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Prudence Francis, MBBS, B Med Sc, FRACP, MD
Head of Medical Oncology, Breast Service
University of Melbourne
Goal: To identify protein and gene biomarkers that will improve risk assessment in women at high risk of developing breast cancer.
Impact: Drs. Francis and Cuzick are expanding their high-risk breast cancer biobank, which is a collection of blood and tissue samples, mammograms, and clinical data from women enrolled in breast cancer prevention and treatment trials. This resource will help them determine which types of breast cancer will respond to different kinds of preventive treatment.
What’s next: The team will collaborate with researchers around the world to collect samples and data from women taking part in several ongoing trials.
While large randomized clinical trials may provide clues for predicting response to therapy or late recurrence, the results don’t apply to every participant because individual responses are influenced by the patient’s and the tumor’s unique genetic profile. By gathering samples and data from women enrolled in clinical trials, Drs. Francis and Cuzick hope to identify biomarkers that will help them understand why some patients respond to therapy and others do not, and to identify patients at high risk of recurrence.
Full Research Summary
Research area: Seeking to improve breast cancer risk assessment in high-risk women by identifying protein and gene biomarkers.
Impact: Prevention research is a long-term game because it takes many years of follow-up to get a clear picture of the value of preventive therapy. This includes not only information on efficacy and side-effects, but also identifying biomarkers for predicting risk and response to treatment. The IBIS Prevention trials led by Dr. Cuzick continue to be the definitive studies on the preventive use of tamoxifen and the aromatase inhibitor anastrozole in women with a high risk of developing breast cancer. The High-Risk Breast Biobank (HRBCBB) was established as a repository for specimens from the IBIS trials with the goal to better understand who is at high risk of breast cancer, who will respond to endocrine (anti-estrogen) treatment—with a special interest in differential response to tamoxifen or aromatase inhibitor (anastrozole for these trials), and who is most likely to experience treatment-related side effects.
Current investigation: The team is expanding their High-Risk Breast Cancer Biobank (HRBCBB), which includes blood, tumor tissue, and mammograms, as well as clinical outcome data and long-term follow-up of individual women in prevention and treatment trials.
What they’ve learned so far: In the last year, Drs. Francis and Cuzick published results from IBIS II, a randomized, double-blind trial investigating the benefit of long-term anastrozole for the prevention of breast cancer in high-risk women. With a median follow up of five years, anastrozole significantly reduced breast cancer incidence, both invasive ductal carcinoma and ductal carcinoma in situ. These results were published in the journal, Lancet. They continue to follow patients to determine the impact of anastrozole on mortality.
What’s next: As new trials such as EXPERT, CHARIOT and DIAmOND are conducted and a new cohort study PRIMROSE is set up, biospecimens from participants in these investigations will be collected and added to the HRBCBB, further expanding this resource for future translational research.
Prue Francis is Clinical Head of Breast Medical Oncology at Peter MacCallum Cancer Centre in Melbourne, Australia. She received her medical degree from the University of Melbourne and completed Medical Oncology training at Memorial Sloan-Kettering Cancer Center in New York, where she spent 4 years. Since returning to Australia she focused her research on breast cancer randomized clinical trials (i.e. BIG 2-98, SOFT) with prospective tissue collection to facilitate translational research. She chairs the Steering Committee for the SOFT and TEXT trials which have led to changes in adjuvant endocrine therapy recommendations for young women with hormone receptor-positive breast cancer.
Dr Francis is Chair of the Scientific Advisory Committee of Breast Cancer Trials Australia & New Zealand (BCT-ANZ) which has been conducting clinical trials since 1978. The multidisciplinary group has enrolled more than 15,000 women in national and international clinical trials across the disease spectrum from breast cancer prevention, DCIS, early stage disease, and neoadjuvant therapy, through to advanced breast cancer trials. The group trials variously involve escalation or de-escalation strategies, with an emphasis on biobanking, and quality of life assessment.
Dr Francis is a member of the St. Gallen International Expert Consensus Panel on the Primary Therapy of Early Breast Cancer, and the Advanced Breast Cancer (ABC) International Consensus Panel. She is a member of the Scientific Committee of the International Breast Cancer Study Group (IBCSG) and a member of the Breast International Group (BIG). In 2015 she was awarded the Medical Oncology Group of Australia Cancer Achievement Award.