Laura J. Esserman, MD, MBA

Chronic inflammation has been implicated in the initiation and promotion of various cancers, including breast cancer. Tumors are often infiltrated with white blood cells (predominately lymphocytes and macrophages) and the cross-talk between these cells and the cancer cells have profound effects on tumor progression. Dr. Esserman and her colleagues have reported that high numbers of these tumors associated macrophages (TAMs), in the absence of an anti-tumor immune microenvironment, predict poor outcomes. In a preclinical study, they demonstrated that a combination of agents targeting TAMs and infiltrating T cells can effectively reprogram the tumor immune microenvironment leading to complete tumor regressions. They are continuing their study of the tumor immune microenvironment in breast cancer and further evaluating strategies to re-educate tumor infiltrating T cells and TAMs towards an anti-tumor response.

Mid-year Progress: Dr. Esserman's team has continued their studies of the tumor immune microenvironment in breast cancer by developing/optimizing several two-color immune-histochemical stains and the requisite multispectral imaging algorithms, for identifying and classifying infiltrating lymphocytes and macrophages. They have furthered their studies evaluating strategies to re-educate tumor associated macrophages and T-cells in the tumor immune microenvironment and shift their activities from pro-tumoral to anti-tumoral. Using a combination of three immune modulating agents, Dr. Esserman's team observed dramatic complete tumor regressions in a laboratory model of aggressive, triple negative breast cancer. In addition to studying the tumor immune microenvironment, they are also interested in studying peripheral immunity in breast cancer. Since blood circulates throughout the body, white blood cells or serum/plasma may serve as a sensitive indicator of disease as well as a barometer of response to therapy. Dr. Esserman's laboratory has recently begun collaborating with other research teams to apply a technique known as immunosignaturing to serum samples from breast cancer patients. The idea behind immunosignaturing is that the human immune system can be used to assess general health status and changes in an individual's immunosignature could indicate the pre-symptomatic presence of various illnesses. Finally, Dr. Esserman's team is continuing their collaboration with physicians in Nigeria to study the very aggressive breast cancers observed there. They have sent supplies for the collection of tumor tissues and blood samples and have recently received seven patient samples from Nigeria that they are beginning to analyze.

Bio:
Laura Esserman is Professor of Surgery and Radiology at the University of California, San Francisco (UCSF) and the Director of the UCSF/Mt. Zion Carol Franc Buck Breast Care Center. Dr. Esserman received her undergraduate degree from Harvard and her MD from Stanford University, where she completed her surgical residency and an oncology fellowship. After completing her medical training, she was awarded a Hartford Fellowship to enable her to pursue her MBA at the Stanford University School of Business. Dr. Esserman has a joint appointment in the Departments of Surgery and Radiology and is affiliate faculty for the Institute for Health Policy Studies and Medical Informatics Program. She is also the Co-leader of the Breast Oncology Program of the UCSF Cancer Center.

Dr. Esserman's practice is devoted to diseases of the breast, particularly breast cancer. At the Breast Cancer Center, patients are looked at as a whole person, and are not identified by their disease. This philosophy is behind Dr. Esserman's interest in helping women become more involved in their own decision making process. The Center is designed to advance the state of the art of delivering breast healthcare through better tools for risk assessment, better prediction of benefit from intervention, knowledge integration across the many disciplines and providers involved in care delivery, and integration of clinical research into the patient care process. The Center was created as part of a multi-million dollar grant, one of three awarded nationally, from the Department of Defense. Novel approaches include the introduction of a collaborative care decision focused model, where patients and physicians make decisions together, and the introduction and testing of tools to use risk assessment and new biological markers explicitly in therapeutic decision making.

Dr. Esserman is also involved in research and furthering the knowledge of providers as well as patients. Current projects include: the development of a vaccine for treatment of ductal carcinoma in situ; clinical trials designed around biomarkers; and developing MRI imaging as a surrogate marker of disease and response in order to improve cancer staging and enable the introduction of novel therapeutics. She also speaks extensively at many public and private forums and has published numerous articles covering a broad range of topics, from immunology to health policy and health care delivery. The philosophy underlying Dr. Esserman's research and practice is to ensure that a patient's sense of comfort, knowledge, and participation are central in delivering the best care possible.

In addition, Dr. Esserman is the Principal Investigator of the I-SPY TRIAL program, a multi-site neoadjuvant clinical trial that has evolved into a model for translational research and innovation in clinical trial design. Dr. Esserman has recently launched a University of California-wide breast cancer initiative called the Athena Breast Health Network, a project designed to follow 400,000 women from screening through treatment and outcomes, incorporating the latest in molecular testing and web-based tools into the course of care.