Unmet Needs in Clinical Research in Breast Cancer: Where Do We Need to Go?

Abstract

This CCR Focus highlights areas in breast cancer research with the greatest potential for clinical and therapeutic application. The six articles in the issue address the state of the science in a broad range of areas with a focus on “hot” though sometimes controversial topics, unanswered questions, and unmet need. From mutational signatures, the cancer genomic revolution, and new inroads in immunotherapy for breast cancer, to unique concerns of vulnerable populations as well as national and global health disparities, these works represent much of the promise of breast cancer research as well as the challenges in the coming years. Each review focuses not only on recent discoveries, but also putting the topic in context including limitations to overcome. This overview is designed to further contextualize the highlighted issues within the broader research landscape. We also present new information from a poll of ALLIANCE for Clinical Trials in Oncology Breast Committee members regarding the most needed and viable potential future NCI-supported clinical trials in breast cancer. The great challenge is to translate the potential benefits of greater scientific knowledge reflected in this Focus series into improvements in outcomes for individuals and populations with breast cancer. A unifying theme across the six articles contained in this CCR Focus is the increasingly recognized value and necessity of collaboration across disciplines from bench to bedside to populations. Only continued and iteratively amplified scientific, clinical and governmental commitment to creating, testing, and implementing new knowledge will reduce the global morbidity and mortality of breast cancer.

Unmet Clinical Need: Developing Prognostic Biomarkers and Precision Medicine to Forecast Early Tumor Relapse, Detect Chemo-Resistance and Improve Overall Survival in High-Risk Breast Cancer

“…From 1989 to 2017, the death rate of female breast cancer dropped by 40% and the 5-year survival for female breast cancer between 2009 and 2015 was 90% [1][2][3]. These advances have been attributed to improvements in cancer prevention, increased cancer screening, and advances in early detection, risk stratification, anti-HER2 therapy, anti-ER therapy, anti-PI3K and anti-mTOR therapy, anti-PD1 immunotherapy, whole genome sequencing (WGS), whole exome sequencing (WES) and combination therapies [4][5][6][7][8][9][10][11].…”

“…In a study of 4,105 patients in the International Breast Cancer Study Group clinical trials I to V, the annualized risk of recurrence was highest within 5-years of a diagnosis of operable breast cancer [15]. Early identification of patients at high risk of developing early tumor relapse using genomics and other multi-Omics tools has been noted to be a top priority of the Alliance Breast Committee in 2016 [5].…”

Effectiveness of Supportive-Expressive Group Therapy in Women with Breast Cancer: A Systematic Review and Meta-Analysis

“…At present, the treatment for breast cancer patients in the world is still mainly targeted drugs [29]. The rapid development of precision medicine has indeed provided better treatment and outcomes for breast cancer patients.…”

A novel immune prognostic index for stratification of high-risk patients with early breast cancer

“…However, the prognostic or predictive value of these assays is limited to hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2−) early breast cancer 11 . Moreover, they have limited prognostic ability for late recurrence (> 5 years after diagnosis) 12 and there is considerable discordance among assays with respect to risk stratification 13 . Accordingly, improvements to existing multigene assays, or development of novel assays, are needed to ensure more accurate prediction of the risk of distant recurrence or responses to treatment.…”