Breast cancer relapse: act as early as possible to save more women
For Pink october 2022, Institut Curie takes a look at its progress in treatment and research to better prevent, anticipate and intercept breast cancer relapse.
Breast cancer affects around 60,000 women each year in France, and ten years after the first diagnosis 15 to 20% of these cancers recur. Among them, so-called “triple-negative” breast cancers are the most risky.
Cancer can recur in the breast itself (local recurrence) or in a remote site, in other organs or tissues, known as metastases. The risk of recurrence and its severity depends on the size of the initial tumor, of whether lymph nodes are affected, and the treatments given. For all types of cancers, we see a local recurrence or appearance of metastases two years after treatment.
Treatment on all fronts at Institut Curie
The leading European center for breast cancer treatment, Institut Curie relies on the multidisciplinary expertise of its teams to reduce risk of recurrence as much as possible:
Imaging, surgery and precision, tumor analysis, adjuvant treatments, post-treatment follow-up... Multidisciplinary treatment is crucial to limit risks of recurrence, with one certainty: the better the initial treatment, the lower the risk of recurrence.
Explains Dr Paul Cottu, medical oncologist at Institut Curie.
Based on initial imaging results and biopsy sampling, physicians detect the presence of hormone receptors and measure the density of growth factors. According to the results and to other parameters (including age, weight, tumor size, appearance of cancer cells, compromise of lymph nodes and inflammatory signs), various treatments or treatment combinations known as adjuvant are prescribed - in addition to surgery - to prevent relapse, such as chemotherapy, radiotherapy, hormone therapy, targeted therapies and/or immunotherapy. Hopes are high that treatments will be further customized according to criteria met through innovation.
Thanks to digital pathology - which combines very thin sections from breast cancer samples with artificial intelligence tools - our diagnoses will be increasingly accurate and therapeutic decisions increasingly relevant for women, in particular for those at highest risk of relapse.
Adds Dr. Anne Vincent-Salomon, pathologist at Institut Curie.
Developing the treatments of the future
The understanding of the mechanisms leading to relapse and how to prevent or predict them is a major priority of Institut Curie’s research teams.
For example, projects are underway to improve the use of PET scans to effectively predict tumor invasion. Furthermore, many teams from the institute are working to decipher the actions of immunotherapy to try to increase performance. To do this, researchers are studying all the cells involved in immunity (including macrophages, lymphocytes and dendritic cells) which offer solutions to improve treatment of breast cancer and its risk of relapse.
Innovative work is also being done on epigenetic processes, using state-of-the-art techniques such as single-cell study to explore new therapeutic strategies. Another area for exploration is iron, whose role in resistance to treatment has now been demonstrated.
Innovative clinical trials
Institut Curie is conducting a number of clinical trials on an international scale, particularly against the most aggressive cancers that are more likely to recur.
The areas explored at the institute include the PADA-1 trial coordinated by Prof. François-Clément Bidard, , medical oncologist At Institut Curie. Involving 83 centers in France and over 1,000 patients, this study showed that it is possible to very significantly delay the development of cancer during hormone therapy by detecting a mutation of resistance to hormone therapy (ESR1 gene) and by targeting it through a change in treatment. The work continues, particularly to try to predict which patients could develop such mutations.
Another revolutionary project is being conducted at Institut Curie involving fibroblasts, these cells that we know to be involved in metastatic spread and resistance to treatment. The RHU CASSIOPEIA project, led by Fatima Mechta-Grigoriou, Inserm research director at Institut Curie, aims to detect and very specifically target the fibroblasts responsible for recurrences using totally new therapies.
Supporting woman affected by relapse
The fear of the risk of relapse is very real for many women suffering from or in remission from breast cancer. Through its interdisciplinary Supportive care department, Institut Curie continues to implement support programs and tools to manage this legitimate fear. In addition, adapted physical activity and nutrition are a major component of support for women to encourage them to adopt behaviors that can drastically reduce the risk of relapse.
Towards an entity devoted entirely to female cancers*
Institut Curie, an expert in female cancers, PSL University and their partners are committed to the project to create an entity devoted entirely to women.
With over 76,000 new cases each year in France, female cancers are a real public health issue. To rise to this challenge, Institut Curie, its academic supervisory bodies and PSL University are committed to an ambitious project, namely to create an entity devoted entirely to female cancers, which will combine all medical, paramedical and scientific expertise alongside companies and patient associations.
The goal: to consider female cancers in their entirety and make them the focus of innovation and research and care expertise in order to better understand, treat and cure them, both now and in the future.
Making women and female cancers the focus of research and treatment
“Female cancers are a real public health issue and as such a priority for us. In terms of the social aspect, we note both that there are considerable disparities in terms of women’s treatment, and that cancer is a factor that worsens insecurity for women, causing them to need more time off work and more work accommodations than men. At the scientific and medical level, although progress in recent decades is undeniable, we now need to have a more comprehensive vision of these cancers with research targeted according to women’s age, from the tumor micro-environment to the individual in her environment,” explains Dr. Anne Vincent-Salomon, head of the project.
This project to build an integrated entity will require all the lifeblood of Institut Curie and of PSL University, and will provide innovative responses to improve prevention, treatment and care according to the various stages of the pathologies and the individual situations. It will be submitted for financing to the Call for Projects to create new Hospital-University institutes as part of the Plan France 2030, closing on November 7, 2022.
*Breast cancer and gynecological cancers (cancer of the uterus, the ovary, the Fallopian tubes, the vagina, the vulva and endometriosis).