Prudence Francis, MBBS, B Med Sc, FRACP, MD
Head of Medical Oncology, Breast Service
Peter MacCallum Cancer Centre
Medical Oncologist, St. Vincent’s Hospital Melbourne
Improving risk and prognostic assessments for breast cancer.
Analysis of biobanked samples—blood, tissue, and clinical data from consenting patients—is a critical component of all cancer research. Mountains of data can be gleaned from these samples, whether it’s looking for patterns that can predict breast cancer risk or maximizing the amount of information gathered from a clinical trial. The IBIS Prevention trials, led by Dr. Francis’ colleague Dr. Cuzick and retired colleague Dr. John Forbes, began in 1992 and continue to be the definitive studies on the use of tamoxifen and anastrozole in patients with a high risk of developing breast cancer. Today, Drs. Francis and Cuzick’s studies help guide the most appropriate screening and preventative strategies for individuals based on better estimates of their breast cancer risk.
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. The High-Risk Breast Cancer Biobank (HRBCBB) was established as a repository for specimens from the IBIS trials to better understand who is at high risk of breast cancer, who will respond to treatment, and who is most likely to experience treatment-related side effects. Using the material collected in the HRBCBB, the team carried out the first biomarker studies in a ductal carcinoma in situ (DCIS) randomized trial evaluating the prognostic role of the breast cancer genes estrogen receptor (ER) and HER2. They confirmed the prognostic role of ER and HER2 in DCIS—i.e., they are markers that can help stratify patients as either high or low risk of recurrence. Furthermore, they found that HER2 also predicted radiotherapy benefit, thereby helping in treatment decisions.
Ongoing analyses by the team include studying the IBIS-II prevention trial to see if a patient’s natural hormone levels affect the performance of preventative therapies in high-risk individuals. They also are examining the role of mutations for more than 100 genes in cancer tissues in the TransATAC chort. In addition, the team will collaborate with researchers around the world to collect data from several ongoing therapeutic trials. The EXPERT clinical trial is a radiation oncology “equivalent” of the TAILORx trial—utilizing a multigene assay to see if radiation therapy can be safely de-escalated in the context of adjuvant endocrine therapy. Correlative studies using biobanked clinical samples from immunotherapy trials such as DIAmOND, and Neo-N, led by BCRF investigator Sherene Loi, provide opportunities to tailor immunotherapy to those patients most likely to benefit.
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.
The Delta Air Lines Award
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