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Laura J. Esserman, MD, MBA
Director, Carol Franc Buck Breast Care Center
Professor of Surgery and Radiology, University of California, San Francisco
Co-Leader, Breast Oncology Program
Alfred A. de Lorimier Endowed Chair in General Surgery
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.
Laura Esserman, MD, MBA, an internationally recognized breast surgeon, breast oncology specialist, and visionary in personalized medicine, is revolutionizing breast cancer screening and treatment throughout our nation today. Her breast cancer work spans a spectrum from basic science to public policy issues and the impact of both on the delivery of clinical care. She is a provocative thought leader calling attention to, and finding solutions for, over-diagnosis and over-treatment of breast cancer, especially of DCIS.
Since 2002, Dr. Esserman has led the I-SPY TRIALS, a ground-breaking national public-private collaboration among NCI, FDA, more than 20 cancer research centers, and major pharma and biotech companies. This trial model, which has now become an international model for translational research, is designed to shave several years and tens of millions of dollars off the drug development process. The trial paradigm is now being developed for use in other disease domains.
Additionally, Dr. Esserman led the creation of the University of California-wide Athena Breast Health Network, a learning system designed to integrate clinical care and research as it follows 150,000 women from screening through treatment and outcomes. As part of the network, she has spearheaded the development of the WISDOM study to learn how to improve breast cancer screening by testing and comparing the safety and efficacy of a personalized screening strategy informed by each woman’s breast cancer risk and preferences against the standard of annual screening.
Dr. Esserman has published more than 300 articles in peer-reviewed journals, and is regularly consulted by prestigious scientific, business, and consumer media including The New York Times, Wall Street Journal, Los Angeles Times, Health Magazine, Prevention Magazine, The Newshour, ABC World News, the NBC Nightly News, the CBS Evening News, and NPR’s Science Friday.
She was included as one of TIME Magazine’s 100 Most Influential People of 2016, and she also received the 2018 Giant of Cancer Care® in Cancer Diagnostics award.
BCRF Investigator Since
The Ann Taylor and Loft Award (a subsidiary of ascena retail group inc.)