Dr. Sharifi, what is the question your research is trying to answer?
Lobular breast cancer accounts for 15 percent of breast cancer diagnoses and is less likely respond well to our standard anti-estrogen treatments than the much more common ductal breast cancer subtype. However, we do not currently have any clinical tools to detect anti-estrogen treatment resistance early. This research is focused on addressing that need by developing non-invasive diagnostic tests for early identification of tumors that are insensitive to anti-estrogen therapy, so that we can do a better job of identifying treatment resistance early and offering patients alternative treatment approaches.
To do this, we are combining two types of tests that could allow us to determine if the treatment is effectively suppressing estrogen signaling to control or eradicate a patient’s breast cancer cells. The first is an imaging test similar to a CT scan that uses a special injected dye called FFNP to highlight areas of breast cancer in the body with high levels of estrogen signaling. The second is a test that measures estrogen signaling in cancer cells found in the blood of breast cancer patients via a simple blood draw. While both tests have been studied in ER+ metastatic breast cancer, neither has been studied specifically in lobular breast cancer.
Why did you propose this project? Why does it interest you personally?
One of major challenges I see my patients with metastatic cancer face is starting a new treatment for three or six months, enduring the associated side effects, and then finding out with their first set of scans that the treatment is not working and the cancer is continuing to grow. This has made me passionate about developing tests to help us do a better job of predicting when a treatment is or is not going to work, either before we start or early in the treatment course, so that we can avoid exposing patients to unnecessary side effects and ensure that they are on the most effective treatment for their individual cancer.
I am particularly interested in developing these types of tests for anti-estrogen therapy in lobular breast cancer as this is an understudied area of great unmet need for my patients living with this breast cancer subtype.
What was your reaction when you learned you'd been awarded the grant?
This initiative through the SNMMI and LBCA provided a unique opportunity to test approaches using advanced imaging for cancer monitoring, as it can be very difficult to obtain support for this type of study in the early phases due to the logistics of the advanced imaging. I was thrilled to learn that our specific project in this area would be supported, as I am particularly excited about the promise of combining advanced imaging with the blood-based liquid biopsy approaches we have developed.
What is the timeline and basic methodology you plan to use to complete the study?
In this study, patients receiving standard anti-estrogen therapy for metastatic ER+ lobular breast cancer will undergo both the imaging and blood test for estrogen signaling before starting treatment, then again after four weeks of treatment. We will then determine whether changes in estrogen signaling in those first four weeks predict which patients will respond to the anti-estrogen therapy.
In terms of the overall project timeline, the research began in October 2023 and is projected to take a year.
What are the potential implications for the patient community?
Our long-term goal is to improve our ability to select the right cancer treatment for a patient on the individual level, which in turn will improve treatment effectiveness and minimize unnecessary side effects to help our patients live both better and longer with a cancer diagnosis.
Laurie, why did the Lobular Breast Cancer Alliance wish to partner with SNMMI on a research grant and why is this type of research important to your organization??
The LBCA is a small patient advocacy organization focused on raising awareness and promoting research on lobular breast cancer. Invasive lobular carcinoma (ILC) is a poorly understood subtype of breast cancer, even though it affects many breast cancer patients. Imaging has always been a challenge for ILC, which is hard to detect. In 2022, LBCA, along with its Scientific Advisory Board and Patient Advocate Advisory Board, made funding a study on imaging a priority.
ILC research faces many barriers, one of which is of course funding. LBCA's aim in funding young investigator and research fellowship awards with partners like SNMMI is to spur investigator interest and to inspire conversation and additional research activity in the field. While LBCA does not have the funds to support larger research grants or support clinical trials financially, we believe our efforts with funding research fellowships is serving the purpose of gaining more traction and attention in the research world. When looking for a partner to fund a research study on imaging, we found that SNMMI shared many of our values and we were pleased to be able to make a larger grant possible through this partnership.
Finally, one of LBCA's goals is to support the active and meaningful engagement of patient advocates in the development and implementation of research studies, as well as the grant review process. We were pleased that SNMMI was willing to incorporate patient advocates as voting members in their review process for the first time. LBCA looks forward to the research findings of this groundbreaking study.