Kornelia Polyak, M.D., Ph.D.
Trials and teaching
Just as any new screening method takes years to develop, new treatments must also be tested over time. One way therapy options are developed at Dana-Farber and other cancer centers is through clinical trials — research studies involving humans. DFCI has conducted several breast cancer clinical trials over the past few years, including one completed last fall involving Herceptin, an immunotherapy drug made from an antibody that targets one of the most aggressive forms of breast cancer. In a study led by Winer and colleague Harold Burstein, M.D., 40 patients were given Herceptin and the drug Taxol prior to breast surgery. The preliminary results are encouraging, with a number of the women having no detectable cancer at the time of their surgery.
While testing the therapeutic capabilities of drugs, researchers are also searching for new genetic markers that may indicate a woman's likelihood of developing breast cancer. Using a technology known as SAGE (Serial Analysis of Gene Expression) developed in 1995, one group of Dana-Farber investigators, led by Kornelia Polyak, M.D., Ph.D., is attempting to unlock the differences between normal breast cells and those responsible for ductal carcinoma in situ (DCIS), an early form of breast cancer in which cells that line the breast's milk ducts reproduce uncontrollably. DCIS is almost always curable if caught before it spreads to surrounding tissue. Polyak's team is using the SAGE process to measure the activity level or "expression" of thousands of different genes in order to find those that trigger the cancer before it demands treatment.
"With this technology, we can look at all the genes expressed at a time, whereas before we had to investigate them one by one," says Polyak. "We try to find molecular markers, genes that will tell us 'this tumor is behaving very badly. You should treat this patient very aggressively with chemotherapy, even at this early stage.' And since we now know most of the sequence of the human genome, we can log on to a computer and find the chromosome location and structure right away."
"With this technology, we can look at all the genes expressed at a time, whereas before we had to investigate them one by one."
— Kornelia Polyak, M.D., Ph.D.
While its scientists are attempting to decode the genetic secrets of breast cancer, the Institute is also developing a survivor's clinic within the Gillette Center to help patients cope with issues that may arise during and following treatment. The clinic will help women with making decisions, such as whether or not to take hormone replacement therapy or be screened for other cancers.
"One of the classic times to become depressed is at the end of treatment," explains Laurie Rosenblatt,M.D., a psychiatrist in DFCI's Department of Adult Psychosocial Oncology. "A patient can experience a mixture of physical and mental exhaustion, grief over the losses her body has experienced, and a general difficulty in handling the changes she's been through. Eventually, we'd like to be able to screen every patient for depression and anxiety at the start of treatment."
Knowledge is a critical factor, and DFCI has made a commitment in recent years to teach women the important role that regular mammograms, clinical breast exams, breast self-examinations, and other steps can play in prevention. From 1998 to 2000, for example, the Institute collaborated with Churches Organized to Save Tomorrow (COST) — a partnership of 12 Boston-area churches — to develop an educational program for African-American women in underserved communities. Funded by The Boston Foundation, the program helped women connect with neighborhood health centers and gain access to free mammography and Pap smears.
"We found people were very receptive to hearing this information through churches, and women were committed to spreading the word," says Jennifer Dacey Allen, R.N., M.P.H., D.Sc., of Dana-Farber's Center for Community-Based Research within the Population Sciences department. "We worked with COST to train women in each congregation to educate and reach out to their families, friends, and acquaintances at church."
With many resources focused on halting breast cancer, DFCI is hoping such efforts soon won't be necessary.
"The next decade will definitely see more advances in the development of drugs and other prevention strategies for breast cancer," predicts Iglehart. "We are going to find out a lot more about the molecular pathways that underlie the disease, and we're going to figure out ways to interrupt those pathways. We are very confident about the future."
