While advances in research mean that breast cancer is being treated more successfully than ever before, the worry of recurrence remains for many patients. Here, Isy Godfrey finds out what scientists at The Institute of Cancer Research, London, are doing to tackle this complex problem.
Like other cancers, breast cancer is sometimes touted as a disease of the modern day. In fact, humans have been working to understand and defeat breast cancer for more than 3,500 years, with the earliest known treatments including cauterisation and arsenic paste.
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Fortunately, progress has accelerated exponentially throughout the centuries. We have developed techniques for detecting breast cancer at earlier stages, and we have an array of treatment options at our disposal, which can be targeted to patients according to the type, stage and genetics of their cancer. As a result, the one-year and five-year survival rates for breast cancer in the UK stand at 97 per cent and 86 per cent, respectively.
However, breast cancer still has a powerful trick up its sleeve: recurrence. Various factors, including the type of breast cancer and its stage at diagnosis, can affect the risk of recurrence, which decreases over time but never disappears. Recurrence is still possible decades after the initial treatment, and this unpredictability places a significant psychological burden on many survivors.
In the UK, national cancer registries do not tend to record data on disease recurrence. However, research suggests that one in five women successfully treated for breast cancer will see the disease return at a later date.
We need to stop breast cancer returning
Earlier this year, our scientists showed that it was possible to predict the recurrence of breast cancer in high-risk patients – even years ahead – by analysing blood samples for tumour DNA, which cancer cells release into the bloodstream. This could improve the chances of detecting cancer early should it reappear.
Ideally, though, we need to stop breast cancer from returning at all. In recent decades, an innovative type of treatment called immunotherapy has provided hope. Immunotherapy, which enhances the body’s ability to detect, target and kill cancer cells, has been shown to reduce the risk of recurrence in aggressive breast cancer. However, more research is needed to understand exactly how these treatments work, how we can maximise their effectiveness while limiting their side effects, and how we can identify those most likely to benefit.
‘Supercharging’ the immune system
Recently, Dr Stephen John Sammut, Leader of our Cancer Dynamics Group, was the main contributor to innovative work that could lead to improved, personalised immunotherapies. Dr Sammut and his colleagues found that when certain immune cells detect breast cancer in one part of the body, they search for similar cancer cells elsewhere. On finding them, they produce antibodies to recruit cancer-killing immune cells.
The team developed a computational tool that could predict which immune cells were most likely to perform this ‘cancer surveillance’. Scientists could use this information to artificially create the same antibodies, thereby boosting the immune system’s response against breast cancer that has spread.
“Immuno-oncology is such an exciting, fast-paced field”
Dr Esther Arwert is working on identifying treatments to enhance the immunotherapy options available to people with breast cancer.
Dr Arwert started her ICR career at our Centre for Cancer Drug Discovery, where critical research took place that led to the breast cancer medication capivasertib – now approved by the Food and Drug Administration (FDA) and the MHRA. She now leads our Functional Tumour Immunology Group, which is affiliated with our Centre for Immunotherapy of Cancer.
Dr Arwert said:
“Immunotherapy has revolutionised the treatment of breast cancer. We now know that we can successfully harness the body’s immune system to control and destroy the disease. The next step is to better understand the complex biology behind immunotherapy so that we can predict patient responses and treatment efficacy. Immuno-oncology is such an exciting, fast-paced field that it’s impossible not to feel motivated working here. I am confident that our work has the potential to transform the lives of many people with breast cancer.”
Preventing dormant cells from reawakening
Other scientists are focusing on alternative treatment avenues. An early-stage study led by Professor Luca Magnani, Leader of our Breast Epigenetic Plasticity and Evolution Group, revealed that hormonal treatment given after surgery can sometimes trigger changes in gene activity that allow breast cancer cells to enter a dormant state.
Upon ‘waking up’, these cells begin dividing again, causing cancer to return. By inhibiting an enzyme called G9a, the researchers eliminated these cells. This discovery could lead to new treatment approaches that remove any worry of breast cancer returning.
Undeterred in our mission to defeat breast cancer
Our scientists are responsible for some of the most transformative discoveries in breast cancer research, from identifying the BRCA2 gene to helping develop a class of drugs called PARP inhibitors. With many of the brightest minds in science continuing to tackle breast cancer from all angles, further discoveries are undoubtedly on the horizon. Thanks to our researchers’ passion and persistence, we believe we can overcome whatever hurdles breast cancer places in our path.
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