|The New Zealand Breast Cancer Register
Over the past 15 years The NZBCF has provided significant funding to regional breast cancer patient registers in Auckland, Waikato, Christchurch and Wellington. Medical researchers now have a clearer picture of breast cancer in New Zealand women - rates of diagnosis by age and ethnicity, treatment by patient and most importantly the outcomes of patients with breast cancer.
The regional registers have now been consolidated into one national register. This will provide a total data set of breast cancer in New Zealand.
A screening test to determine which HER2+ breast cancer patients will benefit from Kadcyla (Francis Hunter – University of Auckland)
A new drug called Kadcyla has been approved for treatment of advanced HER2+ breast cancer. In clinical trials, 44% of tumours shrank when treated with Kadcyla, and on average, patients survived for 7 months longer – a huge gain for anyone facing a terminal illness.
In New Zealand, Kadcyla is approved for use but not publicly funded, presumably because of its high price tag; around $100,000 per patient.
Dr Hunter and his team will develop a new test to identify genes that control a person’s response to Kadcyla, telling doctors who will benefit and who won’t.
“Personalised medicine – pairing patients up with the most effective treatment for them specifically – will improve cancer treatment in the coming years,” says Dr Hunter.
“Thanks to NZBCF funding, our work could benefit patients by ensuring they get the right treatment, and to benefit the public by ensuring that expensive pharmaceuticals are used in a cost-effective way.”
A new test to identify patients who will suffer from severe side-effects on capecitabine (Assoc. Prof. Nuala Helsby – University of Auckland)
Capecitabine is usually the first treatment women with advanced breast cancer receive. Unfortunately, 5-10% of patients on capecitabine experience dangerous side-effects, which can include blistering or severe pain in the hands and feet, diarrhoea, and could even cause death.
Patients who suffer these side-effects do so because they are deficient in the liver enzyme that removes the capecitabine from the bloodstream. This same enzyme also removes thymine from the bloodstream, so Professor Helsby and her team are developing a test where they give patients thymine, measure how much is removed from the bloodstream, and use that data to figure out whether they’re deficient in this important enzyme.
The researchers are already testing this procedure in gastrointestinal cancers, and are now extending it to include advanced breast cancer patients.
“Capecitabine is a very valuable treatment, but it isn’t right for all patients,” says Prof. Helsby.
“If we can determine which patients will suffer severe side-effects before they take the drug, we’ll spare them a huge amount of discomfort, and be able to prescribe them a treatment that they’ll tolerate.”
A clinical study using personalised blood tests to monitor tumour DNA (Prof. Parry Guilford – University of Otago)
For patients with advanced breast cancer, frequent monitoring of their disease provides information about whether a treatment is working. Right now the only way to do that is with expensive, infrequent scans.
Circulating tumour DNA (ctDNA) is released from the tumour into the bloodstream, and can indicate to doctors whether the cancer is growing, and whether the patient’s treatment is working. ctDNA tests are inexpensive and can be done frequently.
Dr Guilford and his team are setting up a clinical trial to determine whether ctDNA can predict whether a patient’s cancer is growing, and whether they’re responding to treatment, faster than the usual methods.
“ctDNA could provide faster feedback to patients and doctors, so that minimal time is wasted on treatments that aren’t working,” says Dr Guildford.
A new targeted therapy for breast cancer (Dr Dongxu Liu – Auckland University of Technology)
Targeted therapies, like Tamoxifen and Herceptin, have emerged in the last few years as very effective ways to treat breast cancer.
Liu and his team are developing a new monoclonal antibody; a type of drug that attaches to a tumour, and triggers the patient’s own immune system to destroy it.
In a recent project funded by the NZBCF, Dr Liu and his team identified a monoclonal antibody that targets a protein called SHON, which is commonly found in breast tumours. Now, Dr Liu will test whether this antibody will inhibit tumour growth in human cancer cells. If those tests are successful, he’ll start running clinical trials of the new drug.
“The NZBCF has supported this project for many years,” says Dr Liu. “It’s exciting that, with their help, we’re getting closer to testing this new treatment in the patients that need it.”
Using the Breast Cancer Patient Register for targeted molecular research (Associate Professor Mik Black – University of Otago)
The Breast Cancer Patient Register contains a wealth of information about NZ women with breast cancer.
Prof. Mik Black is using the huge amounts of data to glean insights into breast cancer incidence, genetic characteristics of tumours, and patients’ responses to treatment.
With this information, researchers will be able to find more effective ways to treat both early and advanced breast cancer.
“The Register gives us an amazing amount of information to work with, which we can use to gain detailed insights into breast cancer trends in New Zealand,” says Prof. Black.
Developing guidelines for breast conserving surgery (Assoc. Prof. Ian Campbell – University of Auckland, Waikato)
Many women with breast cancer have breast conserving surgery, where the tumour and surrounding tissue is removed, rather than the whole breast. Breast conserving surgery allows a much faster recovery compared to mastectomy, with survival outcomes are similar. Unfortunately, around one in five women who have breast conserving surgery are called back for a second surgery because some cancer cells are found near the surgical margins. This is traumatic for the women concerned and costly to the health service, and there’s still some uncertainty as to whether these women really need further surgery to reduce the risk of recurrence.
Professor Ian Campbell is going to examine data from the Patient Register to determine how much breast tissue surrounding a tumour needs to be removed during surgery to minimise the risk of the cancer coming back, and avoid unnecessary extra operations.
“Breast conserving surgery is the best option for most women with breast cancer, but controversy exists on this issue of margins, and it has never been looked at in as large a group women with the degree of detail contained in the Register,” says Prof. Campbell.
“Thanks to the Patient Register, we hope to establish guidelines that all surgeons can follow, so that as few women as possible have to go back for a second surgery.”
Exploring cell nucleus changes as drug targets for advanced breast cancer (Dr Tracy Hale - Massey University)
Dr Hale is exploring how the changes that occur in a cell's nucleus when a cell invades surrounding tissue could reveal potential new drug targets for metastatic breast cancer.
"The first step in metastatic disease occurs when a cell invades surrounding tissue. However, before a cell can invade, its nucleus must become malleable enough to ensure the cell can squeeze through the tissue matrix. This critical stage provides a unique opportunity to prevent metastasis by targeting the key pathways involved," says Dr Hale.
The research team will determine if a protein commonly lost in invasive breast tumours, called HP1a, is responsible for these changes in the cell's nucleus. Understanding how this process works will help identify possible drug targets that could represent the next generation of cancer therapies.