Professor of Laboratory Medicine
Angela and Shu Kai Chan Endowed Chair in Cancer Research
Leader, Breast Oncology Program
Director, Applied Genomics
University of California
San Francisco, California
Seeking biomarkers of response that can be used to adjust treatment for an individual patient when drugs are not working.
Studies are ongoing to apply newly identified biomarkers of response in a “monitor and respond" approach.
These studies could identify "non-responders" early, allowing for adjustments to therapy and improve outcome for these patients.
Neoadjuvant chemotherapy (NAC), or chemotherapy prior to surgery, allows physicians to assess the effect of the drug and can reduce tumor size, allowing for breast conserving surgery. Women with aggressive disease who respond well to NAC have a much better prognosis than those who do not.
Early predictors of non-response will provide clinicians with insight into the likelihood that a patient's current therapy will minimize her risk of relapse and death, and may serve as a basis for deciding to switch to a more effective treatment.
Over the last few years, Dr. van ‘t Veer’s team has developed biomarkers using data from pre-treatment tumor biopsies to predict response to a variety of therapeutics tested in the I-SPY 2 trial, and analyzed changes in tumor genes and molecular pathway during therapy.
The idea is that characterizing residual disease and its emerging dynamics in non-responding patients may increase understanding of why some patients did not respond to the chemo- or targeted-therapy, and what alternative treatments might have been more effective. They will next test this strategy in a new I-SPY2+ trial in which they plan to monitor response and adapt treatment to the individual.
Results from this study may shape the treatment switching strategy for non-responding patients and bring biomarker-optimized, real-time adaptive treatment to individual patients on a large scale, and ultimately, improve survival rates.
Dr. van ’t Veer is a renowned molecular biologist, Principal Investigator of the Athena Breast Health Network at UCSF and Leader of the Breast Oncology Program in the Helen Diller Family Comprehensive Cancer Center. She is the former Head of Diagnostic Oncology at the Netherlands Cancer Institute, and inventor of MammaPrint. Dr. van ’t Veer’s research focuses on personalized medicine, and aims to advance patient management based on knowledge of the genetic makeup of the tumor as well as the genetic makeup of the patient. This allows physicians to optimally assign systemic therapy for those patients that are in need of such treatment and to ensure the selection of the therapy that is most effective. She is the chair of the Biomolecular Committee of the I-SPY 2 trial ensuring CLIA compliant companion diagnostics. Dr. van ’t Veer’s research shows that molecular diagnostics and microarray genomics technology increasingly impact patient management. Molecular genomics contributes to the knowledge of who is at risk for breast cancer, how external factors may influence this risk, whether breast tumors are likely to metastasize or not, and which subtype of tumors will likely respond to what therapy.