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Hope S. Rugo, MD, FASCO
Director, Breast Oncology and Clinical Trials Education
UCSF Helen Diller Family Comprehensive Cancer Center
Professor of Medicine
University of California
San Francisco, California
Goal: To develop new, more effective therapies for triple-negative breast cancer (TNBC), an aggressive form of the disease.
Impact: Dr. Rugo is pursuing ways to improve response to immunotherapy in patients with TNBC. Her work could lead to more effective combination approaches for treating a subtype of breast cancer that currently has few targeted treatment options.
What’s next: She and her team will investigate the MYC cancer gene, which may play a role in preventing immune cells from killing tumor cells. They will also determine whether analyzing circulating tumor DNA (ctDNA) in the blood can be used to predict metastatic relapse in those who have estrogen receptor (ER)-positive breast cancer.
While immunotherapy has benefitted many patients with various types of cancer, it has been considerably less successful in treating those who have breast cancer. Triple-negative breast cancer (TNBC) responds somewhat better to immunotherapy compared to other subtypes of the disease, but most patients still do not benefit from it. Dr. Rugo is studying how TNBC cells are able to avoid attack by the immune system so that new and better immunotherapies can be developed.
Full Research Summary
Research area: Developing new treatment options for patients with triple-negative breast cancers.
Impact: Triple-negative breast cancer (TNBC) is an especially aggressive subtype of breast cancer. Treating TNBC remains a major challenge due to the limited number of effective drugs. Immunotherapies called checkpoint inhibitors have been effective against some advanced TNBC, but most patients have not received benefit from current immunotherapy approaches. Dr. Rugo is studying ways to improve response to immunotherapy by targeting pathways regulated by the MYC cancer gene.
In a separate study, Dr. Rugo is evaluating the use of liquid biopsy for the early detection of drug resistance and disease progression in patients with hormone receptor-positive, early-stage breast cancer with a high risk for recurrence. The results of these studies will help to predict early risk of recurrence, aid in treatment decisions to prevent cancer recurrence, and provide an opportunity to study the mechanisms of resistance.
Current investigation: Dr. Rugo will focus on understanding the role of the MYC cancer gene in protecting the tumor from an immune attack. In a second study, they will utilize serial liquid biopsy to analyze circulating tumor (ct)DNA to determine the efficacy of ctDNA to predict recurrence and to study mechanisms of resistance in patients receiving adjuvant hormone therapy.
What she’s learned so far: Her group has discovered new vulnerabilities in the treatment of TNBCs, which form the foundation of the current study. They have identified the MYC cancer gene as an important factor in mediating TNBC disease and other aggressive breast cancers. In other studies, Dr. Rugo and her team have shown that patients with high numbers of circulating tumor cells (CTCs) have a greater risk of relapse compared to those who have few or no CTCs.
What’s next: Dr. Rugo and her colleagues will continue to determine ways to improve immunotherapy for patients with TNBC. This includes ongoing studies to understand how the MYC oncogene may hide tumor cells from a patient’s immune system. Also, to determine the mechanism of CDK1, a protein that regulates the cell cycle, and MYC gene activation. The team will also continue their investigations on the effectiveness of using ctDNA for monitoring disease progression in estrogen receptor-positive breast cancer.
Hope S. Rugo, MD, FASCO, is a medical oncologist and hematologist specializing in breast cancer research and treatment. A Professor of Medicine, Dr. Rugo joined the Breast Care Center in 1999 after a decade of experience at University of California San Francisco (UCSF) in malignant hematology and bone marrow transplantation for a variety of diseases, including breast cancer. She entered the field of breast cancer in order to incorporate novel therapies based on an understanding of the biology of cancer with excellent quality of care into the treatment of women with breast cancer.
Dr. Rugo is the Director of Breast Oncology and Clinical Trials Education at the UCSF Helen Diller Family Comprehensive Cancer Center. She is a principal investigator of multiple clinical trials focusing on combining novel targeted therapeutics with standard treatment to improve the treatment of both early and late stage breast cancer, and has published widely in this area. Her current research interests include immunotherapy and combinations of targeted agents in the treatment of breast cancer to overcome resistance. In addition, Dr. Rugo has conducted a number of studies focusing on reducing toxicity from therapy, resulting in approval of scalp cooling to reduce chemotherapy induced hair loss, and a steroid mouthwash to reduce targeted agent stomatitis. She is an investigator and the chair of the Safety Committee for the multicenter adaptively randomized phase II I-SPY2 trial, and also serves on the Novel Agents Committee. Dr. Rugo is the co-chair of the Triple Negative Working Group and an active member of the Translational Breast Cancer Research Consortium (TBCRC), and is the principal investigator of several TBCRC trials including a multi-center immunotherapy trial funded by the Breast Cancer Research Foundation (BCRF). She is an active member of the Alliance (formerly CALGB) Breast Committee, as well as ASCO, where she serves on the Guidelines Committee and as an editor for the Education Committee.
In addition to her research, Dr. Rugo is an active clinician, and is committed to education, regularly lecturing locally, nationally, and internationally on subjects relating to the treatment of and supportive care for breast cancer. At UCSF, Dr. Rugo runs the Breast Forum, an open bimonthly evening educational session for breast cancer patients, families, and friends from throughout the bay area.
Dr. Rugo graduated from the University of Pennsylvania School of Medicine in 1983. She completed a residency in internal medicine and primary care followed by a fellowship in hematology and oncology at the University of California San Francisco. She was a post-doctoral fellow in immunology participating in laboratory research at Stanford University from 1988-1990. In 1990, Dr. Rugo joined the faculty at UCSF in the Division of Hematology and Oncology. Dr. Rugo has been recognized for her excellence in both patient care and in teaching of both medical students and training physicians. She has received several awards including the Bank of America Giannini Foundation Award and a UCSF Clinical Cancer Center Investigator Research Program intra-mural award. In 2006, she was honored for her work in Breast Cancer Research by the Friends of the Breast Care Center.