IMPROVING TREATMENTS FOR TRIPLE NEGATIVE BREAST CANCER

IBCSG VIII and IX Clinical Trial DNA Follow Up

Researchers are improving and refining breast cancer treatments by delving into the DNA of patients who have previously volunteered for breast cancer clinical trials.

“We already have the ability to distinguish between different levels of ‘severity’ of breast cancer, but we need to develop this further,” says Dr Nicholas Zdenkowski, Medical Advisor at Breast Cancer Trials.

While breast cancer treatments can already be targeted and personalised, Dr Zdenkowski says new and highly accurate tools could help determine which triple negative breast cancer patients can be cured with surgery alone. Triple negative breast cancer accounts for 15 per cent of all breast cancers.

“The standard approach is to offer women with the triple negative subtype of early stage breast cancer a fairly intensive treatment with chemotherapy, because there are no sufficiently accurate tests to determine which patients definitely don’t need any further treatment beyond surgery,” he says.

“Many patients worry that triple negative breast cancer has a worse prognosis than other breast cancer types, however, this is not always the case.”

Breast Cancer Trials provided data from previous trials called IBCSG VIII and IX, which had enrolled 228 and 330 patients respectively, towards the development of molecular tools to predict the recurrence of breast cancer after chemotherapy treatment.

The lab-based analysis looked at specific DNA methylation markers, or profiles, in the genes of breast cancers that had been surgically removed from patients. The study was centred around blood and tumour specimens held from clinical trials between 1985 and 2009.

The methylation markers helped categorise the early-stage triple negative patients into three groups: those who were cured with surgery to remove the cancer and so didn’t need further treatment; those who needed chemotherapy to prevent the cancer from returning after treatment; and those for whom chemotherapy was not effective, where the cancer came back elsewhere in their body despite that treatment.

However, Dr Zdenkowski says this test method needs further research before it can be considered for routine use in the clinic.

“As with any new test or treatment, the method requires rigorous evaluation to ensure it does what it promises to,” he says.

The use of well-collected and ‘clean’ clinical trial data in this way also illustrates the value in continuing to study and learn from patients who volunteered for previous trials.

“Ultimately, from this research, we hope to be able to reassure some patients that they can be cured with surgery alone,” Dr Zdenkowski says.

“We can also reassure others they will be cured with chemotherapy.”

“The third group, whose cancer will return even with surgery and chemotherapy, is the group in need of better treatments that we hope to find through ongoing research – so we can give them the best chance of being cured of cancer.”

Publication:

DNA methylation markers predict recurrence-free interval in triple-negative breast cancer.
Fackler MJ, Cho S, Cope L, Gabrielson E, Visvanathan K, Wilsbach K, Meir-Levi D, Lynch C.F., Marks J, Geradts J, Regan MM, Viale G, Wolff AC, Sukumar S, Umbricht CB. npj Breast Cancer 2020; 6Article No. 3;, https://doi.org/10.1038/s41523-020-0145-3.