Monica Bertagnolli, MD
President, Alliance for Clinical Trials in Oncology
Chief, Division of Surgical Oncology
Dana-Farber Cancer Institute/Harvard Medical School
Brigham and Women's Hospital
To discover biomarkers that can help identify breast cancer patients who are most likely to respond to therapy or who are at risk for experiencing side effects.
In the years following a breast cancer diagnosis, patients experience several health concerns including side effects from cancer treatment, along with an increased risk of developing comorbidities, second cancers, and metastatic cancer recurrence. Lifestyle factors such as obesity may impact each of these risks as well as the increased risk of cardiovascular disease (CVD); breast cancer survivors have an 80 percent higher risk of mortality from CVD compared to age-matched controls. Emerging evidence suggests that Clonal Hematopoiesis of Indeterminate Potential (CHIP), an asymptomatic condition in which otherwise healthy individuals harbor mutations in genes commonly altered in blood cancers, also contributes to risk of CVD. Although aging is the strongest risk factor, CHIP occurs in patients treated for cancer at a significantly higher rate than in the general population. Dr. Bertagnolli is examining the interplay between obesity, CHIP, and adverse cardiovascular outcomes since this association remains unclear. Her team will conduct a prospective study using the data obtained from a large randomized controlled trial, Breast Cancer Weight Loss Trial (BWEL), conducted as part of the Alliance Clinical Trials in Oncology (NCT02750826). This work will help to identify patients with a high risk of poor outcomes, define strategies to reduce the prevalence of CHIP or the cardiovascular risk associated with CHIP, and demonstrate which patients may be most likely to benefit from lifestyle intervention as a part of their breast cancer management.
The BWEL study is a unique compilation of rigorously annotated clinical data; including patient disease, treatment characteristics, cancer, and non-cancer outcomes, as well as serial weight, diet, and physical activity information. Analyzing the data from BWEL, Dr. Bertagnolli and her colleagues are primed to answer three key questions: what is the relationship between obesity and CHIP in patients treated for breast cancer; how do obesity and CHIP influence CVD outcomes after treatment; and what is the impact of lifestyle interventions (such as weight loss) on the incidence of CHIP or on the relationship between CHIP and CVD risk?
Dr. Bertagnolli is a Professor of Surgery at Harvard University Medical School, and an Associate Surgeon at Dana Farber Cancer Institute and Brigham and Women’s Hospital . She is presently the Chief of the Division of Surgical Oncology at Dana Farber/Brigham and Women’s Cancer Center. She is also a member of the Gastrointestinal Cancer and Sarcoma Disease Centers at DF/BWCC, where she collaborates with colleagues in medical oncology, radiation oncology, and pathology to treat cancer patients in a tertiary care setting.
Dr. Bertagnolli maintains an active research laboratory focused on understanding the role of the inflammatory response in epithelial tumor formation. In 1999, she extended her basic laboratory observations to the clinical trials setting as the lead Principal Investigator of the Adenoma Prevention with Celecoxib Trial. This pivotal study, reported in 2006, demonstrated dramatic suppression of colorectal adenomas with selective cyclooxygenase-2 inhibition, but also uncovered unanticipated cardiovascular toxicity with these agents. Dr. Bertagnolli was an organizing member of gastrointestinal correlative science initiatives within the NCI-funded Cancer Cooperative Groups, where she facilitated integration of tumor-specific molecular markers of treatment outcome into nation-wide clinical cancer treatment protocols. She has had numerous leadership roles in multi-institutional cancer clinical research consortia, and from 2010-2011 served as Group Chair of Cancer and Leukemia Group B (CALGB). Dr. Bertagnolli was elected in July 2011 to lead the Alliance for Clinical Trials in Oncology, a new NCI-funded cooperative group formed by merger of CALGB, the North Central Cancer Treatment Group, and the American College of Surgeons Oncology Group. For her outstanding achievements, she was elected to the National Academy of Medicine in 2021.
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