Cynthia X. Ma, MD, PhD
St. Louis, Missouri
Professor of Medicine, Division of Oncology and
Section of Medical Oncology
Washington University School of Medicine
St. Louis, Missouri
Advancing the use of precision medicine for patients with estrogen receptor-positive breast cancer.
Estrogen receptor (ER)-positive breast cancer typically responds well to endocrine therapy. However, up to 20 percent of patients will experience a recurrence. Drs. Ma and Ellis are conducting a clinical trial called ALTERNATE, which aims to develop a biomarker that can predict the long-term outcome of patients with ER-positive breast cancer receiving neoadjuvant (pre-surgical) endocrine therapy (fulvestrant or the combination of fulvestrant plus anastrozole) to identify those who may forego adjuvant (post-surgery) chemotherapy. The study is following patients for ten years after surgery or until the patient experiences a recurrence. Results from the study could spare many from the toxicities of chemotherapy and lead to more personalized treatments.
The trial has enrolled 1,473 post-menopausal women with Stage II-III ER-positive breast cancer and is currently in the follow-up phase. Drs. Ma and Ellis are performing ongoing molecular analyses to identify resistance mechanisms and novel drug targets. They have also validated a hormone receptor-based biomarker model called PEPI that predicts response to endocrine therapy in postmenopausal women with ER-positive, HER2-negative, locally advanced breast cancer.
Drs. Ma and Ellis will continue to obtain and perform analyses on tumor biopsy and blood samples from study participants during the follow-up period. They will test blood samples for biomarkers at year five post-surgery and at serial time points up to ten years for high-risk patients and at recurrence to identify biomarkers that will be able to predict risk for late recurrence in this patient population.
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