Jane Zones, Board Member

Martine Piccart issued a call for a major “NASA-type” effort to generate tailored therapies for early breast cancer.

Piccart, a prominent Belgian breast cancer researcher who co-founded the Breast International Group (BIG) ten years ago, was this year’s honored William McGuire Memorial lecturer. McGuire, a co-founder of the San Antonio Breast Cancer Symposium, was a supporter of breast cancer advocacy, and opened the symposium to advocates and their organizations. He was a pioneer in estrogen receptor characterization, one of the first developments that allowed the possibility of targeted treatment.

Dr. Piccart’s talk was an overview of international breast cancer research and a call for massive investment to capitalize on recent developments toward eradicating metastatic disease by better tailoring therapy for early stage breast cancer. You can see her slides online at http://sabcs09.m2usa.com/sabcsdsv.html

Building on the theme of a cultural shift that has taken place in breast cancer over the years toward individualizing treatment, Piccart described a wide range of studies, mostly from the many research groups within BIG, that aim to determine the unique characteristics of individuals at the molecular level, in order to isolate which subgroups are most amenable to different treatments. The overall aim is to continue to reduce the overtreatment of patients for whom particular treatments are ineffective, and to direct treatment to those who would benefit from it.

Piccart noted that the development and validation of biomarkers (such as estrogen receptor and HER2 and genetic signatures) has been extremely slow. Biomarkers have been identified retrospectively by analyzing the characteristics of patients for whom system therapies were successful or not. She encouraged those in the audience to develop biomarkers in tandem with the emerging new systemic treatments as essential to determining efficacy. At the same time, she warned us not to dismiss the still basic importance of characteristics such as tumor size and nodal involvement as significant prognostic factors in determining individualized treatment efficacy.

One of the more intriguing points – known to people within breast cancer, but not so well understood by the general public — was that breast cancers can be divided into four distinct subtypes: ER negative/HER2 negative (basal cell type); HER2 positive; ER positive with low proliferation (luminal A); and ER positive with high proliferation (luminal B). Using this model, along with genomic typing and molecular characterization, new treatments can tested for subgroup efficacy.

Piccart made a plea for researchers to “put their egos in the closet,” to share their data at an early stage, and to build partnerships among academic and pharmaceutical groups to marshal resources to advance knowledge. (Piccart’s disclosure statement acknowledged her relationships with sixteen different drug companies).

The presentation was personalized by the inclusion of photographs of the various researchers involved in the studies she described, as well as group photos of staff and research collaborators, and included childhood photos of herself and her two major founding colleagues.