Published on January 4, 2018
In December, I headed south to San Antonio to attend the San Antonio Breast Cancer Symposium. The conference, which has been going on for 40 years, is set up to provide the latest and greatest information on experimental biology, etiology, prevention, diagnosis and therapy of breast cancer. While the messaging is directed primarily towards physicians and researchers, I attended as a patient advocate through the Alamo Scholarship program and representing YSC RISE advocates. I’ve been to these types of conferences before, but this was my first time at this conference. I’ll be honest, even with my advocacy experience and training it was a bit overwhelming. There’s roughly 8,000 people in attendance, and information was flowing rapidly through plenary sessions, breakout sessions and posters. Luckily, the advocacy program offers a mentor session at the end of each day in which some of the physicians and researchers share some of their key takeaways to help break down the complexity of the conversations.
By attending as a part of the scholarship program meant that much of my time was already allocated to specific sessions designed just for advocates. We started the week off getting to know each other—I believe there were almost 50 advocates from around the world with a variety of advocacy experience. It was great to hear everyone’s experiences and backgrounds. NBCC also provided an opportunity for the advocates to hear from two great researchers on their work with metastatic breast cancer—Dr. Alana Welm and Dr. Cyrus Ghajar. These two are clearly making progress in understanding how and why breast cancer metastasizes, but there is still work to be done.
In the middle of the week, I attended a session on molecular biology where several researchers reported on topics like drug development and big data. I’ll admit this session was tough to tackle and keep focused since this isn’t my expertise. However, I’m fascinated by these topics, so I accepted the challenge to step outside of my comfort zone. Here’s a synopsis of what they talked about:
Markus Warmuth, MD from H3 Biomedicine in Cambridge, Massachusetts presented on how we go about targeting drug discovery. He began by giving us his perspective on the “ingredients” for success as well as reviewing challenges. For successes, the target selected must be valid and impactful. Secondly, we must understand the right way to modulate while making sure the targets are not essential for an important pathway. Another key ingredient is the target must be in a patient population and measurable in humans. And finally, it must allow for enrichment strategy. The challenges or “opportunities” are that the cancer genomes are complex, and it’s important to find ways to synthesize. Warmuth concluded with reiterating that target validation is a process that moves at all stages of drug development and goes beyond the lab. Our ability to change outcomes will depend on innovation and target modulation.
Mia Levy, MD, PhD, from Vanderbilt University Medical Center talked about the Era of Precision Medicine and Big Data: how clinical decisions can be improved. She referenced the “tsunami of genomic data” not only in the labs but in the clinical setting as well and trying to incorporate how to treat breast cancer patients. Levy looks at the different tools that we currently have and how to make the best decision while also addressing the challenges. To break this complex subject down, Levy gave a real-world example of looking at a car such as a Tesla where everything is built in (navigation, apps, music, etc.) versus an average car where you can bring your own tools like your phone and plug it in to/linking to your car to get the same kind of technology. Bottom line, even with technology we still struggle with making the decisions needed for our own health.
There were so many topics to choose from but since I was diagnosed at 35 with ER+, HER2+, BRCA2+ breast cancer, I was also interested in the discussion on adjuvant treatment of premenopausal ER+ breast cancer. Dr. Prudence A. Francis from the Peter MacCallum Cancer Centre in Melbourne, Australia talked about these questions:
1) Who needs chemo and have multigene assays resolved this question already?
While multigene assays can play a role in resolving the question of chemo or not, there have been limited outcomes data (trials TAILORx & MINDACT) for young women with a low-risk assay score and adjuvant tamoxifen (Nolvadex or Soltamox) alone. The conclusion is we’re still learning about how this can affect young women.
2) What about safety of a GnRH agonist with chemo? Can this help women who are considering pregnancy?
Fertility considerations for women undergoing chemo should have a fertility consultation and possibly start a GnRHa one week prior to chemo. Trials that relate to fertility and chemo are POEMS, TEXT and SOFT. The POSITIVE trial is also looking at interrupting adjuvant endocrine therapy to attempt pregnancy. Conclusion is to consider fertility consultation regardless if chemo is planned and before endocrine therapy is started.
3) How is ER+ defined?
ASCO guidelines that that if 1 percent cells stain positive for ER and/or PR, then hormone therapy should be administered. Reasons that endocrine therapy is given is because it reduces local recurrence (especially if the woman wants to conserve the breast), reduces regional recurrence and distant metastases, and reduces risk of a new contralateral breast cancer.
4) Does ovarian function suppression improve outcomes?
For women taking tamoxifen for 5 years, her 15-year breast cancer mortality is reduced. Risks are better in younger women.
5) Are aromatase inhibitors better than tamoxifen (Nolvadex) if combined with Ovarian Function Suppression (OFS)?
Several different therapies such as tamoxifen, chemo and ovarian ablation have been effective for women under 50. However, ovarian ablation is less certain. In several studies done around the world, it was confirmed that women under 35, ER+ do have a higher risk of recurrence. Women who develop amenorrhea have a reduced risk. The question whether ttamoxifen works in younger women has been proven to be effective and ovarian ablation shows uncertainty in women under 40. While the SOFT trial primary analysis that there was not significant advantage for adding ovarian suppression for premenopausal women, although the median age was 46.
As an advocate, this is a challenging week no matter how much experience you have. The San Antonio Breast Cancer Symposium is overwhelming there’s no getting around that but if you keep coming back each year, it gets easier. My key takeaways and advice for attending this conference or any conference for that matter, can be broken down into three parts. First, there’s are always more topics and areas to focus on than one person can handle so pick what’s important to you and try not to let the other stuff distract you. Secondly, remember that we bring our own skills to the table and each advocate can use their skills to help make a difference. It’s okay that you might not understand everything that’s being said in the sessions. I had a doctor tell me once that if she wanted another scientist, then she would have asked for one, but she wanted an advocate, someone who can have a voice for all patients. I remember that statement every time I feel overwhelmed with the content of the sessions. And finally, use these conferences to meet not just researchers and clinicians but other advocates. We can all learn from each other to be better advocates. Take time to introduce yourself to someone new—whether it be a researcher or another advocate. You never know how you can help each other.
At the starting line, running through life one race at a time,
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