Titles and Affiliations
Director Breast Care Center
Professor of Surgery & Radiology
Department of Surgery
Research area
Understanding the immune system’s role in the progression and treatment of breast cancer and ductal carcinoma in situ (DCIS).
Impact
Our immune system is comprised of a variety of cell types, each with specific functions. One of these, called a B-cell, creates antibodies that can bind to foreign substances such as toxins to neutralize them. Occasionally a B-cell will produce antibodies called autoantibodies (AAbs) that bind to our own cells or proteins and are often associated with autoimmune diseases. Their influence on breast cancer treatment response, however, remains largely unexplored. Dr. Esserman and her colleagues are clarifying the role of the immune system in the development and treatment of DCIS and invasive breast cancer. Their research aims to identify specific profiles of AAbs associated with response to treatment. Their results may offer novel approaches to enhance treatment outcomes and ultimately uncover novel targets for antibody directed therapies or cancer vaccines.
Progress So Far
Dr. Esserman and her team found that among women with high-grade DCIS who were treated with an immune-boosting therapy injected directly into the breast lesion, responses ranged from complete disappearance of the DCIS to no change at all. They also observed that women who responded well had higher numbers of a specific immune cell within the DCIS lesion, as well as higher levels of AAbs circulating in the blood, suggesting AAbs may help eradicate tumor cells and/or serve as a marker to predict who is most likely to benefit from this kind of treatment.
What’s next
Building on these results, Dr. Esserman and her team are expanding their approach to test two new immune-activating treatments delivered directly into the breast lesion in high-risk DCIS. Because standard immunotherapy given intravenously can cause significant side effects, this local delivery method is designed to be safer and reduce side effects. Patients will also receive an immune checkpoint inhibitor, a treatment that helps release the immune system’s natural brakes against cancer. Using advanced imaging and blood-based technologies, the team will study tissue and blood samples collected before and after treatment to determine exactly where immune cells are located within the tumor, how active they are, and whether specific markers, including AAbs, are linked to better outcomes. The goal is to build a detailed picture of how the immune system responds to these new treatments to guide future therapies that treat DCIS or prevent it from progressing to invasive breast cancer while minimizing side effects.
“We have the opportunity to continue testing new immune strategies, and by better understanding what drives success, we may be able to have a simple local injection that eradicates high risk very early-stage cancers, and, in the future, advance these approaches to the setting of high grade immune driven invasive cancers.”
Biography
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.
