W. Fraser Symmans, MD
Professor and Director of Research Operations, Department of Pathology
Professor of Translational Molecular Pathology
University of Texas MD Anderson Cancer Center
Developing gene-based prognostics tests to guide treatment decisions for patients with estrogen receptor-positive breast cancer.
Most breast cancers are driven by hormones, particularly estrogen. These cancers, referred to as estrogen receptor (ER)-positive, are treatable with anti-hormone (endocrine) therapies. As breast cancers progress, however, they often lose sensitivity to endocrine therapy. This is particularly true in breast cancers that have spread to other tissues—a process called metastasis. Dr. Symmans is developing a series of gene-based tests referred to as SET (Sensitivity to Endocrine Therapy) that can be used to guide treatment decisions in patients with metastatic (stage IV) or regional (stage II-III) breast cancer. This assay employs advanced technology and has the potential to allow more precise treatment decisions compared to current assays—this is vital for the clinical management and improvement of outcomes for breast cancer patients with aggressive and advanced breast cancers.
In the last year, Dr. Symmans has demonstrated that the SET2,3 test (used to predict sensitivity to endocrine therapy for Stage II or III breast cancer) is technically accurate and reliable. Moreover, the SET2,3 test adds significant additional information to current prognostic tests such as OncotypeDX® or MammaPrint®. This is most likely due to the improved measurement of endocrine sensitivity. They have also demonstrated that the SET4 test that combines measurements of gene expression signatures and gene mutation for Stage IV breast cancer is highly reproducible.
Based on promising predictive results for patients with stage II, III and IV ER-positive breast cancer, Dr. Symmans' team will determine how SET2,3 should be used to guide endocrine therapy planning. In the next year, they will build on their success with SET2,3 and focus on developing an accurate test to predict and quantitate benefit from chemotherapy. In addition, Dr. Symmans and his colleagues will determine if the duration of chemotherapy affects the sensitivity to subsequent endocrine therapy as measured by the SET assay.
Dr. Fraser Symmans is Professor and Director of Research Operations in the Department of Pathology at MD Anderson Cancer Center, where he practices Breast Surgical Pathology and Cytopathology and also directs the Breast Cancer Pharmacogenomics Laboratory. He received his medical degree from the University of Auckland, New Zealand, completed his residency at Columbia University, New York, and fellowship at MD Anderson Cancer Center, Houston. Dr. Symmans joined the faculty of New York University Medical Center in 1993 and moved to MD Anderson Cancer Center in 2000. Dr. Symmans’ research is focused on breast cancer, with specific emphasis on neoadjuvant (pre-operative) treatment trials for evaluation of chemosensitivity and development of diagnostic tests to select the most effective treatments for individuals with breast cancer. This research program has led to the development of predictive molecular tests that are currently being evaluated in a prospective clinical trial. His other ongoing research is addressing the effects of biopsy sample quality on genomic test results in order to establish appropriate best practices for clinical diagnostic use. Additional responsibilities include: Co-Chair for the Translational Breast Cancer Research Consortium, Director of Translational Research Program for the Alliance clinical trials group, and member of the Breast Cancer Steering Committee for the National Clinical Trials Group.
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