A novel statistical tool that identifies the genetic and molecular patterns of tumors offers a more reliable prediction of the clinical trajectory of an individual’s breast cancer, including if, and when, it could come back.
Cancers are usually named after the place in which they originated; however, due to the complexity of the disease and the variety of treatment options and outcomes, this may no longer be enough. Research has found that breast cancer alone can be split into 11 different subgroups, each with separate clinical trajectories.
Delving deeper into the genetic and molecular make-up of individual tumors, researchers from the Cancer Research UK Cambridge Institute (UK) have created a new statistical tool that has greater accuracy in predicting whether a woman’s breast cancer will relapse.
“Treatments for breast cancer have improved dramatically in recent years, but unfortunately for some women, their breast cancer returns and spreads, becoming incurable. For some, this can be many years later – but it’s been impossible to accurately predict who is at risk of recurrence and who is all clear,” commented the lead researcher of the study, Carlos Caldas (Cancer Research UK Cambridge Institute).
“In this study, we’ve delved deeper into breast cancer molecular subtypes, so we can more accurately identify who might be at risk of relapsing and uncover new ways of treating them.”
The study, recently published in Nature, involved the scientists examining the genetic changes that occurred within the tumors of nearly 2000 women in a longitudinal study taking place over 20 years, particularly noting whether the cancer recurred.
Results showed that, even in tumors that initially appear similar, the clinical trajectories can vary significantly. For example, among women with triple-negative breast cancer, they found one distinct subgroup with an initially poor outlook but with low risk of recurrence if they have 5 years in remission.
They also found subgroups of women with estrogen receptor-positive tumors who were at a higher risk of their cancer coming back 20 years following first diagnosis. This information may help in determining initial treatment plans, suggesting whether the individual would benefit for longer courses of treatment or more frequent follow-ups.
“We’ve shown that the molecular nature of a woman’s breast cancer determines how their disease could progress, not just for the first 5 years, but also later, even if it comes back.” commented Oscar Rueda (Cancer Research UK Cambridge Institute), first author of the paper. “We hope that our research tool can be turned into a test doctors can easily use to guide treatment recommendations.”
Though currently too detailed for everyday clinical use, the team are now working on a more routine test that give doctors the ability to give women a more accurate prediction of their future, allowing for treatments to be personalized to the individual and their cancer’s molecular subgroup.
Karen Vousden, chief scientist of Cancer Research UK, commented: “This study provides some valuable new insights into how we might identify women whose breast cancer is likely to return.”
“We’re still a way off being able to offer this type of detailed molecular testing to all women and we need more research to understand how we can tailor treatments to a patient’s individual tumor biology. But this is incredibly encouraging progress. One in seven women will get breast cancer in their lifetime in the UK, and we hope that research like this will mean that if faced with the disease, even more of our daughters and granddaughters will survive.”
Sources: Rueda OM, Sammut S-J, Seoane JA et al. Dynamics of breast-cancer relapse reveal late-recurring ER-positive genomic subgroups. Nature. doi:10.1038/s41586-019-1007-8 (2019) (Epub ahead of print); www.cancerresearchuk.org/about-us/cancer-news/press-release/2019-03-13-molecular-patterns-could-better-predict-breast-cancer-recurrence
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