VIDEO: Important developments underway in breast cancer

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The most important developments that are immediately on the horizon is a better understanding of the genomics of breast cancer. What mutations are present, and which ones are driving cancers? And more importantly, we learn not only about the genomic aberrations, but why they're there and what they're doing. In particular, which are the ones that arise when a patient becomes resistant to therapy that may actually be driving resistance? That's very valuable information to know, and we can actually get that now from doing serial analysis, using liquid biopsy, so it's less invasive. And we can actually look at the tumor DNA that's circulating in the blood to see what mutations are arising over time. Cancer, after all, is evolution and selection of the fittest. And the molecular changes that happen to befall a cell that give it a growth advantage or give it a resistance advantage for patients on therapy are critical to understand because we can develop drugs against some of these molecular aberrations. If they encode a kinase, that's a little easier because those are what we call druggable targets. We can also create antibodies to some of these targets. So this is what's going on now. The low hanging fruit is genomics. We can sequence, and we can discover and develop drugs. The next frontier is understanding the non-genomic changes that a cancer cell undergoes. These are much more complicated. These include epigenetic changes, which can be due to modifications in the gene that are not sequence changes like promoter of the methylation of the promoter area or changes in histone, which regulates gene expression.

There's also differences in tumor energetics, how tumor cells use energy. This has been known for decades when Otto Warburg, a noted pathologist and biochemist, noted that tumor cells use deoxyglucose more. They use the more inefficient half way of generating energy. And we can exploit that. In fact, there are a couple of drugs that exploit tumor energetics. The Selinexor, for example, which is approved in multiple myeloma. And we actually have a trial going on at MD Anderson that is looking at it in breast cancer. How DNA repairs itself. This is another area that particularly in BRCA1 and 2-related cancers has been exploited with the use of PARP inhibitors that block another arm of DNA repair, such that patients whose tumors already have DNA repair deficiencies are much more vulnerable to that product. That's an area that we need to exploit more, and there's many more biological pathways that I believe will lead us to better therapies. And then finally, the whole area of how the immune system attacks breast cancer, even though it's a very hot topic. Breast cancers are not as immune-producing to the human body as other cancers, like melanoma and lung cancer. And so we're trying to understand how to make the immune system more reactive to breast cancers using drugs other than the checkpoint inhibitors, which are somewhat effective. And as I mentioned earlier, have led to two approvals but still are not fully effective. And so understanding the inner workings of the immune system to make a breast cancers more vulnerable is a very important area of research. And I think you're gonna see a advances in that area as well.