Titles and Affiliations
Director, Central Nervous System Metastasis Program
Associate Professor of Medicine
Harvard Medical School
Massachusetts General Hospital
Boston, Massachusetts
Research area
Identifying new strategies for the prevention and treatment of breast cancer that has spread to the brain.
Impact
Breast cancer that spreads to the brain occurs in more than a third of patients with advanced breast cancer. While advances in cancer therapies have improved our ability to control breast cancer outside of the brain, more breast cancer patients are dying of brain metastases. The genetic and molecular drivers of metastasis are largely unknown. The overarching objective of Dr. Brastianos’ work is to characterize the tumor and immune microenvironment of brain metastases that will shed light on their fundamental biology and to ultimately identify novel therapeutic targets. Dr. Brastianos hopes to quickly translate her team’s scientific findings to innovative clinical trials for patients with breast cancer brain metastases.
Progress Thus Far
Over the past year, Dr. Brastianos and her team made significant progress in their efforts to understand and ultimately improve treatment for patients with breast cancer that has spread to the brain. The team continued to expand a large, international collaborative network to collect and study tumor samples. This effort has resulted in one of the most extensive collections of breast cancer brain metastasis samples in the world, supported by partnerships across institutions in North America, Europe, Asia, and Australia. Using this resource, they are comprehensively analyzing a large number of tumor and blood samples using advanced single-cell technologies. Analysis revealed that immune cells inside the tumors often show signs of exhaustion, which could limit their ability to fight the cancer. Dr. Brastianos also found that tumor cells in the brain can display unique characteristics that allow them to evolve and survive in the brain’s unique environment. To build on these findings, she and her team began using a new technology platform to examine how tumor and immune cells interact on a large scale. Early results show patterns of immune activity within brain tumors that could guide future treatments.
What’s next
In the coming year, Dr. Brastianos will continue efforts to understand how breast cancer cells are able to survive and grow after spreading to the brain. She and her team will validate their findings of specific biological features in tumor cells that may help them adapt to and thrive within the brain. The team will analyze a large set of patient samples, as well as examine how these features may relate to resistance to treatment by drawing on their extensive clinical database. To support this effort, Dr. Brastianos is piloting a new platform called 10X Visium, which allows gene expression mapping across tumor tissues while preserving information about where cells are located. This will help them better understand how cancer cells interact with immune cells inside brain metastases and how those interactions may influence how tumors respond to therapy. In addition to their lab-based studies, Dr. Brastianos is bringing discoveries into the clinic. Two clinical trials based on her team’s research are currently enrolling patients. One national trial is testing targeted therapies for patients with brain metastases who have specific genetic alterations; this trial is open at more than 100 sites across the U.S. The second trial is evaluating a combination of immunotherapy and a CDK4/6 inhibitor for patients with breast cancer that has spread to the brain and spinal fluid. These studies mark exciting progress toward personalized treatment options for patients with breast cancer brain metastases.
Biography
Dr. Priscilla Brastianos is the Director of the Central Nervous System Metastasis Program at Massachusetts General Hospital of Harvard Medical School. Originally from Vancouver, British Columbia, she received her BSc in biochemistry and chemistry from the University of British Columbia, where she graduated as her class valedictorian. She completed her medical school training at Johns Hopkins School of Medicine, and her internal medicine residency training at Johns Hopkins Hospital. Following her training at Johns Hopkins, she pursued her fellowship training at the Dana-Farber Cancer Institute and Massachusetts General Hospital. As a physician-scientist, Dr. Brastianos received a number of prestigious awards for her scholarship and research.
Dr. Brastianos’ research focuses on understanding the molecular mechanisms that drive brain metastases. Her pioneering work has led to national multicenter cooperative group trials that she is leading. She also leads a multidisciplinary central nervous system metastasis clinic at Massachusetts General Hospital. Her hope is that the findings from genomic studies will provide an understanding of the molecular pathways that drive brain metastasis, which will allow the development of more rational therapeutic approaches for this common and devastating complication of cancer.
