and that Aboriginal and Torres Strait Islander women know that it is okay to undertake cancer screening programs and that they are proactive in doing that. I also hope that there can be some services that are close to home, and that there aren’t financial costs.”

“A lot of people say that cancer treatment is free, but we’ve come across a lot of women who need to organise babysitters, their own accommodation, their petrol, and they’ve got to pay for parking at the hospital, just as some examples.”

“So there seems to be a lot of other barriers that aren’t really considered when you say that cancer treatment is free.”

Dr Anna Singleton is a Senior Research Fellow at the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW. Her research focuses on co-designing and implementing accessible and scalable digital health services to improve health outcomes for people living with and beyond cancer.

We spoke with her about the EMPOWER-SMS clinical trial and what it aims to achieve for breast cancer patients.

“Our EMPOWER-SMS clinical trial really aimed to improve women’s health and wellness after they’re finished their sort of initial treatment, surgery, chemotherapy, and radiation therapy.”

“What consumer representatives have told me is that they finish those treatments, they ring the bell, they’re so excited, and then they go home, and months go by, and they’re still not feeling quite like themselves, they sort of miss the support that they were getting from the community.”

“They Googled cancer online and what to do after cancer and all these different things came up, which was super overwhelming for them.”

“So, we thought, why don’t we create a program to help support you during that time and sort of point you in the right directions. So, EMPOWER-SMS is a co-designed health and wellness text message program. So, people get four text messages per week for six months about a range of different topics.”

“So, it could be related to the food that you should be eating, or how much exercise you should be getting, or how to manage some of those really tough side effects, like hot flushes and joint pain. There’s also links to helpful websites or free programs that you may or may not know about in the community. And the aim is really to link up the information that your doctors have already given you with freely available services that are offered in your community, and just really provide that individual support directly to your phone that you’re already using every day.”

What were the main findings of the trial?

“What we found was that receiving these messages helped people miss fewer doses of their endocrine therapy because they were able to better manage some of those really tough side effects and they knew who to talk to when they needed help.”

“There were quite a few messages about if you’re feeling this certain way or if you’re noticing these side effects, go speak to your doctor about it and ask them if it’s normal. See if there’s any options for you. Because they’ve given you this medication because it’s supposed to be helping you more than it’s hurting you. And if it’s hurting you a lot, then we need to look at some other options.”

“So, it was really that type of messaging. We also found that it slightly helped people improve their physical activity by about five minutes each day, which is really exciting. It doesn’t sound like much, but new research shows that even doing five extra minutes of physical activity every day can lower your risk of heart disease and lower your risk of cancer coming back.”

“It was cool that a little text message could sort of do all that. But I think more importantly than all of that, we got a lot of feedback from people about the messages, and 100 percent of them said it was easy to understand, and 91 percent said they were useful, and it helped them with managing their health and that was really, exciting.”

“Some of our participants said it felt like they had a secret friend who was supporting them, and nobody else had to know about it. One person even said, ‘it was nice that I could change my behavior, and nobody knew it was because of what was happening in a text message. It just looked like I was doing it on my own’.”

Was there someone on the other end or were these automated messages that got sent to them?

“In that trial, they were discouraged from texting back. Some people would, which was also totally fine. Since the trial, we’ve sent it out to over 850 people during the COVID-19 pandemic. And they were allowed to text back. And, they would just say things like ‘oh, thank you so much for the advice’.”

“If they did ask any medical questions, which was maybe 10 messages out of the hundreds and hundreds of messages we received, we would just instruct them to speak to their doctor about that particular issue.”

How do regular text messages contribute to improving medication adherence among breast cancer patients?

“So, I think it depends. These messages were really designed for people with a lived experience of breast cancer, with their doctors. So, I think it added this sort of extra layer of helpfulness and they were really based in science and the program wasn’t solely. medication. It was about your health and wellbeing as a whole.”

“So, I’ve seen quite a few papers that only do a message a day about adhering to your medication, and they often fail. And I do wonder if it’s because there’s too much focus on the one thing and the one message coming at the same time every day.”

“So, if you are looking for sort of daily reminders, I think that’s the place that you’d want to go, especially apps that have a bit of information or some videos. I did a study about the Medsafe app, which is good for people who take a lot of different medications because you can program them in.”

“It sort of looks like a pill box on the screen and you can tick off when you’ve taken it. So, then you have a list that sort of tracks if you took it today. I think there’s lots of ways that you can use tools that you have every day like your phone, or even a calendar and a check mark, that works too. It’s whatever works for you.”

What are the potential challenges of reaching patients through text messages?

“So, there’s huge problems at the moment with spam text messages. People are very nervous to open text messages, and to click any links in text messages. So, I’m actually running a new trial where GP practices will be sending a text message inviting people to this program across Australia.”

“I’m making sure that that message really feels like it’s coming from that GP and it’s coming from the exact same number where they always get their appointment reminder message from is really important so that they can trust that it’s not some sort of spam thing trying to steal their money, which can be really difficult.”

“And not only for the patients as they may call the practice, and it may clog up the phone lines. So then other patients who need help can’t get it because the receptionists are busy dealing with this big problem. So, it has been very challenging recently trying to sort of navigate the space.”

What do you foresee as the next steps or future research directions and improving medication adherence for breast cancer patients?

“Yeah, so I’m launching a trial in general practice and so that one is focused on physical activity, but medication adherence is a secondary outcome that we’re looking at and seeing if it is helpful or not to have these messages about how to manage side effects or how to create little habits to remember to take your medication, especially when you’re starting out with the new medication.”

“You’ve just come out of the hospital. It’s a new habit you have to form. How can I make it easier based on science? I’ll be your nerd helping you in the background sending you messages about it. We’re also trying to understand how we can integrate this into services that already exist. So, Breast Cancer Network Australia has an incredible phone line where you can call and get advice and support and they can point you in the right direction, whatever you need.”

For women who are currently undergoing or about to start endocrine therapy, what advice would you give them?

“I can tell you what all the consumer representatives have told me. I had some amazing consumer representatives from Breast Cancer Network Australia, and the Westmead Breast Cancer Institute. And they were so funny telling me about their experiences and they were giving me tips about, you know, if you’re having a hot flush at night, lay a towel on your bed. And then if you have a hot flush, and you’re feeling sweaty, pull it off the bed, put another one on. So, it’s just about normalizing that these things are happening and there are ways to manage them.”

“One tip they said was, if you really like swimming, that’s a good idea because if you’re exercising and you have a hot flush, you’re already wet, so you’ll cool down right away. It was just beautiful to see how they could spin sort of an annoying situation into a lighthearted thing. And we are wanting to make sure to normalise that other people are going through this as well, and to reach out if they need support.”

“We also want people to know that they should tell their doctors if they need help, as they’ll have more tips for you. Some of the side effects can get better over time if you continue taking your medication, and making sure not to stop taking it without speaking to your doctor because that can be a big problem as well.”

“So just a few of those tips. I’m not an expert in endocrine therapy but I just can share the information that sort of the doctors and the consumer reps have told me about it.”

What are your hopes for the future of breast cancer research?

“In general, a cure for all the different types and the strains of breast cancer so that we don’t have to deal with this anymore. I mean, a vaccine would be amazing, the same way that they have done for cervical cancer. I just think they’ve revolutionized the way we think about it as a prevention versus a cure.”

“I think having support for people who sort of finish that initial active treatment phase and who are moving into sort of trying to navigate their life again, but also having to go through those yearly scans that are scary. I also want to see more support for people living with metastatic disease. I think people are living years and years and having happy big, long lives with metastatic breast cancer and there’s just not enough information and support for them.”

“I have an amazing colleague at the Daffodil Center named Dr Andrea Smith who is a person with lived experience with metastatic breast cancer who’s just done incredible work in the space, and for the for the first time her and her team have been able to have an accurate number for how many people with metastatic disease are living in Australia, which is just incredible because now they can accurately say this is the amount of people who need help and support.”

“So, across the board, I think there’s exciting things happening. I’m happy to be part of it and to uplift consumer voices, to understand what they need and how I can help facilitate it.”

Dr Stephen Luen is a Medical Oncologist and Translational Researcher at the Peter MacCallum Cancer Centre in Melbourne. His current research interests include the study of genomic and immune biomarkers in breast cancer, with a particular focus on investigating biological characteristics and developing clinical trials for high-risk subgroups of patients.

We spoke to Dr Luen about the role of genomic testing in breast cancer treatment.

“At the heart of it, there’s two main components of genomic testing as we call it, and it’s becoming much more common as our standard approach to breast cancer. So, one is what we call germline testing, which is essentially testing and looking at the DNA in normal cells in an individual.”

“Usually that’s from a blood sample or from a mouth swab or something. And many people will understand that sometimes we’re looking for mutations in certain genes that might be inherited, that increase your lifetime risk of breast cancer. But increasingly we’ve recognized we can also use that to predict benefit from certain drugs.”

“So, the classic example is with a BRCA1 or BRCA2 gene mutation, where we can use PARP inhibitors. But moving beyond that, we’ve also looked at doing genomic testing on the tumour itself. And by doing that we start to understand what changes in the DNA are driving the cancer to grow and propagating that cancer’s growth.”

“Sometimes we’re able to identify those alterations and target them with specific drugs. Now, in the old days, these drugs were only partly effective, and they were pretty toxic. So, they caused lots of side effects, but the newer generation of drugs are certainly becoming cleaner, they have less side effects and they’re more potent so they’re potentially more effective.”

“And so, in my talk, I would like to sort of present some data and discuss some of the themes that are coming about with the development of these drugs.”

How does genomic testing contribute to personalised treatment approaches for breast cancer patients?

“The whole premise of the genomic testing is to understand what is driving this individual cancer, because every cancer is unique. And in that way, you can really personalise the treatment for each patient. So, if there’s a change in one of the BRCA genes, you can then use a PARP inhibitor. If there’s a change in PIK3CA, you can use a PI3 kinase inhibitor, and it sort of pushes away from that concept of everyone having the same treatment.”

“They all come in trials where they use things like chemotherapy and endocrine therapy. So, it’s the idea of personalising treatments so that you can better target the individual cancer.”

What are some potential benefits of undergoing genomic testing for breast cancer patients?

“From my perspective as a clinician the most common reason we’re doing genomic testing is to identify, ideally, a change that results in a new drug target, and that means we can potentially use a drug that has improved efficacy and really good effectiveness in an individual’s tumour to be able to control the cancer better or even increase the chance of cure.”

“And I think this allows patients to have more choices in terms of therapy. Of course, there’s nuances in how you use those drugs. Are they used in combination with other drugs? Are they used at certain times? Are there particular what we call lines of therapy? Are they used in early breast cancer or advanced breast cancer? But it gives us more choices and helps us understand how to best manage a cancer, optimise patient outcomes, as well as improve quality of life.”

“We’ve fortunately just had approval of Olaparib in the neoadjuvant setting. This was from a clinical trial called OlympiA. There will be some discussion about that trial at the symposium. But there are a multitude of other clinical trials that are coming about, and in my presentation today, I’m just going to highlight a few clinical trials in those fields.”

“There are a number of clinical trials using these drugs called Selective Estrogen Receptor Degraders (SERD), which target the oestrogen receptor, and they actually degrade the oestrogen receptor. And these are proven to be more effective in patients with these mutations in a gene called ESR1.”

“And this is an acquired resistance mechanism, so it gives us an opportunity to treat a cancer that is developing resistance to our standard hormonal therapies. Another example is the INAVO120 clinical trial, where they’ve really introduced a PI3 kinase inhibitor early on in the piece, and that’s shown effectiveness in phase III data in combination with the current standard treatment.”

“However, we always need to balance this with the side effect profile that adds when you add it in combination. And finally, I did also want to talk a bit about new strategies. I’ve mentioned a drug called Saruparib, which is a new next generation PARP inhibitor, which will be tested in a new clinical trial that’s upcoming called EVOPAR-BREST01.”

“So, just a few clinical trials on the horizon and there are many more with new drugs coming through.”

What advice would you give breast cancer patients who might be considering genomic testing?

“So I think the first thing you should do is have a discussion with your medical oncologist. Genomic testing is something that is relatively new, but I’d expect most oncologists to have some literacy around this and be able to discuss it with you. There are a few ways to get genomic testing. Of course, some of them are reimbursed. And most of that is germline testing.”

“At the moment, there is also a national program where we’re able to perform a comprehensive genomic test on a tumour, and I’d encourage people and clinicians to consider using those tests to be able to springboard our patients on to give them opportunities in clinical trials and access to novel drugs, which hopefully will improve their outcomes.”

“So, in the context of genomic testing and targeted therapies, I think this is definitely one way forward, and the way I think it’s going to happen is through one of the themes that I’m going to talk about, which is bringing in these drugs early and in combination, bearing in mind that there may be some increased toxicities or side effects that are associated with that approach.”

“But what’s happening in drug design now with targeted therapies, is that there’s a real focus on two things. One, to make the drugs more potent and hopefully therefore more effective, but also to make them more selective, which means they hit a target very selectively and they result in much fewer side effects.”

“The ideal situation here is to be able to target resistance mechanisms all in that first line of therapy, to really give you the best duration of response as well as quality of life in that first line setting, which I think will be the way forward with targeted therapies in breast cancer.”

About Professor Marina Reeves

Marina Reeves is a Professor in the School of Public Health and Deputy Associate Dean of Research in the Faculty of Medicine at the University of Queensland. She is also an advanced accredited practicing dietician coordinating a research program that is focused on breast cancer epidemiology and the role of supportive care interventions in improving outcomes and quality of life for women diagnosed with breast cancer.

We spoke with Professor Reeves about the importance of optimizing care for metastatic breast cancer patients through diet and exercise.

Research focus: how exercise and diet can improve quality of life for breast cancer patients

“So metastatic breast cancer is when the cancer spreads outside of the local breast area, usually to distant parts of the body. For women with breast cancer, it’s often to the bones, or it could be the lungs, brain, liver, or other sites.”

“And so those women live with an incurable, but treatable, disease. And treatments have evolved over the last few years. So, it’s great that we’ve got some newer treatments. And those women are living for longer than they did in the past, which is wonderful. But they’re living for longer still with battling side effects and impacts on their quality of life.”

“And so, our research is really focused on how exercise and diet can help to improve their quality of life. Potentially they’re survival, but really focused on improving that quality of life.”

Exercise benefits women with metastatic breast cancer both physically and emotionally

“We’ve got really good evidence on how exercise benefits women with early-stage breast cancer. Both evidence that shows that it’s likely associated with survival, but also helps to manage a range of side effects, so fatigue, but also helps to improve their mental wellbeing, as exercise does for everyone in the population.”

“In the metastatic setting, this evidence is just starting to slowly grow and so we’ve got some really good evidence now, through a new trial that’s just come out, on the benefits of exercise specifically for women around fatigue, quality of life, reducing pain, and improving sexual function.”

“So, lots of benefits that we can start to see in this population of women with metastatic breast cancer, which is great.”

What types of exercises are recommended for women with metastatic breast cancer?

“So, it’s really important that you start slowly, but often. So even if you’re not doing any exercise at the start, any exercise is going to be beneficial, but ultimately what we want women to be able to get to, similar to the general population, is increasing what we’d call vigorous physical activity or that aerobic cardiovascular physical activity, which could just be walking, but also trying to get them to increase their resistance exercise, so strength based exercise, because it’s really important.”

“And our particular interest is on maintaining that muscle mass and preventing what we know with age, but also with cancer and with treatments will decline.”

Diet and breast cancer

What role does diet play in managing metastatic breast cancer?

“So, women are bombarded with information, if a woman was diagnosed with either early-stage breast cancer or metastatic breast cancer and went to ‘doctor Google’, they will find a wealth of information, but not necessarily evidence based information. And so, we know this population is particularly prone to misinformation around diet.”

1. Maintain adequate protein intake

“And so, we know that dietary intake in addition to resistance exercise is really important in maintaining that muscle mass. And so, our primary recommendation to women is around maintaining adequate protein intake. We also know that some women, depending on the treatments that they’ve had, can get taste alterations. So, the taste of meat, or certain foods may not be the same as they were.”

“So, we really work on how to make sure that you’re still getting adequate protein intake within the foods that you’re eating.”

2. Prioritise muscle mass

Support and resources for women with metastatic breast cancer

“This is an area that we’re particularly passionate about advocating for, because currently women with metastatic diagnosis, not just around diet and exercise, but generally tend to get a lot less support than what a woman with an early-stage diagnosis receives. And so, there’s a strong movement and need for there to be equitable access to that support.”

1. Need to improve access to resources and information through hospitals

“Currently, Breast Cancer Network Australia has resources and information available. Some hospitals may provide some tailored support for metastatic breast cancer, but very few of them offer exercise programs for that group of women. They’ll offer exercise programs for early stage, but very few will offer exercise programs specifically for metastatic women.”

2. Advocate for greater support for women with metastatic breast cancer

“And so, we’re trying to advocate and create the evidence to change that practice. We do know that women have access, if they go and see their GP, to get onto a chronic disease management plan. And that gives them Medicare reimbursed sessions to see an exercise physiologist or a dietician, but it’s limited in terms of the number of sessions that they can receive with that.”

“So, our goal is to try and change the way and the supports that are available to these women in the future.”

“So, my hopes for women with breast cancer, and my reason for focusing on this research is my mum who had metastatic breast cancer, and I saw the terrible time that she went through and the impacts of the treatment and the cancer on her quality of life.”

Professor Marina Reeves’ hope for the future

“And so, my goal is that no women have to suffer like my mum. Ideally, no women ever die from breast cancer again. And that would be the ideal, that no one ever gets breast cancer. But my goal is that we can create the supportive care intervention so that women can live and thrive with a metastatic breast cancer diagnosis.”

Breast cancer diet FAQs

What foods to eat?

Explore various foods that may help in reducing the risk of breast cancer or aid in managing it, including leafy green vegetables, cruciferous vegetables, allium vegetables, citrus fruits, berries, fatty fish, fermented foods, beans, herbs, spices, whole grains, and walnuts.

What foods to avoid

Explore the foods and beverages that individuals with breast cancer may consider limiting or avoiding, such as those containing soy, to potentially reduce risk or manage the condition.

Do you have a breast cancer diet guide for clinicians?

While we don’t have a specific diet guide, there are some key dietary considerations for breast cancer patients based on current research. Here are some general recommendations that clinicians and patients may find useful:

• Focus on wholefoods: emphasise fruits, vegetables, wholegrains and legumes whiles aiming for a variety of colours and types to ensure a range of nutrients.
• Healthy fats: encourage sources of healthy fats like olive oil, avocado, nuts, and fatty fish (like salmon), while limiting saturated and trans fats.
• Lean proteins: suggest lean protein sources such as poulty, fish, beans, and plant-based proteins.
• Limit processed foots: encourage reducing the intake of processed and sugary foods, as well as red and processed meats.
• Keep up hydration: remind patients to stay well-hydreated, primarily with water.
• Maintain a healthy weight: discuss the importance of maintaining a healthy weight, as obesity can be a risk factor for recurrence.
• Limit alcohol consumption: suggest limiting alcohol intake, as it has been linked to an increased risk of breast cancer.

Is there any evidence that keto diet helps metastatic breast cancer?

The ketogenic (keto) diet, which is high in fats and low in carbohydrates, has gained attention in cancer research, including metastatic breast cancer.

While there is some preliminary interest in the keto diet’s potential benefits for breast cancer patients, more comprehensive research is necessary to determine its effectiveness and safety. It’s essential to approach dietary changes cautiously and with professional guidance.

Both the plant-based diet and the Mediterranean diet have been associated with potential benefits for cancer prevention and overall health:

• A Plant-Based Diet: A plant-based diet focuses on consuming a variety of fruits, vegetables, whole grains, legumes, nuts, and seeds, providing a wealth of vitamins, minerals, and antioxidants. Research suggests that this diet may lower the risk of certain cancers, including breast cancer, by reducing inflammation, improving hormone levels, and promoting a healthy weight. High fiber intake from plant-based foods is linked to improved gut health and may further help lower cancer risk. Overall, a plant-based diet is often associated with lower body weight and reduced obesity risk, both of which are important factors in cancer prevention.
• The Mediterranean Diet: The Mediterranean diet emphasises the consumption of fruits, vegetables, whole grains, fish, olive oil, and moderate wine intake, promoting heart health and well-being. Its anti-inflammatory properties may help reduce cancer risk by modulating inflammation and oxidative stress. Clinical studies indicate that adherence to a Mediterranean diet may be associated with lower breast cancer risk and improved survival rates among diagnosed individuals. This diet provides a balanced intake of healthy fats, lean proteins, and complex carbohydrates, supporting overall health.

Both diets are rich in nutrients and have been linked to various health benefits, including potential protective effects against breast cancer. They emphasise whole foods and healthy fats, which can be important for overall health and well-being.

Encouraging patients to adopt a balanced, nutrient-dense diet can be beneficial. As always, it’s essential for individuals to consult with their healthcare team before making significant dietary changes.

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About Exercise Physiologist Dr Eva Zopf

Dr Eva Zopf is an exercise physiologist whose research interest focuses on the role of exercise as medicine for the management of cancer. Aside from developing, conducting and evaluating exercise intervention studies in cancer patients, Eva is also dedicated to improving the supportive care services available for cancer survivors.

We spoke with her about the PREFERABLE-EFFECT study and the role of structured exercise in metastatic breast cancer and quality of life outcomes.

What are the effects of exercise on fatigue and quality of life?

Background to the PREFERABLE-EFFECT Study

“So, we actually decided to run this trial because there’s been quite a lot of evidence around the beneficial effects of exercise in cancer patients. But most of the studies that have been conducted to date have looked at patients that have localised disease or have been treated with curative intent, and so there’s actually not a lot of evidence in patients who have metastatic disease.”

“So, the aim of this project was to look at the effects of exercise on fatigue and quality of life in patients with metastatic breast cancer. And the reason being that those patients often have ongoing treatment. They have a higher symptom burden generally than patients that have localized disease.”

“So, for those that finish their treatment in a localised setting their symptoms might subside after a few years. We do know that those that have ongoing treatment, the symptom burden will increase, or is more likely to increase over time, so we wanted to figure out if exercise is also beneficial and safe for those patients.”

“What we did first of all, was divide the group, or the study participants up into two groups. So, we had one group that received breast cancer exercise advice and a physical activity tracker. The other group received that as well, but they also received a structured exercise program. So that consisted of two supervised exercise sessions for the first six months, and it was reduced to one supervised exercise session for the last three months.”

Exercising safely in structured exercise sessions resulted in:

1. Reduced fatigue

“The sessions included aerobic training, like riding on a bike or walking on a treadmill, and resistance training to improve muscle mass and also some balance training. And what we found is that the group that participated in the intervention study, so had that structured exercise program, they had higher quality of life outcomes than the participants in the control group, and they also had lower levels of fatigue.”

2. Lower pain levels and decreased shortness of breath

“So those were our two primary endpoints that we wanted to look at. We looked at a number of other outcomes, for example some of the symptoms that are quite common in patients with metastatic breast cancer like pain and dyspnoea. We also saw that the patients in the intervention group actually had lower pain levels throughout the entire intervention period of nine months and also lower levels of dyspnoea. Dyspnoea is shortness of breath, which is also quite commonly reported.”

3. Better sexual functioning

“In addition, we looked at some of the breast cancer specific symptoms or side effects like reduced sexual functioning and we saw that the intervention group also had better sexual functioning than the control group and the same applied to some of the endocrine sexual symptoms that some of the patients experienced from endocrine treatment.”

Breast cancer exercise recommendations

1. Aerobic training and vigorous activity

“So, we did a combined program so our exercise program consisted of aerobic training, which is more cardiorespiratory training, that improves blood circulation through your heart function. For example, that can be running, cycling, swimming, and so forth. We didn’t offer swimming, but just as an example of aerobic training.”

2. Resistance training and muscle-strengthening activity

“Resistance training, which is a type of weight training, which generally improves your muscle mass and balance training, which can also obviously improve balance, but we know with some patients who receive chemotherapy and when neuropathies are an issue, that can help in those terms as well.”

3. General exercise advice for breast cancer patients

“We compared that to our control group that just received exercise advice. So, the general advice for cancer patients is to be physically active for about 150 minutes per week. So, participants received an activity tracker. And given we saw better improvements or better quality of life and lower fatigue in the intervention group, we do feel like that just providing exercise advice might be enough.”

“But that really structured and supervised exercise program, where in our case it was two supervised sessions per week is really required to maximize the benefits that you can get from exercising.”

Recommendation: Supervised resistance and aerobic exercise for patients with metastatic breast cancer.

Additional benefit: decreased health care costs

“We did also did a cost effectiveness analysis to see whether it was cost effective. And so, we looked in both groups how often patients saw their GP or used other services such as how often they went to the hospital or required any other care. And we did see that those that took part in the structured exercise intervention also had lower health care costs. And so, we do think there’s a benefit of getting more support or exercise integrated as a routine component of cancer care.”

“I think there is still a little bit of a way to go to provide those services to all. But we definitely think, if possible, try to find an exercise physiologist who has experience working with cancer patients to just get support in what exercise you can be doing and to get an exercise program prescribed to you to then hopefully follow through and experience some of the benefits that the patients on our trial did.”

What are your hopes for the future of breast cancer research?

1. Improved exercise support for cancer patients

“So, for me, the reason I get out of bed every morning is to really improve the exercise support that cancer patients in general receive, whether that’s breast cancer or another cancer.”

2. Integrate exercise as a standard component of cancer care

“I think in Australia, the opportunities to see an exercise physiologist or get those rebated services are quite low. So that would be a first step to hopefully maybe increase those sessions or those consultations that you can get. But in general, I think we definitely need to find a way to integrate exercise as a standard component of cancer care.”

“And if we look at other countries, for example Germany, where I’m from, we have an oncological rehab program, similar to cardiac rehab here and that’s subsidized by the health insurance companies and that means exercise becomes more accessible.”

3. Remote access to exercise programs for breast cancer patients

“We’ve just started a new international trial, where we’re looking at Zoom-based exercise sessions, so providing a telehealth or live remote training for 12-weeks, so that we can offer the exercise program to patients that live more remotely and can’t access an exercise physiologist, and we want to see whether that’s just as effective as in person supervision.”

“And again, that the aim of that is to make exercise more accessible. At some stage, my hope is that every patient that’s diagnosed with cancer has access to exercise support.”

The Benefit of Complementary Therapies

If you liked this podcast, find out more about how a balanced diet can also be a complementary therapy to enhance wellness for those affected by metastatic breast cancer in our podcast: Optimising care for metastatic breast cancer patients through exercise and diet.

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Professor Bruce Mann is the Director of Research at Breast Cancer Trials, Professor of Surgery at the University of Melbourne and Director of the Breast Tumour Stream at the Victorian Comprehensive Cancer Centre.

His research interests focus on tailored screening and treatment for early breast cancer, and we spoke to him about some of the key challenges in diagnosing very early breast cancer.

“Very early breast cancer is interesting. What we know is that if breast cancer is diagnosed when it’s stage 1, so that’s when the cancer is less than 2cm in size and has not spread to the lymph nodes, the likelihood that that person will die from breast cancer is really small.”

“And the amount of treatment that’s needed is relatively small. This is an area that many people consider to be sorted because we have good treatments, and with existing treatments the results are extremely good. So, people would say, well, what’s the problem?”

“I see that it has become a challenge because why would you do research into an area that’s already sorted?”

“In addition, there’s quite a lot of controversy or there’s a lot of conversation around the issue of over diagnosis. The concept of over diagnosis, it is important, it is the diagnosis of a condition that, if undiagnosed, would never have become clinically significant in that person’s lifetime.  And if you’ve got such a condition, then side effects of any treatment are actually a harm to the individual. That is they would be better off not diagnosed.”

“And so, some people suggest that we’ve got to that point with breast screening, that a lot of the things that are diagnosed should never have been diagnosed, and therefore there’s an ambivalence around screening, and the truth is there’s not that much research going into it.”

“My view and what I’ll be talking about in the conference is that this is an area where there is an enormous potential for us to improve breast cancer outcomes. And there’s two aspects to it. One that I won’t be talking about a lot on but is very much the focus of the session in the conference, is the possibility or the importance of moving away from current screening, which is all women 50 to 74 who are invited to have a standard mammogram every two years.”

“That’s what we’ve been doing since 1993. It’s what we’re still doing. There is, in my view, enormous potential to improve that by moving towards risk adjusted screening, which would mean that individuals would be assessed, and each woman’s individual risk would be determined.”

“And depending on the risk and on other things such as mammographic density, a more personalized screening program would be implemented. And we think that by doing that, we could have something that’s more effective.”

“So, we would find more cancers early, and it’s likely to be cost effective because by finding cancers earlier, treatment would not only be more effective but should be less expensive. So that’s one of the aspects that I would see as the challenges in very early breast cancer. It’s about finding more cancers and diagnosing more cancers at this very early stage.”

“The other aspect to it is the idea of optimizing treatment or de-intensifying treatment. The current treatments are very effective, but all treatments have side effects. Surgery has side effects, radiation has side effects, chemotherapy has side effects, and the hormonal therapies certainly have side effects.”

“Many women who have been diagnosed with breast cancer identify those side effects of treatments as quite severe and would like to be able to safely reduce them. Our current approach is that in my view we haven’t done enough research into that. And so, when we have a patient with one of these very early breast cancers, we say that here is the treatment we recommend and we recommend it not because we know that it’s needed, but we don’t know that it can be safely omitted.”

“And so most people would say, well, look, it’s important that the cancer doesn’t come back. So, if you don’t know that we can safely avoid that treatment, I will take it. And that is how things are. One of the things that we’ve done here is a number of trials in this area.”

“But one of the important ones is our PROSPECT trial, where we used MRI scans after diagnosis in someone with an apparently isolated low risk cancer, to look for other areas of cancer. And those women who had a clear MRI and had no additional cancers, and the cancer itself was low risk, were treated without radiation.”

“The results, we analyzed it a couple of years ago, and what we found is that in 440 women who had the MRI, we found additional areas of cancer in 11%. And they were all treated appropriately. In 201 women who met all the criteria, who were treated without radiation, there was only a single local recurrence at the five-year mark.”

“It was a 1% local recurrence rate, which is less than we hoped for, actually. We were surprised how good it was. But even more surprising, of all 440 women who had the MRI, we found those additional cancers and treated them. Not a single one of those patients has had the original cancer recur around the body.”

“There have been no distant recurrences. And that raises the possibility that perhaps this may be the way that we can find a group of women who could safely avoid, particularly the hormonal blocking tablets.”

“It’s still a hypothesis. We have a follow up study known as PROSPECTIVE, and part of the main aspect of PROSPECTIVE will be to confirm that we can safely omit radiation, but an additional arm will be to investigate whether we could safely reduce the amount of hormone blocking tablets, because if we could do that, it would truly be a big change in the way that breast cancer is considered.”

“It’s a number of years before we do it, but the PROSPECTIVE trial should open later this year and, that’s something that I’ll be talking about in my presentation at the conference on Thursday.”

How important is interdisciplinary collaboraton in treating patients with very early breast cancer?

“The interdisciplinary collaboration is absolutely critical. In PROSPECT, the key disciplines have been the radiologists who generally diagnose the cancers through screening and do the MRIs, the surgeons who do the surgery, the pathologists, and then the radiation oncologists, who assess the situation and confirm that this is a situation where omission of radiation is reasonable.”

“That will be really important going forward for our new study, particularly as radiation oncology has changed and we have new approaches using shorter treatment courses, so that will be important. Other groups who are important include the psychologists. One of the reasons for doing this is that we believe that there will be less psychological impact on patients who are assessed in this way and treated in this way.”

“We’ve been working with Associate Professor Lesley Stafford, who is a clinical psychologist,  and her team to do work initially on PROSPECT, but certainly on PROSPECTIVE. And then when we move to the question of reducing the amount of endocrine therapy, the contribution of the medical oncologist will be critical as well.”

What are some of the barriers of challenges that exist in ensuring patients are receiving timely care for their breast cancer?

“So, if someone doesn’t have screening and she’s destined to develop a cancer, it is much more likely that her cancer will be more advanced. If someone has a higher stage of cancer, so a stage two or stage three cancer, the treatments are clearly essential to give her the best chance of survival.”

“My hope for the future of breast cancer care is that we get to a situation where the vast majority of patients who develop breast cancer are diagnosed at stage one or maybe stage two, really before the cancer has spread to the lymph nodes, so that we can use our effective treatments and fully expect that the cancer will not come back.”

“If we can do that, then there will always be a group who present at a later stage, and we will have the capacity and the resources to give those women the very best care that’s available.”

Professor Prue Francis is the Clinical Head of Breast Medical Oncology at the Peter MacCallum Cancer Centre and a Consultant Medical Oncologist at St Vincent’s Hospital in Melbourne. She Chaired the International Steering Committee responsible for the SOFT and TEXT clinical trials, that have led to practice changes practice in the management of young women with hormone receptor positive early breast cancer.

Associate Professor Steven David is an experienced Radiation Oncologist at the Peter MacCallum Cancer Centre, bringing a strong interest in implementing cutting edge radiation technology to provide his patients with the highest level of care.

We spoke to Prue and Steven about oligometastatic breast cancer from the perspectives of a Medical Oncologist and a Radiation Oncologist, and the current standard treatment approaches for this disease.

Oligometastatic breast cancer is a term used to describe a specific situation in breast cancer. When breast cancer spreads beyond the original tumor, it’s called metastasis. Most metastatic breast cancer involves multiple spread-out tumors in various places.

However, in oligometastatic breast cancer, the cancer has spread but only to a limited number of places—typically, just a few distant spots like the bones, liver, or lungs. It’s different from more widespread metastasis because the cancer is not as scattered or extensive.

In simpler terms, if you think of metastatic breast cancer as a large network of many new tumor spots, oligometastatic breast cancer is like having just a few new spots. This smaller number of metastases can sometimes make it easier to treat and manage, often with a combination of local treatments (like surgery or radiation) and systemic treatments (like hormone therapy or chemotherapy).

The goal with oligometastatic breast cancer is often to control or reduce the spread and potentially extend the time before the cancer progresses further.

“So, traditionally we think of breast cancer as either being an early stage breast cancer, where the cancer is confined to the breast or the breast and the regional or the nearby lymph nodes, and then we talk about metastatic breast cancer where actually there is a spread of the breast cancer to a place that is distant from the breast and the nearby lymph nodes, for example the bone, the lung or the liver,” Prue said.

“Now, oligometastatic breast cancer has some similarities to metastatic breast cancer in that there are metastases that are distant from the breast and the nearby lymph nodes, but there is a limited number of metastases, so typically with oligometastatic breast cancer there’s a maximum of up to five metastases, so it’s a small number of metastases.”

What are some of the current standard treatment approaches for oligometastatic breast cancer?

“Well, typically, oligometastatic breast cancer would be treated more like metastatic breast cancer, and if there are a very limited number of distant metastases, for example, some patients might have only one distant metastasis, the question that arises is: could that patient actually be treated perhaps more like early breast cancer, but with some additional technique to try and eradicate that problem site, that single site of distant metastasis?”

“And so that’s why we try to think more carefully about this situation. We lack evidence for that sort of approach, but this is something that we think about, and we want to study,” she said.

What are some of the primary goals of radiation therapy when treating oligometastatic breast cancer?

“So, radiation therapy in the last 10 years has developed a new technique or a new modality of delivering radiation and it’s due to technology, and that technique or technology is called stereotactic radiation,” said Steven.

“It can be delivered to any part of the body and it’s different from any other type of radiation in that it can be delivered like a laser beam, very accurately, very quickly, and with almost none or very few side effects to anything around where you’re aiming it at.”

“And so immediately what people have thought about in oligometastatic breast cancer is why don’t we use that technique to eliminate the oligometastases or destroy them? We can do that very quickly in maybe 10 or 15 minutes with one or two treatments, with excellent long-term outcomes in terms of killing off the cancer in that spine,” he said.

How do you determine if a patient with breast cancer is suitable for radiation therapy?

“So, in the oligometastatic setting as technology has gotten better, we can distribute it more broadly, and in more situations. But there are some scenarios where you can’t do it. For example, if a metastasis is right near something that is very critical such as the spinal cord, it’s almost impossible to kill that deposit without also killing the spinal cord, and then it would be disastrous for a patient,” he said.

“So, location, number of metastases, size of metastases, and also if the patient’s had previous radiation, let’s say for a breast cancer, and then an oligometastases is nearby, it makes it very challenging because you’re overlapping with treatment you’ve given in the past. And so those are the sorts of factors we look at and think about.”

“When we decide if someone’s safe for oligometastatic treatment. One of the earlier studies that was done in oligometastatic breast cancer was looking at patients with a few different types of malignancies. There was lung cancer, there might have been prostate cancer, breast cancer, different types of malignancies, but all with a small number of metastatic sites.”

“And this trial was trying to look at if those patients had their disease otherwise controlled by a drug therapy that they’d started on, if they could try to deliver a dose of either radiation or perhaps surgery to a site, could you actually give them a better outcome by eradicating those local tumours, and just focusing on those distant metastases?”

“And that trial suggested that there was a survival advantage. It was not a very large trial, but it suggested that there was a survival advantage. But the number of breast cancer patients in the trial was relatively small. It wasn’t only a trial looking at breast cancer.”

“Then more recently, there’s been a trial that was trying to address this question again, but in a specific breast cancer population. And again, thinking about whether trying to eradicate those small number of sites of distant metastases could lead to a better outcome in terms of survival. And, in fact, that follow up trial actually did not show a benefit in overall survival.”

“So, I think we’re in a situation where we know we can deliver local radiation to these sites and potentially get some control of those sites, but whether that actually ultimately impacts the patient’s overall journey with metastatic breast cancer and their survival has not actually been clearly shown in breast cancer.”

“So, we really need more information to say that we should be doing this, really to routinely offer this. So, it remains really something that needs to be proven for breast cancer.”

In what ways does personalised medicine play a role in treating oligometastatic breast cancer?

“It’s a good question and I think I can answer it with starting with examples of two different sorts of patients. So, for example, there might be a patient who had breast cancer 15 years ago and had it treated successfully. And then 15 years later, they develop one bone metastasis. That patient has oligometastatic disease. A similar patient, in my case, has oligometastatic disease, and turns up with three bone metastases on the same day that they’re diagnosed with their primary, and that’s part one,” said Steven.

“And part two is, there are patients with different subtypes of breast cancer. We talked about HER2-positive, there’s triple negative, and there’s other types. So, these trials generally group all those patients together and call them all oligometastatic patients, and we now know that there’s different types of oligometastatic disease, and so I think whenever you start research you group everyone together and try and find a bit of an answer to a global question because it’s very hard to recruit very narrow groups of patients.”

“But I think where we’re heading now is really looking at subtype specific patients and researching them differently because we do believe that it’s possible there might be very different answers for those different patients. So that’s the subject of ongoing research and investigation,” he said.

What are your hopes for the future?

“Well, in the oligometastatic setting the attractive thing is that it has never been thought that you could cure metastatic disease, and really that’s something across all of cancer. So, it’s a bit of a prior golden egg, a prize really, patients would love it and doctors obviously would love it if we could cure stage four disease,” said Steven.

“And I’ve seen Prue give a talk on that topic, on HER2-positive breast cancers, and she thinks they will be cured sometime soon. And perhaps radiation stereotactic to small deposits may be part of that story. And I think that would be a fantastic thing to talk about and to be able to say to patients, we’re going to cure you, even though it’s spread beyond the breast. And there’s every chance that’ll be in our lifetime, I think,” he said.

“I think in the area of oligometastatic disease, we have a few new tools in our kit bag from a drug therapy point of view that haven’t previously been tested formally in patients with oligometastatic disease. They’re things that we now would use in a higher risk, early-stage breast cancer patients,” said Prue.

“For example, a PARP inhibitor in a patient with a BRCA mutation or a CDK4/6 inhibitor in a patient with ER-positive HER2-negative high-risk disease, or perhaps immunotherapy in a high-risk triple negative breast cancer patient.”

“So, the question is, if we were to apply these types of therapies in the context of the overall treatment paradigm for a patient with an oligometastatic disease with those specific features, could that translate into any difference in a patient with a very limited number of metastases? Could that translate into any cures? Because at this stage we don’t have good information on how that would work with those newer therapies,” she said.

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Breast Cancer Trials is dedicated to finding new and better treatments and prevention strategies for people affected by breast cancer. OLIO is an immunotherapy clinical trial which is examining whether the addition of a Olaparib to standard chemotherapy with or without durvalumab will improve outcomes for young premenopausal women with high-risk early breast cancer.

Dr Stephen Luen is the study chair of the OLIO clinical trial and we spoke to him about the aim of this research, how it might improve patient outcomes, and his hopes for the future of breast cancer research.

“So, recently we published some data looking at a very young women with hormone receptor positive breast cancer to try to understand what features in their breast cancers might give clues as to why their cancers may be more aggressive or have a higher chance of recurrence. And based on those findings, we’ve proceeded with a trial concept to try to add in targeted therapies for a subgroup of these tumors to improve their outcome.”

What is the aim of the OLIO clinical trial?

“So, we know that in hormone receptor positive breast cancer in young women, that they can have an elevated risk of recurrence, up to two to three times that of older patients. And the aim here is to target particular features of the tumor, and in this case, that’s called homologous recombination deficiency, with treatments that are dedicated to targeting those pathways to improve the chance that when we do an operation there is no tumor left over, but also to improve the outcomes in terms of the chance of cure to prevent recurrence.”

“So the aim of this trial is to develop the optimal treatment pathway for these patients to improve their chance of cure.”

How prevalent is HR-positive breast cancer?

“Yeah, that’s a good question. So, hormone receptor positive, HER2 negative breast cancer is the most common breast cancer subtype of all breast cancers that we diagnose. It makes up about 70 percent of cancers. However, the typical hormone receptor positive breast cancer is in post-menopausal women and older women. So, it is quite unusual for a young woman to develop breast cancers that are hormone receptor positive, HER2 negative.”

“And for this reason, we’ve investigated this more closely, and with the elevated risk we wanted to identify why these patients are getting cancer, but also how to best treat them.”

Why might young women with HR-positive breast cancer have higher rates of recurrence?

“So, it’s not totally clear why these tumors have a higher rate of recurrence. There are a couple of things that we do know. So, when we look under the microscope at features that show how aggressive the cancer is, in other words, how rapidly we think that cancer is growing, in young women we can see that they have much more aggressive cancers than their older counterparts.”

“There may be several reasons for that. We imagine that homologous recombination deficiency leads to a situation that is called genomic instability, where you accumulate more changes in the DNA of the tumor that can make the cancer more aggressive. There are also other features, so for example, young women may have higher levels of estrogen compared with postmenopausal women, and because these breast cancers are driven by hormones, it may be that in that situation they have more aggressive features.”

“In patients who have homologous recombination deficiency, there is some defect in the body’s ability to repair DNA changes. When we give a Olaparib, which is a class of drug called a PARP Inhibitor, it further decreases the ability to repair DNA. And when this occurs, you can get a massive accumulation of changes in the DNA of the cell, which causes that cell to die because it cannot cope with that level of DNA damage.”

“So, this is how the Olaparib drug works in this situation, and we think it probably works even better or synergizes with chemotherapy which causes cell death through its usual pathways.”

What role does the immune system play in trying to make a treatment more effective?

“So my lab and other people around the world have spent a lot of time investigating the immune system and its interaction with cancers, particularly breast cancer. And our lab has done a lot of work at looking at quantity of immune cells within a tumor itself, which is kind of like a surrogate marker for that interaction between the patient and the tumor.”

“And we know that there are subtypes of breast cancer that are much more visible to the immune system. So, for example, triple negative breast cancer is known to be more visible to the immune system and, indeed, we’ve seen some positive results with adding immunotherapy in this subtype.”

“There seems to be less of a role in hormone receptor positive tumors, however, based on some of the research we’ve done, we believe there is a subset of these tumors that do have a stronger interaction with the immune system. And part of what we’d really like to do here is identify which of those tumors have that robust immune sort of interaction, and whether we can then target that group with drugs that allow the immune system to be fully unleashed.”

“So, the OLIO clinical trial is looking to recruit a total of 56 patients, and the patients that are eligible are patients who are young, so aged less than 45 years, and they have hormone receptor positive, HER2 negative breast cancer that is deemed to be high risk. And they are going to undergo treatment with chemotherapy in what we call the neoadjuvant setting, which is chemotherapy before surgery.”

“To be eligible for the trial, patients can be recruited for something we call a prescreening, which involves simply doing a genetic test on the tumor to see if this feature we call homologous recombination deficiency is present. And if it is present, they then may be eligible to proceed with the full trial with the intervention.”

“I believe with the advent of new therapeutics; we’re really looking at using targeted drugs to improve the outcomes in particular subsets of patients. So, I think for the future what I’d really like to see is to be able to understand which subgroups are going to respond to these treatments so that we can really optimize their outcomes at a personalized treatment kind of level.”

What are your hopes for the future?

“So, I think my hopes for this clinical trial, obviously, are that we see some positive results. If this is positive, I feel strongly that we should look to do a larger, what we call a registrational study, and that will enable this treatment to be fully accessible and available to the general public so that we can identify these high-risk individuals, particularly young patients, and we can treat them with the best possible treatment.”

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