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Patients with aggressive breast cancers, including those with large tumours, high-grade triple negative or HER2 positive breast cancers are at high risk of treatment resistance and of the cancer returning after treatment, leading to poor survival outcomes. These patients often receive therapy before tumour removal (termed neoadjuvant therapy) aimed at reducing the size of the cancer prior to surgery. Currently, there are few biomarkers to predict which patients will respond to neoadjuvant therapy and those that will not, and response to neoadjuvant treatment is an indicator of patient outcome.

This project, led by Dr Amy McCart Reed (University of Queensland), will use cutting-edge genomic techniques to identify markers of treatment response or resistance. The study also aims to identify the most effective genomic technology, for personalised medicine, to profile individual tumours to match patients with the best therapy.

The spread of breast cancer to the brain is a major cause of mortality for patients with triple negative breast cancer (TNBC). In this study Prof Kum Kum Khanna (QIMR Berghofer Medical Research Institute) will examine whether Auranofin, a drug proven to be safe for the treatment of rheumatoid arthritis and can cross the blood-brain barrier, can be repurposed for the treatment of metastatic TNBC. Auranofin will be tested in combination with other FDA approved anti-cancer drugs known to reach the brain to identify new combination therapies for the treatment for metastatic TNBC.

Metastasis is an incurable spread of cancer and is the main cause of cancer death. It is evident that metastatic cancers differ from the primary tumors from which they originate. Yet, much is unknown about how breast cancer spreads.

One of the main challenges in understanding cancer metastasis is a lack of access to tissue from people with advanced disease.

In this NBCF-funded study, Dr Zhi Ling Teo will use a unique tissue bank that has been established at the Peter MacCallum Cancer Centre to trace the full lifecycle of aggressive HER2+ breast cancer. In particular, her study will focus on changes in the immune system over the course of the disease and how this affects outcomes. 

Overall, the study will provide new information on ways to anticipate, inhibit or suppress the evolution of drug resistance and metastasis in HER2+ breast cancer.

Estrogen receptor positive breast cancer is the most common cause of breast cancer, affecting up to 80% of female and 90% of male breast cancer patients. In ER+ tumours, the hormone estrogen fuels the growth of the cancer. Current treatment options aim to either block the estrogen receptors, or lower the levels of the estrogen hormone in the body, to starve the tumour of its fuel. However, this treatment also leads to estrogen deprivation in the rest of the body, which can lead to side effects.

This study, led by Dr Amy Dwyer from the University of Adelaide, will trial a completely new treatment strategy. Instead of eliminating estrogen receptor activity, the team will test therapies that reprogram the estrogen receptor to prevent the growth of tumours but retains activities needed by the body.

The project will trial drugs that are already on the market, which have been shown to modulate estrogen receptor activity. There will likely be additional benefits to these new treatments, including promotion of bone and muscle health, increased libido and prevention of hot flushes. The hope is that this new approach may be able to treat women with breast cancer, without making them feel miserable in the process.

Chemotherapy is well known to have off-target adverse events, such as cardio-toxicity, or damage to the heart. This can lead to cardiovascular disease later in life, which is now a leading cause of death among breast cancer survivors.

It is possible to reduce the risk of cardiovascular disease through specialised exercise rehabilitation. This is usually provided in supervised clinic-based programs, but these can be challenging to access for women due to time, travel and cost barriers. Home-based alternatives have not been as effective. 

Tele-rehabilitation could bridge the gap – enabling direct supervision by a clinical exercise specialist while the participant completes the therapy in their own environment. 

This approach has previously been shown to be effective for people with coronary heart disease, and this will be the first time it is used with women who have previously had breast cancer.