Breast cancer recurrence looms in the minds of many women with a history of breast cancer. For some, breast cancer can return many years after initial diagnosis. These late recurrences are a significant challenge for clinicians.
“There are millions of women worldwide,” said BCRF investigator Dr. Pamela Goodwin, “who have an important risk of recurrence, especially if the risk is summed over many years.”
Dr. Goodwin along with fellow BCRF researchers Dr. Daniel Hayes and Dr. Joseph Sparano and Kevin Kalinsky, MD, MS (Columbia University Medical Center), hosted a workshop in Toronto, Ontario February 15-16 to discuss late recurrence in hormone positive breast cancers.
“A cooperative, worldwide effort is needed to better understand the issues around late recurrence,” said Dr. Hayes.
To jumpstart these efforts, the workshop convened more than 40 international experts in clinical oncology, laboratory research, epidemiology, mathematical oncology and patient advocacy. Its purpose: to review existing knowledge, facilitate collaboration, and identify ways to utilize existing resources to more precisely predict risk of recurrence.
“Our ultimate goal is to foster joint international research activities that would lead to more rapid understanding of which patients are at risk of late recurrence, and how those recurrences can be prevented,” said Dr. Goodwin.
A good prognosis with unknown risk of recurrence
Most breast cancers require estrogen to grow. These tumors, called estrogen receptor (ER+) or hormone receptor (HR+) breast cancer, make up more than 70 percent of all breast cancers.
When detected early, ER-positive breast cancers are treatable and may even be cured with drugs that target the estrogen receptor or prevent estrogen production, called endocrine therapy. Results from clinical trials have shown that at least 5 years of endocrine therapy substantially reduces the risk of the cancer recurring and continued endocrine therapy beyond 5 years also reduces the risk of recurrence.
Despite remarkable results with endocrine therapy, some women with a history of ER-positive breast cancer will experience a recurrence of their breast cancer five, or even more years after initial diagnosis and ostensibly curative therapy.
The challenges behind understanding late recurrence
The underlying mechanisms of late recurrence are poorly understood and likely include multiple factors. The ones discussed and debated at the two-day meeting included failure to complete the full course (typically five years) of endocrine therapy, development of resistance to anti-estrogen drugs, tumor dormancy and the existence of occult micrometastases. The influences of lifestyle factors including obesity, as well as life events, such as illness, surgery or other trauma were also considered.
Participants proposed several priorities to advance the research. These included utilizing existing tumor and blood biorepositories (when available) to identify predictive biomarkers for late recurrence, validating liquid biopsy technology to detect these biomarkers, as well as the design of clinical and preclinical studies to better understand why some tumors stay dormant and others don’t. This will help identify the right group of patients to test rational strategies in prevention trials.
“When doctors can identify patients who have a very small, or even no, chance of recurring, these patients can potentially safely stop extended endocrine therapy,” Dr. Hayes continued. “ Furthermore, if patients still at risk can be identified, possible efforts to prevent such recurrences might be considered.”
The meeting was co-sponsored by BCRF through a grant to Dr. Hayes and the Hold’em for Life Charity based in Toronto, Canada.
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