Laura J. Esserman, MD, MBA
San Francisco, California
Director, Carol Franc Buck Breast Care Center
Professor of Surgery and Radiology
Clinical Program Leader, Breast Oncology Program
Alfred A. de Lorimier Endowed Chair in General Surgery
UCSF Helen Diller Family Comprehensive Cancer Center
To characterize the tumor microenvironment to identify strategies to improve outcomes for breast cancer patients.
Immunotherapy is a promising treatment for breast cancer, but currently few patients benefit from it. 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 and her team 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. However, their work has also shown that other immune factors play a role in suppressing anti-tumor immune activity. In her current BCRF research, Dr. Esserman is utilizing novel imaging technologies to analyze the immune cell composition of the aggressive tumors found in women of African descent. Results from this work will inform more effective, targeted interventions to treat these patients.
Prior work has demonstrated that by understanding which immune cells are in the tumor neighborhood and how close they are to each other can predict how well tumors will respond to immunotherapy. Therefore, Dr. Esserman’s team has developed new protocols to better identify the immune components in a tumor sample. In collaboration with fellow BCRF investigator, Dr. Funmi Olopade, Dr. Esserman used her immune biomarker panel developed with BCRF support to analyze the immune microenvironment of breast tumor tissue samples from 144 African and African American women. They found distinct differences in the immune microenvironment in tumors from Black women compared to tumors from white women, though there were no differences by race in the level of PD-1 and PD-L1 molecules, which are used to predict response to immune checkpoint immunotherapy.
In the coming year, Dr. Esserman and her colleagues will expand their cohort of Black women drawing on enrollment in 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, and the racial disparities that exist—this has the potential to increase our understanding of the spectrum of disease and the types of interventions that might improve outcomes for these women.
If it were not for BCRF, we would not have had the funding to pursue the exploration of the tumor immune environment and the role it plays in generating response to standard chemotherapy in combination with immune checkpoint inhibitors. These insights are helping us to understand whether African and African American women have similar patterns in their tumor immune environments and how we can use these insights to personalize and optimize treatment. - Dr. Esserman
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.
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