Report from 33rd Annual San Antonio Breast Cancer Symposium, Dec. 8-12, 2010

The 33rd San Antonio Breast Cancer Symposium (SABCS), attended by 9,000 physicians, scientists, and advocates from 94 countries, opened with a sobering reminder of the importance of clinical and translational research. The recent loss of healthcare advocate Elizabeth Edwards to breast cancer underscored the reasons why so many people travel to this event from across the globe every year -- to learn about new clinical practice so that patients can immediately benefit from these advances and to share innovative technologies and ideas so that researchers can continue to transform treatment with the ultimate objective of curing and preventing breast cancer.

This goal is what inspired the creation of BCRF in 1993. The impact that the Foundation has on today's breast cancer research is indisputable, as BCRF investigators led the projects and presented many of the new clinical insights and laboratory findings. SABCS also serves as a forum to recognize special achievements of leaders of the breast cancer community. Among the special recognitions awarded this year, the AACR Distinguished Lecture for Breast Cancer Research was given to Alan Ashworth, PhD, FMedSci, FRS (Breakthrough Breast Cancer Research Centre, the Institute of Cancer Research, London, UK). Dr. Ashworth, a BCRF grantee since 2008, is a member of the team that discovered the BRCA2 gene in 1995. In 2005, he and his colleagues discovered that cancer cells that carry mutated BRCA1 or BRCA2 are highly sensitive to PARP inhibitors, which are now being tested in clinical trials for triple negative breast cancer as well as BRCA tumors.

The McGuire Lecture, one of the most distinguished forums at the Symposium, was delivered by BCRF grantee George W. Sledge, Jr., MD (Indiana University School of Medicine). In his presentation, Dr. Sledge paid a heartfelt tribute to the late William L. McGuire, MD, who was his fellowship advisor and one of the founders of SABCS. Adopting McGuire's motto of "biology is destiny," Dr. Sledge, the current president of the American Society of Clinical Oncology and a BCRF grantee for 12 years, attributed his accomplishments to Dr. McGuire's example of bridging the clinical experience with laboratory research and emphasizing the importance of individuality of each patient. Dr. Sledge shared insightful observations on the current state of breast cancer research and challenged the audience to prepare for the obstacles -- not just the benefits -- that scientific progress, such as next-generation sequencing and appearance of the $1,000 genome, will bring. He also encouraged the creation of health information databases and continued transnational research collaborations, and he cited the importance of BCRF support to his own accomplishments.

Several other BCRF investigators presented their work at SABCS. Matthew J. Ellis, MD, PhD (Washington University in St. Louis) reported on a multi-center study comparing the effectiveness of three aromatase inhibitors used pre-surgery for post-menopausal women with estrogen receptor-rich breast cancer. Dr. Ellis and colleagues found no differences in the participants' response to these drugs. However, they observed that women with luminal A subtype tumors responded best to these therapies, which suggests the possibility that this group may be able to avoid chemotherapy altogether.

One of the more surprising results reported at SABCS came from James Rae, PhD (University of Michigan). His group tested an existing theory that a person's ability to metabolize tamoxifen can influence the amount of benefit received. Their findings, as well as those from a separate, independent study that took place in Europe, did not support this theory at all, but rather demonstrated that the differences in drug targets and estrogen signaling pathways -- not the ability to metabolize tamoxifen -- may account for varied levels of response.

Jose Baselga, MD, PhD (Vall d'Hebron Institute of Oncology and Massachusetts General Hospital), representing NeoALTTO, an international clinical trial, reported on the effectiveness of lapatinib, or trastuzumab (commonly known as Herceptin®), or the combination of both, used jointly with paclitaxel when given pre-surgically to patients with HER2-positive breast cancer. This study involved 455 patients at 99 locations. The researchers observed that these drugs' effectiveness almost doubled when lapatinib and trastuzumab were combined, as opposed to when either trastuzumab or lapatinib is used alone. Additional studies are needed before this practice becomes standard, but the evidence of increased benefit from the drug combination has important and immediate clinical research implications.

In addition to papers on treatment advances, SABCS included presentations on quality of life and access to care. For example, BCRF grantee Dawn L. Hershman, MD, MS (Columbia University) reported on the association between prescription co-payment amount and compliance with adjuvant aromatase inhibitor therapy in women with early stage breast cancer. Several presentations focused on the correlation between obesity and breast cancer, and a mini-symposium was dedicated to healthcare disparities.

BCRF co-sponsored two parallel events in San Antonio in conjunction with SABCS. BCRF and Susan G. Komen for the Cure partnered with the Triple Negative Breast Cancer Foundation (TNBCF) for the TNBCF annual conference on December 7, during which experts on this aggressive form of breast cancer made presentations on their research. BCRF was represented on the TNBCF conference organizing committee by Scientific Advisory Committee chair Clifford Hudis, MD (Memorial Sloan-Kettering Cancer Center), as well as Dr. Sledge and Lisa A. Carey, MD (University of North Carolina). The presenters included BCRF grantees Dr. Baselga, James Ford, MD (Stanford University), Funmi Olopade, MD, MB, FACP (University of Chicago), and Lajos Pusztai, MD, D.Phil (MD Anderson Cancer Center). Finalists for the TNBCF grant awards presented and defended their proposals, and Dr. Ford was one of the two researchers awarded a TNBCF grant, for research building on the results of his BCRF-funded clinical trial of neoadjuvant chemotherapy plus a PARP inhibitor. His team will seek to identify the molecular and cellular determinants of drug resistance to PARP inhibitors.

In conjunction with the European School of Oncology, BCRF also co-sponsored a satellite symposium on December 10, Controversial Topics in Breast Cancer: Straight Talk with International Experts. Co-chaired by BCRF Scientific Director Larry Norton, MD (Memorial Sloan-Kettering Cancer Center) and BCRF grantee Martine Piccart-Gebhart, MD, PhD (Institut Jules Bordet), the evening event attracted over 600 researchers, medical oncologists and other professionals who appreciated the casual setting to freely exchange information on new developments with their colleagues. BCRF grantees on the faculty of experts included Dr. Baselga, William Gradishar, MD, FACP (Northwestern University), and Gabriel Hortobagyi, MD (MD Anderson Cancer Center) and discussion topics included personalized therapy, bone-targeted therapies, and resistance to chemotherapy.

The Symposium ended with "year in review" summaries on several topics, moderated by C. Kent Osborne, MD, who also co-directed SABCS. Two of the presenters were BCRF grantees, Dr. Carey and Mitch Dowsett MD, PhD (Royal Marsden Hospital NHS Trust).

The 2010 SABCS will be remembered for questioning standard practices and theories. For instance, the meeting saw challenges to previous reports on the ability of bisphosphonates, a class of drugs used to build bone strength, to reduce the risk of breast cancer metastasis in pre-menopausal women. However, results showed that bisphosphonates may improve survival for patients with early stage breast cancer who were five or more years past menopause. The rigor, courage, and dedication with which breast cancer researchers pursue their work should be noted -- and that sometimes means that existing practice must be changed.