Last week, Breast Cancer Campaign ran a press briefing about their new Gap analysis, a study that aims to shine a light on the biggest gaps in breast cancer research and treatment in the UK. At the briefing, Professor Sue Eccles from The Institute of Cancer Research, London -- who had the task of pulling together the submissions of more than 80 leading UK experts for the analysis -- shared a platform with the University of Dundee’s Professor Alistair Thompson and Breast Cancer Campaign’s Chief Executive Baroness Delyth Morgan.
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The analysis, published today in the journal Breast Cancer Research, lays out ten priorities which research institutions, funders and policy makers need to address urgently -- if they don’t, Breast Cancer Campaign says, 185,000 lives could be needlessly lost to breast cancer by 2030. I was already familiar with some of the priorities, such as the need to better understand cancers at the genetic level, but others were new to me.
One major point that Professors Eccles and Thompson kept returning to was the urgent need for scientists to be able to get hold of samples, or biopsies, from cancers which have spread to new parts of the body -- such as the bones, liver or brain.
Currently, the researchers pointed out, only one tumour sample is taken from breast cancer patients, from the original tumour. If the biopsy shows that, for example, a patient has ER positive cancer, which uses hormones to grow, they could be offered hormone therapy. Or if the tumour sample tests HER2 positive, patients could be offered trastuzumab (Herceptin).
But cancers often find a way to mutate, evade first-line treatments, and spread throughout the body. Secondary cancers are often different from the primary cancer, which is why they can be very difficult to treat. But even if a secondary cancer does not respond to the usual breast cancer drugs, there could still be an existing cancer drug that will work – but we will only know the right drugs to use by taking a biopsy.
Professor Thompson pointed to a very powerful statistic: one in six women with secondary tumours could benefit from an existing treatment when first-line treatments have failed. That means that a second biopsy could be the difference between life and death in thousands of women.
Professor Eccles compared treating cancer to shooting at a target: we need the right sort of bullet for each different type of breast cancer. “Until you know what you're shooting at, you don’t know what the right bullet is,” she said. A secondary sample would give us effective bullets for a huge number of patients. It could also save a lot of money currently spent on therapies which we would know were likely to fail -- money which could be invested in more research.
A second biopsy from a secondary site could also make a huge difference in our understanding of how cancers which started in the breast mutate and metastasise, and could lead to new treatments to tackle treatment-resistant cancer. Although clinicians are understandably concerned about the risks associated with a second biopsy, without it we simply don’t know which treatments could be saving patients’ lives, and doctors are often left shooting in the dark.