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Laura J. Esserman, MD, MBA
Professor of Surgery and Radiology
Director, Carol Franc Buck Breast Care Center
Co-Leader, Breast Oncology Program
UCSF Helen Diller Family Comprehensive Cancer Center
University of California
San Francisco, California
Goal: To identify biomarkers that can predict response to therapy or risk of recurrence.
Impact: Dr. Esserman has developed new technologies to monitor—and potentially predict—response to immunotherapies in invasive breast cancer as well as ductal carcinoma in situ (DCIS). Her findings may lead to more personalized and effective cancer care by advancing immune-based diagnostic and therapeutic strategies.
What’s next: She and her team will examine a panel of blood-based biomarkers to identify individual biomarkers or combinations that may be useful in predicting response, early in the course of immunotherapy.
Immunotherapy is a promising treatment for breast cancer, but currently few patients benefit from it. Biomarkers are needed to identify patients who, early in the course of therapy, are not responsive to the treatment. Dr. Esserman has developed procedures for staining breast cancer tissue to identify the presence and location of cells within a tumor that mediate immunity—an advance that may allow scientists to predict whether a patient will or won’t benefit from immunotherapy.
Full Research Summary
Research area: Predicting response to immunotherapies in both invasive breast cancer and ductal carcinoma in situ (DCIS), an early, non-invasive pre-cancer.
Impact: While immunotherapy is a promising approach to treating breast cancer, few patients currently benefit from it. Thus, biomarkers are needed to identify patients who, early in the course of therapy, are not responsive to immunotherapy. This would potentially allow doctors to switch those patients to another therapy to achieve the best possible response and avoid unnecessary toxic side effects. Dr. Esserman is studying immunity within the tumor itself and characterizing immune and cell death markers in the blood that could guide immunotherapeutic approaches and be used to monitor response to these treatments.
Current investigation: Having developed procedures for staining breast cancer tissue to identify the presence and spatial proximity of immune cells to tumor cells, Dr. Esserman and her colleagues are now applying these procedures to monitor and potentially predict response to immunotherapies in invasive breast cancer as well as DCIS.
What she’s learned so far: The team has demonstrated that the number of immune cells (particularly T cells), as well as their proximity to tumor cells, were associated with a good response to immunotherapy in invasive breast cancer. For triple negative tumors, having T cells near the tumor cells was the most important predictor for an excellent response.
Their work has also shown that local immunotherapy of DCIS resulted in an expansion of immune cells within DCIS lesions. However, this did not result in reduced tumor size or cell killing, suggesting that even though there was an immune response, other factors are at play suppressing anti-tumor immune activity.
What’s next: With the support of BCRF, Dr. Esserman plans to examine a panel of blood-based biomarkers to identify individual biomarkers or combinations that may be useful in predicting response early in the course of neoadjuvant (pre-surgery) immunotherapy for breast cancer.
Dr. Esserman is a surgeon and breast cancer oncology specialist, and is the Director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco (UCSF). In 1996, she started the Center of Excellence for Breast Cancer Care at UCSF to integrate clinical care and research, automate tools for the capture of patient and clinical data, and develop systems to tailor care to biology, patient preference, and performance.
Dr. Esserman is nationally and internationally known as a leader in the field of breast cancer and has published over 200 articles. She served as a member of a taskforce for President Obama’s Council of Advisors on Science and Technology (PCAST) Working Group on Advancing Innovation in Drug Development and Evaluation. The group was tasked with making recommendations to the federal government about how to best support science-based innovation in the process of drug development and regulatory evaluation.
She is the Principal Investigator of the I-SPY TRIAL program, a multi-site neoadjuvant clinical trial (which includes a phase 2 and 3 trial) that has evolved into a model for translational research and innovation in clinical trial design. Dr. Esserman has recently launched a University of California-wide breast cancer initiative called the Athena Breast Health Network, a program designed to follow 150,000 women from screening through treatment and outcomes, incorporating the latest in molecular testing and web-based tools into the course of care. Athena is in the final stages of launching a statewide demonstration project and phase 1/2 trial of personalized screening.
BCRF Investigator Since
The Ann Taylor and Loft Award (a subsidiary of ascena retail group inc.)