Penn faculty, physician scientists and medical trainees frequently contribute to research in the fields of medical and surgical oncology. Both Penn and the Abramson Cancer Center have created a culture deeply rooted in research, academic medicine, clinical introspection and interaction.
As Breast Cancer Awareness Month draw to a close, we've organized recent breast cancer articles and studies originating from Penn.
TailorX Trial – Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer
Penn Medicine researchers Daniel Haller, MD, and Robert Burger, MD, took part in the landmark Trial Assigning Individualized Options for Treatment (Rx) (TAILORx). A large international study, TAILORx sought to determine the necessity of adjunct chemotherapy in the treatment of women with early stage HR-positive, HER2-negative, axillary lymph node-negative breast cancer—the most common form of the disease. After assigning low, intermediate and high risk of recurrence scores to more than 10,000 women, the study found that chemotherapy was not beneficial for about 85% of women older than 50 with low-to-moderate risk of recurrence and all women younger than 40 in the low-risk group.
The findings of TAILORx were presented at ASCO 2018, and were featured in an interactive online webinar from Penn Medicine shortly thereafter hosted by Angela DiMichele, MD, Co-Leader of the Breast Cancer Research Program at the Rena Rowan Breast Center of the Abramson Cancer Center, and Co-Chair of the Breast Cancer Committee of the Philadelphia-based ECOG-ACRIN Cancer Research Group, which coordinated the study.
Overall Survival is Similar Between Women Who Seek Care at One or More Institutions After Diagnosis of Operable Breast Cancer in the Community
Are the characteristics and outcomes of women treated for operable breast cancer in the community unlike those of women treated elsewhere? To find out, Julia Tchou, MD, Austin Williams, MD, MSEd, and Alycia So, MD of Penn Surgery examined a cohort of 162,803 women with operable breast cancer (stages I-III) from the more than 1,500 Commission on Cancer accredited facilities curated in the National Cancer Database (NCDB). Dr. Tchou leads a laboratory within Penn Surgery currently investigating the construction of a CAR-T cell specific for c-Met, which has halted tumor growth in immune-incompetent mice with tumor xenografts.
In the study, demographics, cancer-specific characteristics and overall survival differences between patients who stayed at their home institutions or left for breast cancer treatment elsewhere were compared. Among the findings of the authors report: although women who left the community setting for treatment elsewhere had more advanced disease on average, and were more likely to have private insurance, higher education levels, and a variety of characteristics favorable to survival (including younger age, fewer additional illnesses and breast cancer subtypes more amenable to treatment), their overall survival was similar to women who remained in the community for care.
BRCA Founder Outreach (BFOR) Study
Internationally recognized cancer experts Susan Domchek, MD, and Katherine Nathanson, MD, of the Basser Center for BRCA at Penn Medicine, are working in collaboration with thought leaders in the fields of cancer research and genetics in New York, Los Angeles and Boston to launch the pilot phase of a new, independent research initiative: the BRCA Founder Outreach (BFOR) Study.
BFOR offers BRCA genetic testing at no cost to women and men over the age of 25 of Ashkenazi (Eastern European) Jewish ancestry, who comprise approximately 95% of the American Jewish community. Ashkenazi Jews have a risk for heritable BRCA mutations up to ten times that of the general population. To receive the free BRCA test, BFOR participants provide a blood sample to the BRCA from a laboratory in their community. They then elect to receive their test results through their primary care physician or through a BFOR genetic counselor. Follow-up genetic counseling and/or additional genetic testing may be recommended based on the participant’s test results and family history.
Immunotherapy for Breast Cancer is Finally at the Doorstep: Immunotherapy in Breast Cancer
Recently, a deeper understanding of the underlying biology of breast cancer and the availability of newer agents has brought about a shift in the approach to immunotherapy for breast cancer, and a consequent improvement in outlook. Lucy De La Cruz, MD, a surgical oncologist at Penn Medicine, reviewed the latest advances in breast cancer immunotherapy for the Annals of Surgical Oncology.
Among Dr. De La Cruz’s conclusions: The promise of immunotherapy has been realized as the fourth major therapy in cancer therapy for several solid tumors including lung, bladder, colon cancer, and melanoma. In fact, recent clinical trials suggest that immune-based therapies have now crossed a critical threshold for some women with breast cancer, particularly those with triple negative breast cancer (TNBC) and HER2-positive breast cancer (HER2+BC).
Dr. De La Cruz specializes in surgery for benign and malignant disorders of the breast at Penn. She has authored or co-authored recent articles on the role of Th1 cytokines in breast cancer therapy and prevention and the impact of neoadjuvant chemotherapy on breast cancer subtypes, among other key areas of interest.