Associate Professor, Department of Hematology and Medical Oncology
Louisa and Rand Glenn Family Chair in Breast Cancer Research
Director, Glenn Family Breast Center
Director, Breast Medical Oncology
Winship Cancer Institute of Emory University
Refining and identifying new biomarkers for risk to better personalize therapeutic strategies in early-stage breast cancer.
The RxPONDER clinical trial was immensely valuable for identifying the right treatment for patients with early-stage hormone receptor (HR)-positive, HER2-negative breast cancer. In the study, patients were defined by their recurrence score which was calculated based on the results of a genomic test called OncotypeDX®. In those who had a low recurrence score (less than 25), the study found no added benefit of chemotherapy in postmenopausal patients whose cancer had spread to three or fewer lymph nodes. In premenopausal women the opposite was true, they benefitted from chemotherapy. This study was groundbreaking, and Dr. Kalinsky and his team will pursue further research to build upon its findings and make its results more universal and accessible for patients.
There remain a number of questions to address from RxPONDER and Dr. Kalinsky and his colleagues will pursue two separate questions in their study. The first will reassess how menopause is classified in patients. In RxPONDER, menopausal status was based upon self-reported menstrual history, but this can be an imperfect measure. The team is evaluating other methods to classify menopausal status. In the second part of their study, the team is testing an alternative low-cost method for measuring risk of recurrence.
The team will explore if menopause can be defined by hormone levels measured in RxPONDER patient samples prior to start of treatment. Initial focus will be on patients who are aged 55 to evaluate if patient outcomes differ based on the method used to define menopause: blood hormone levels versus menstrual history. In parallel, they will evaluate a computer-aided diagnostic method called CHIP (need to spell this out) as a less costly alternative to current tests. CHIP generates a risk score based on image analysis of unique cellular arrangements and characteristics from tumor samples. These studies build on the findings of RxPONDER and will further refine which patients with early-stage, estrogen-driven breast cancer will or will not benefit from chemotherapy—this has the potential to spare some patients unnecessary side effects from chemotherapy.
Kevin Kalinsky, MD, MS, is Associate Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. He serves as the director of the Glenn Family Breast Center at Winship where he is tasked with fulfilling the vision to improve breast cancer outcomes by aligning research and education with cancer treatment and prevention. A breast cancer physician and investigator, Dr. Kalinsky’s research involves the development of early-phase clinical trials to assess novel therapeutics in breast cancer based on tumor genomics. Breast Cancer Research Foundation funding has been dedicated to further understanding the risk of late recurrence in patients with estrogen-driven breast tumors through novel blood markers as well as artificial intelligence.
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