Breast Unit

Location: Royal Marsden

Section: NHS Clinical Research Programme

Head of Unit: Professor Ian E Smith FRCP

Introduction

The Breast Unit is one of the largest in the UK with around 1,000 new breast cancer referrals per year at the Sutton and Chelsea sites. The Unit provides a major clinical service and research commitment to the Royal Marsden and The Institute. Most patients are directly referred by their general practitioners for diagnosis and treatment, and for surveillance if at high risk. They are treated in multidisciplinary clinical teams working to common clinical guidelines and protocols. The Unit has an unrivalled opportunity for clinical and biological research through its close laboratory links with the Academic Department of Biochemistry, The Institute, and the Breakthrough Toby Robins Breast Cancer Research Centre. Translational research (linking laboratories to clinics) is central to our research strategy and our aim is to have a portfolio covering all main areas of breast cancer research from prevention to palliation. Our research programme is linked to the National Cancer Research Network, Cancer Research UK and national and international multicentre breast cancer trials.

Recent Highlights

• Professor Mitch Dowsett gave the William McGuire memorial lecture at the San Antonio Breast Cancer Conference 2007. This is the most prestigious international lecture that can be awarded in the field of breast cancer research
• Professor Ian Smith has been appointed first Chairman of the newly formed UK Breast Intergroup, a body designed to promote and co-ordinate the successful running of national and international breast cancer trials in the UK
• The Unit has continued this year to publish key papers in the world’s most prestigious cancer journals including New England Journal of Medicine, Journal of the National Cancer Institute, Lancet and Journal of Clinical Oncology
• The Breast Unit has become centrally involved in the development of one of the most promising new drugs to treat breast cancer, Lapatinib, an oral small molecule which acts on the same pathway as Trastuzumab (Herceptin) but which may have clinical advantages. Dr Stephen Johnston was the lead investigator and first author in a recent key publication demonstrating high activity in the treatment of inflammatory breast cancer, and also identifying molecular markers to predict response. He is currently UK Principal Investigator for a Phase III trial of this agent with Letrozole and is leading a neoadjuvant biomarker study (MAPLE). Professor Smith is UK Principal Investigator in the ALTTO trial, a world-wide collaboration to assess whether Lapatinib may have advantages over Trastuzumab in early breast cancer

Future Aims

Our clinical service strategy is to develop further our primary referral practice at both ends of the hospital and a new Rapid Diagnostic and Assessment Centre (RDAAC) at Chelsea is under construction along the lines of our highly successful RDAAC at Sutton. The Unit will continue to deliver state of the art treatment for all stages of breast cancer and provide leadership in the development of novel therapies. A key aim is to build on our current translational research links between the clinical Breast Unit, the Academic Department of Biochemistry and the Breakthrough Centre. Our main themes will continue to be:

• The chemoprevention of breast cancer. We plan to initiate pilot trials involving partial oestrogen ablation in postmenopausal women; participate in the IBIS2 national prevention trial; develop algorithms to identify women at high risk of breast cancer without BRCA1/2 mutations. These projects will be run with the Academic Department of Biochemistry, the Breakthrough Centre and The Institute's teams in the Section of Cancer Genetics
• Neoadjuvant medical therapies before surgery. This will be integrated with The Institute's molecular biology programmes in the Breakthrough Centre and the Academic Department of Biochemistry, with the aim of developing predictive testing and monitoring of response using molecular endpoints. We shall use this to study new therapies in early breast cancer and in the longer term to optimise treatment for the individual patient
• The development of novel therapies both within the neoadjuvant setting and in metastatic disease
• The use of translational research to underpin and direct both our own clinical studies and large multicentre Phase III trials
• Improving the efficacy of primary radiotherapy to the breast by improved fractionation and dosimetry together with techniques for minimising damage to normal tissues
• The assessment of the role of sentinel node biopsy in neoadjuvant therapies