When I began treating breast cancer, we treated patients according to whether they were pre-menopausal or not, and whether there was any sign of cancer in the lymph nodes of the armpit. We knew that some cancers were more aggressive by looking at them under the microscope and that they often recurred. In breast cancer, we understood that a majority of tumours responded to hormone treatment.
Since then, our knowledge has expanded, and we now understand many more characteristics of cancers and treat according to these factors rather than just the size of the tumour. In breast cancer, we can now identify a number of different subtypes of breast cancer by standard means, and we have been involved in many clinical studies that have been pivotal in determining new therapies.
Working with many of the excellent scientists at the BC Cancer Agency and the University of British Columbia (UBC), we are beginning to use new methods to further define different subtypes of breast cancer. And we are not just looking at the initial cancer, but we are also collecting biological samples of recurrent cancers to see if these cancers change and if we can understand why they are resistant to chemotherapy.
One of the other hats I wear is Co-Chair of the Breast Site Committee of the National Cancer Institute of Canada–Clinical Trials Group (NCIC-CTG). This is a group that organizes and runs both national and international clinical studies. Not only can we determine the best treatments through these studies, but we can also try to understand why some cancers respond and some do not.
I am currently working with the BC Cancer Agency’s Dr. Torsten Nielsen on collecting close to 2,000 specimens from a study led by the NCIC–CTG to determine if we can show which cancers should be treated with a type of chemotherapy known as paclitaxel (Taxol), and which persons can be spared that drug.
I led another Canadian clinical trial that looked at a novel drug, named olaparib, that we thought may be active in breast and ovarian cancers. This study showed for the first time that this drug was active in some women with a type of aggressive ovarian cancer—high-grade serous carcinoma.
What is most exciting for me is that we have tumour samples from all the Canadian women who participated in this trial. With the Agency’s Dr. David Huntsman and Dr. Sam Aparicio, we are analyzing these samples at the Genome Sciences Centre to understand why some cancers responded and others did not. These studies will change how we treat women in the future.