Our impact: Breast Cancer

Our Breast Cancer theme aims to identify new ways to predict outcomes for individual patients and develop new targeted treatments and diagnostic methods. Our research has led to significant improvements in care and the introduction of new treatment options for breast cancer patients. 

The Institute of Cancer Research, London (ICR) has a world-leading reputation in the identification and characterisation of genetic factors associated with causing breast cancer, including the BRCA genes. This had led to the development of genetic tests for BRCA gene mutations in partnership with biotechnology company Illumina, and new, targeted drugs such as olaparib.

Since 2016 the Theme has benefitted from a new research facility, the Ralph Lauren Centre for Breast Cancer Research, led by Prof Nick Turner, which is leading the way in the discovery of molecular differences between tumours to optimise how individual patients are treated. 

Molecular Profiling tests

A key aim of the Breast Cancer Theme is to identify and validate key genetic ‘markers’ that will help to guide treatment decisions by predicting how patients will respond to drugs and their risk of disease recurrence or progression.

The TransATAC database, established under the leadership of Professor Mitch Dowsett, contains 2000 samples of breast tumour tissue collected from post-menopausal breast cancer patients taking part in the ATAC (LATTE) trial.

The samples in this database were used to validate tests that look for genetic ‘markers that can predict how patients will respond to treatment with hormone therapy and the risk of their cancer recurrence.

The National Institute for Health and Care Excellence (NICE) used the database as part of their on-going assessment into tumour-profiling tests, resulting in the publication of new guidance in December 2018 which approved the use of new and more accurate tests to determine the best course of treatment for individual patients.

Development of clinical calculator

In collaboration with Queen Mary University London, research led by Dr Juliet Richman at The Royal Marsden NHS Foundation Trust has confirmed that a web-based calculator algorithm, called clinical treatment score 5 (CTS5), can predict risk of recurrence in hormone-positive breast cancer patients. Those identified as having a low risk of recurrence could then be spared an additional 5 years of hormone therapy, which researchers believe could have a huge impact both physiologically and physically.

HeartSpare-IA - changing the standard of care

Dr Anna Kirby led the HeartSpare IA study, a series of three clinical trials, which demonstrated that a voluntary breath-hold technique was more effective at sparing the heart from radiotherapy than the free-breathing technique commonly used. This heart-sparing radiotherapy technique has now been adopted as a standard of care across many UK hospitals, with the aim of reducing cardiac side-effects of radiotherapy.

NICE approval of new breast cancer drug

In 2016, EMA and FDA approved the use of the targeted drug palbociclib in combination with fulvestrant, for women with advanced breast cancer, based on the Phase III trial, PALOMA3. This trial, which was led by Professor Nick Turner, showed that the combination of palbociclib and fulvestrant extended life in patients with hormone-positive breast cancer by seven months, compared to treatment with fulvestrant alone. In addition to slowing the progression of breast cancer, this new treatment combination can delay the need for chemotherapy, sparing patients the debilitating side effects that can occur. In November 2019, it was announced that palbociclib plus fulvestrant was approved for use on the Cancer Drugs Fund. More overall survival data from PALOMA-3 will be available in future and this data could be used to support a future recommendation for routine NHS use. 

Guidelines for managing breast cancer patients in the COVID-19 pandemic

During the COVID-19 pandemic surgery for estrogen receptor positive (ER+) and human epidermal growth factor receptor 2 negative (HER2−) breast cancer (70% of the overall breast cancer population) is frequently being deferred in favour of neoadjuvant endocrine therapy because of patient safety concerns and resource availability. Thus there was a need for accurate identification of patients with cancers most likely to be poorly controlled by endocrine therapy so their surgery or systemic treatment could be prioritised. In order to address these issues, Professor Dowsett led a consortium that developed and published guidelines for managing these patients where clinical safety or resource issues related to the COVID-19 pandemic impact the availability of surgery.

Using a blood test to match women with breast cancer treatments

Our UK multicentre plasmaMATCH study paved the way for liquid biopsies to rapidly and routinely identify subgroups of women with metastatic breast cancer for effective targeted therapies, a step-change in delivering precision therapeutics with significant potential for other cancers.