Download See the former case for support for the Personalised Breast Cancer

The personalised breast cancer programme
Transforming the future for patients
with breast cancer
Paving the
way to
personalised
breast cancer
care
May 2016
Introduction
Researchers in Cambridge are at the forefront of pioneering research into
personalised care for breast cancer patients. The ambition is to pave the way for
genetic testing to become a routine part of clinical care and for treatment to be tailored
to the unique genetic profile of each patient’s tumour.
As you are reading this, somewhere in the UK a woman is being told she has breast
cancer. Every year, around 50,000 women receive this news – that's 137 women
every single day. Breast cancer is common – one in eight women in this country will
receive this diagnosis at some point in their life. Although rare in comparison, the
disease also affects men - with equally devastating consequences.
Thanks to research, today more people survive breast cancer than ever before.
What we currently know about breast cancer
Over the past decade there has been significant progress in our understanding of the
biology of cancer in general and breast cancer in particular. Advances in genomics
have increased our understanding of how tumours develop, grow and spread.
We now know that breast cancer is
not a single disease but a group of
diseases with the common feature
being changes in the genome of
breast cells that cause abnormal cell
growth. The number of genes that
can cause cancer if affected by
variation is large and, as yet, not
finally determined.
Diversity at the genetic level means
tumours have equally diverse
The Cambridge Breast Unit at Addenbrooke's Hospital in
Cambridge
characteristics and vary in their speed
of growth and responsiveness to
treatment and that some are more
dangerous than others. Ultimately, this means a different quality of life and survival
chance for each patient.
In recent years, cancer treatment has gradually moved away from the ‘one-size-fits-all’
approach and towards personalised treatment with stratification of patients based on
the molecular makeup of their tumour. This approach has had some success.
Early in the diagnosis process, patients today are tested for the presence of specific
proteins, for example oestrogen receptor (ER) and human epidermal growth factor
receptor (HER2) in their cancer cells and receive treatment that targets these proteins
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However, the current classification of breast tumours has significant limitations. Many
patients still face a poor prognosis because effective, targeted treatment for their type
of cancer does not exist or the tumour becomes resistant. Further research is needed
to develop targeted therapies for all types of breast cancer.
“I met the most amazing lady whilst having
chemotherapy. We went through our treatment
together and supported each other, waited with
each other. I am the lucky one – thanks to
wonderful treatment and care, I am alive today.
But she isn’t and we don’t know why.”
Alison Saunders, breast cancer survivor
The METABRIC study – a breakthrough in our
understanding of breast cancer
A major breakthrough in understanding the molecular changes underlying the different
types of breast cancer has been generated by Professor Carlos Caldas, in
collaboration with Breast Cancer Agency scientists in Vancouver. Professor Caldas is
Director of the Cambridge Breast Cancer Research Unit at Addenbrooke’s Hospital
and Chair of Cancer Research at the University of Cambridge.
In this study, one of the largest global studies of breast cancer tissue ever conducted
and funded by Cancer Research UK and British Columbia Cancer Foundation,
Professor Caldas and his fellow researchers examined the genetic changes that had
taken place in breast tumour cells in great detail.
As a result of what is known as the METABRIC study, published in 2012, they were
able to show which genes had mutated, which genes were working in overdrive and
which were being shut down. Based on their specific genetic changes, breast tumours
could be grouped into ten different subtypes (the INTCLUST classifier), with each
subtype associated with distinct patient outcomes, ie differences in tumour
aggressiveness and survival.
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The Personalised Breast Cancer Programme
Personalised medicine holds great promise yet its
effectiveness in a real-life clinical setting needs to be
demonstrate. Currently, Professor Caldas’ Cambridge team
is testing the feasibility and value of using genomic testing in
clinical practice, in the real-life NHS setting of the
Cambridge Breast Unit. This research aims to translates the
findings of the METABRIC study into patient benefit through
a personalised approach to breast cancer.
Known as the Personalised Breast Cancer Programme, this
study is unique in the UK and at the forefront of breast
cancer research worldwide.
Over 5 years, between 1,500 and 2,000 breast cancer
patients (female or male) will be recruited at the Cambridge
Breast Unit. For each patient’s tumour, a highly detailed
DNA profile will be obtained and mutations identified to
provide a personal ‘mutation barcode’. The study accepts a
wide range of breast cancer patients ensuring it will be
representative of the wider population.
Professor Carlos Caldas,
Director of the Cambridge
Breast Cancer Research
Unit at Addenbrooke’s and
Chair of Cancer Research at
the University of Cambridge
The programme objectives are to:
CLINICAL APPLICATIONS:
 Develop the use of genomics to personalise breast cancer care in a real-life
clinical setting
 Use the mutation barcode to predict likely outcomes for patients and, ultimately,
help patients understand their prognosis and make informed choices
 Identify patients best suited to standard treatment, targeted therapies or new
drugs in clinical trial
RESEARCH APPLICATIONS:
 Generate new knowledge about genetic mutations, risk factors, and the
interplay between the immune system and breast tumours
 Increase the numbers of patients eligible for genomics-driven clinical trials and
inform the design of new trials
 Show, in the longer term, whether using ‘genomics’ improves clinical outcomes
RESOURCE BUILDING:
 Create a large database of genomic data linked to patient follow-up which will
be valuable for future research
 Put Cambridge at the centre of the latest developments and strengthen
collaborations with existing clinical trials and national efforts (e.g. Genomics
England) and other world-leading groups
 Attract investment from pharmaceutical companies
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“Even though my hospital treatment has finished, it
isn’t over. Every day, I’m reminded when I take my
medicine and when I see my scars. I’m supporting
this programme so women in the future can be more
confident that they’re receiving the best possible
treatment for their particular cancer, so they can
reconstruct their bodies and their lives as quickly as
possible”.
Joy Martin, breast cancer survivor
Project timeline and milestones
The study will be conducted in two stages.
Stage 1: feasibility for integrating genomic testing into a clinical breast cancer setting
This stage involves setting up standard procedures and protocols as well as testing
their practical application. Furthermore, this stage involves the setting-up of an
expert panel and the development of clinical decision making processes towards
tailoring treatment and conveying complex genomic information in a patient-friendly
way and linking it to medical records. More than 100 patients will be recruited to test
whether reliable DNA sequencing information can be generated in an acceptable
timeframe.
Stage 2: full clinical implementation (Year 2 to Year 5)
Knowledge gained from stage 1 will help shape the implementation of the broader
clinical programme in the full cohort of patients, which includes extensive data
gathering and demonstration of impact for patients. The vast majority of the 1,500 2,000 breast cancer patients will be recruited in this stage.
Transforming breast cancer care
Cambridge scientists are driving research to advance breast cancer care. The
personalised breast cancer programme bridges the gap between the substantial
advances in research and the implementation of improved breast cancer care into
routine clinical practice.
The study will be conducted at the Cambridge Breast Unit at Addenbrooke’s Hospital,
a world-leading clinical centre at the heart of a scientific campus with close links to
other world-leading research groups and organisations, putting Cambridge at the
centre of the latest developments.
Over 6,000 people attend the Cambridge Breast Unit every year, and of that number
around 500 are diagnosed with breast cancer.
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“It sometimes felt like I was spending my whole life in
hospital. Each chemo session took hours – there were
checks, blood tests, a weigh-in and consultation. But I
felt really lucky to have such amazing medical
treatment on my doorstep and took part in various
research trials. If other people hadn’t volunteered for
research before me, I might not be alive today.”
Sally Newman, breast cancer survivor
The role of Addenbrooke’s Charitable Trust (ACT)
ACT’s mission is to support Cambridge University Hospitals (CUH), which runs
Addenbrooke’s and the Rosie hospitals, providing benefits for patients over and above
those achievable through mainstream funding alone. ACT supports care, research and
education.
This involves initiating and maintaining translational and clinical research programmes
of exceptional relevance to patients and/or the NHS that would not be possible without
charitable support.
ACT is committed to funding high-quality research expected to generate patient
benefits in the short to medium term. We use rigorous selection and monitoring
processes, unbiased scrutiny and peer review by qualified experts.
ACT has previously funded a broad range of translational research projects and has a
long standing partnership with the Cambridge Breast Cancer Research Unit. With
approximately half of its previous research funding dedicated to cancer research, ACT
is well placed to fund this programme of applied cancer research. To maximise on
opportunities in support of this programme, we are aiming to work in close
collaboration with the University of Cambridge Development Office (CUDAR).
The fundraising campaign
To fund the feasibility study (stage 1) and provide three-year funding for essential research
posts, ACT has committed to raise £1,163,028. As of April 2016, we have raised £1,048,000,
leaving a gap of £115,000.
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Dr Jean Abraham (Honorary Consultant and Senior Clinical
Research Associate) was appointed in April 2015, through ACT
funding, to oversee progress and implement the project on a
day-to-day basis. Recruitment of the ‘feasibiliy study’ patients,
is expected to begin summer 2016.
The direct cost for the five-year project, reaching 1,500 to 2,000
patients, is estimated at £8.4 million* (*this may change as this
is an evolving research programme).
On 6 July 2015, ACT launched its Bracode Campaign to raise
funds for this programme. Further information can be found at
www.act4addenbrookes.org.uk/bracode.
How you can help transform breast
cancer care in Cambridge and the UK
Dr Jean Abraham
Honorary Consultant and
Senior Clinical Research
Associate
Today, we are at a tipping point where personalised care for
breast cancer patients could become a reality. But we need your help to make this
happen sooner rather than later.
£5,000* will allow one patient diagnosed with breast cancer to take part in the
programme. By supporting this remarkable initiative, you can help us save more lives
and play a part in medical history.
Please get in touch
We hope that you find this programme compelling and will consider giving it your
support.
If you would like to find out more please contact:
Samantha Sherratt, Interim Director of Fundraising at ACT on 01223 349298 or by
email at [email protected]
or
Dr Jenny Longmore, ACT’s Director of Research [email protected]
Addenbrooke’s Charitable Trust
Box 126
Addenbrooke’s Hospital
Hills Road
Cambridge
CB2 0QQ
www.act4addenbrookes.org.uk
01223 217757
Registered charity number 1048868
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