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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 characterize the immune microenvironment of tumors to identify strategies to improve outcomes for breast cancer patients.
Impact: Dr. Esserman is characterizing the immune cells surrounding breast tumors to help determine those patients that are most likely to respond to immunotherapy. She will expand her studies to examine those cells in women of African descent — who develop very aggressive breast cancers and at a younger age — to improve the outcome of immunotherapy for these patients.
What’s next: Dr. Esserman has developed new technologies to characterize several biomarkers of immune response. She and her team will now examine those biomarkers in women of African descent to determine those likely to respond to immunotherapy with immune checkpoint inhibitors.
Immunotherapy is a promising treatment for breast cancer, but currently few patients benefit from it. Biomarkers are needed to identify patients early in the course of therapy, who are not responsive to the treatment. Dr. Esserman has developed techniques to examine 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 will not benefit from immunotherapy.
Full Research Summary
Research area: Utilizing biomarkers, which have been found to identify immune cells in the tumor microenvironment, to determine the response of patients to immunotherapy.
Impact: Identifying those patients that would be responsive to immunotherapy would help inform treatment decisions to achieve the best possible outcome for patients while avoiding unnecessary toxic side effects. Dr. Esserman has developed new technologies to monitor—and potentially predict—response to immunotherapies including a special imaging technology. Since there are relatively few studies that describe the tumor biology of breast cancer in African women, Dr. Esserman will utilize these technologies to analyze the immunological features of breast cancers in this population. She and her team hope to improve our understanding of the immune composition of the aggressive tumors found in women of African descent which will help craft more effective, targeted interventions to treat these patients.
Current investigation: Utilizing previously developed techniques to identify and characterize the immunological features of breast cancers from women of African descent to help guide targeted interventions to improve outcomes for these patients.
What she’s learned so far: Dr. Esserman has developed procedures for staining breast cancer tissue to define the immune microenvironment of tumors — specifically, these procedures help identify the presence and spatial proximity of immune cells to tumor cells. Her studies have resulted in the identification of specific biomarkers for various immune cells. Moreover, the team has demonstrated that the number of immune cells (particularly T cells) and their proximity to tumor cells was 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 of an excellent response to immunotherapy. Their work has also shown that while local immunotherapy of ductal carcinoma in situ (DCIS) resulted in an expansion of immune cells within the DCIS, this did not result in reduced tumor size or cell killing – suggesting that there are other factors that play a role in suppressing anti-tumor immune activity.
What’s next: In the coming year, Dr. Esserman will apply her biomarker findings (multiplex immunofluorescence biomarker panels) to determine their predictive potential for women of African descent. In collaboration with fellow BCRF investigator, Dr. Funmi Olopade, her team will characterize the immune infiltrates of tumors from Nigerian women using these biomarkers. In addition, they will compare the resulting data from Nigerian breast cancer patients with that obtained from African American women with high risk early stage breast cancer, available from the I-SPY clinical trials. The highly characterized tumors from the I-SPY clinical trials and the Nigerian cohort assembled by Dr. Olopade will provide a unique opportunity for insight into the biology of tumors that arise in African and African American women.
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