Stuart J. Schnitt, MD
Chief of Breast Oncologic Pathology,
Dana Farber/Brigham and Women’s Cancer Center
Associate Director, Breast Oncology Program,
Dana-Farber Cancer Institute/ Brigham and Women’s Hospital
Professor of Pathology, Harvard Medical School
Determining which patients with early-stage, BRCA-driven breast cancer respond best to chemotherapy.
The BRCA1 and BRCA2 genes are the most commonly affected genes in hereditary breast and ovarian cancers. Normally, BRCA 1 and BRCA2 function to ensure the proper repair of DNA damage, but mutations in these genes lead to rapid accumulation of DNA errors, which is the underlying cause of cancer. However, this defect also makes BRCA-mutated cells vulnerable to treatments that cause DNA damage. Cisplatin, a chemotherapy agent not typically used to treat breast cancer, had demonstrated good activity in BRCA mutation carriers with breast cancer and in some women with triple-negative breast cancer (TNBC). Recently, Drs. Tung and Schnitt completed the INFORM trial, which showed that while cisplatin is an active agent in BRCA mutation carriers with breast cancer, it was not more effective than the standard chemotherapy regimen. Drs. Schnitt and Tung are evaluating why some breast cancers respond to chemotherapy, including platinum chemotherapy, and other breast cancers do not.
As part of the INFORM clinical trial, clinicians collected valuable biopsies as well as tumor and blood samples. Drs. Schnitt and Tung are now analyzing the samples to determine biomarkers that are predictors of chemotherapy and/or cisplatin response and resistance in BRCA mutation carriers with breast cancer. Although this work is being conducted in breast cancers that developed in women with inherited BRCA1 and BRCA2 mutations, the results will also help to understand the behavior of breast cancers in women without these inherited mutations, including patients with TNBC and estrogen receptor-positive breast cancer.
In the upcoming year, Drs. Schnitt and Tung will proceed with analysis of the tumor and blood samples collected as part of the INFORM trial. The samples provide a unique and valuable cohort to assess the molecular landscape of hereditary breast cancers and to find biomarkers of tumor proliferation and of response and resistance to chemotherapy. This will be the largest cohort of breast cancers from BRCA mutation carriers to undergo such extensive molecular analyses. In addition, the team also plans to use artificial intelligence to analyze tumor samples. Using these images, they are working to develop an algorithm to identify those patients likely to respond well to treatments.
Stuart J. Schnitt, M.D. is the Chief of Breast Oncologic Pathology for the Dana-Farber/Brigham and Women’s Cancer Center, Associate Director of the Dana-Farber Cancer Institute/Brigham and Women’s Hospital Breast Oncology Program, co-leader of the Dana Farber Harvard Cancer Center Breast Program, Senior Pathologist at Brigham and Women’s Hospital, a Professor of Pathology at Harvard Medical School and an internationally recognized expert in breast pathology.
Dr. Schnitt did his internship and residency in Anatomic and Clinical Pathology at Beth Israel Hospital in Boston followed by a fellowship in surgical pathology, also at Beth Israel Hospital. He was a faculty member in the Beth Israel Hospital/Beth Israel Deaconess Medical Center Department of Pathology from 1984-2017, including 11 years as Director of Anatomic Pathology and subsequently Vice Chair for Anatomic Pathology. He has published over 350 original articles, review articles, editorials, commentaries, and book chapters, primarily in the area of breast diseases. He has authored a popular breast pathology textbook entitled “Biopsy Interpretation of the Breast”, now its third edition. The first two editions of this book were also published in Chinese. In addition, he is one of the editors of the 4th and 5th Editions of the “World Health Organization Classification of Tumours of the Breast”, published in 2012 and 2019, respectively.
Dr. Schnitt is a Past President of the United States and Canadian Academy of Pathology (2010-2011). Other notable honors include the Arthur Purdy Stout Society of Surgical Pathologists Annual Prize (1999), the Albany Medical College Distinguished Alumnus Award (2014), the Lynn Sage Distinguished Lecturer (2014), the Maude Abbot Lecture at the United States and Canadian Academy of Pathology Annual Meeting (2016), the United States and Canadian Academy of Pathology F.K. Mostofi Distinguished Service Award (2018), the United States and Canadian Academy of Pathology Harvey Goldman Teaching Award (2019), and the International Society of Breast Pathology-Breast Cancer Research Foundation Larry Norton, MD Award (2019). He is particularly proud to have been involved in the training of 39 breast pathology fellows since 1995. He has lectured extensively around the world. His research interests and contributions to our understanding of benign breast diseases and breast cancer have been broad, but have largely focused on risk factors for local recurrence in patients with invasive breast cancer and ductal carcinoma in situ treated with breast conserving therapy, benign breast disease and breast cancer risk, and stromal-epithelial interactions in breast tumor progression.
The Joan Lunden Award
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