Stanford Cancer Institute News

Spring 2017

Research Advances Enable Individualized Patient Care

SCI's Clinical Breast Cancer Program

About 250,000 women are diagnosed with breast cancer each year in the US, and about 40,000 women die of the disease. While no one would suggest that any two of these women are the same, until the early 2000s their disease was considered to be one-size-fits-all.

When diagnosed, the vast majority of patients in the past received a treatment schedule based on the extent of their disease (the tumor size and whether or not the tumor had spread to the lymph nodes): surgery usually followed by radiation and/or chemotherapy. It was an aggressive strategy to combat a lethal disease, and it saved and prolonged countless lives. But while the patients were treated the same, not all responded the same to the therapy.  Why not?

It is now clear that breast cancer is not a single disease, but in fact a family of related diseases. The different forms of the disease—often referred to as intrinsic sub-types (based on pioneering discovery research here at Stanford using gene “chip” array technology)—feature unique genetic and behavior characteristics, as well as differing risk factors, which require more nuanced treatments strategies.

In response, Stanford takes a team approach to treating breast cancer. Every new patient is seen by a multidisciplinary group of experts who work together to develop an individualized care plan. The treatment continuum begins with breast imaging—typically a mammogram, but there are also ultrasound and MRI imaging techniques—performed by a radiologist specialized in breast imaging techniques. When a mass is found a biopsy is performed by the radiologist or by a surgeon. The tissue sample is sent to expert pathologists specializing in breast cancer who identify its sub-type, and levels of aggressiveness and extent of any spread to lymph glands.

The imaging and pathological data are then collectively reviewed by a committee of medical oncologists, surgeons, radiation oncologists, geneticists, psychosocial specialists and others who work together to develop an initial course of treatment. Stanford’s breast cancer group holds weekly meetings to evaluate cases. Their considerations also include the relevant details of each patient’s health status and even family history (ie, does she have any relatives who have had breast cancer?).

“Having the multidisciplinary team allows us to make those decisions about what represents the most appropriate and most effective therapy for each individual patient,” said renown breast cancer specialist George Sledge, MD, Professor, and Chief of Stanford’s Division of Oncology.

For example, if the pathology report shows that a tumor is estrogen sensitive, meaning that estrogen helps fuel its growth, then that patient’s treatment may begin with an estrogen-blocking drug to inhibit tumor growth before moving on to other therapies. Similarly, women diagnosed with larger tumors will often begin their treatment with chemotherapy to shrink the size of the tumor to increase the odds of effective surgery, and preserve healthy breast tissue.

Another important benefit of this individualized approach is that it reduces patients’ exposure to toxic treatments. It has long been observed that some tumors do not respond to chemotherapy, but because they didn’t know which ones, doctors were compelled give chemotherapy to all their patients. Years of research has identified which sub-types or individual cases will not respond to chemotherapy, and thus spared many women from undergoing rigorous treatment which yields no benefit.

“One of the biggest advances in breast cancer in the last ten years is that we are able to use much less chemotherapy,” said Sledge.

Another important advance is the increased understanding of how specific genetic mutations, particularly BRCA1 and BRCA2, contribute to breast cancer incidence. SCI members have been leaders in laboratory and clinical research in this area, and were part of a recent study showing that a new combination drug therapy was effective in women with BRCA-related breast cancer.

SCI members are leading and participating in numerous ongoing breast cancer clinical trials, and details can be found through the Cancer Clinical Trials Office and the Stanford Women’s Cancer Center.

“Research cures cancer; it’s only a disease,” said Sledge, a self described ‘pathological optimist.’ “It won’t be easy, but human knowledge, experience and willingness to try new things will ultimately prevail.”