OUR RESEARCH
THE YEAR IN REVIEW
Trials activity has been strong over the last year, in terms of patient recruitment, data analysis and presentations, and new trials. We have expanded the number of trials sites and the number of investigators to give greater coverage of the Australian and New Zealand landmass. We would like to give a more diverse population the opportunity to participate in clinical trials, both for equity of access and to improve the generalisability of trial results to the patients who are being treated in routine care.
Dr Nicholas Zdenkowski is the Chair of the BCT Scientific Advisory Committee.
Homegrown trials are a cornerstone of our program, giving BCT researchers a chance to contribute on a national and international stage. EXPERT continues to recruit steadily in locations as diverse as Zurich, Taipei, Santiago and Tamworth, with over 50% of the total target sample enrolled. The Breast MRI Evaluation Study rapidly completed recruitment of 406 patients and is currently in analysis, aiming to identify which patients benefit most from breast MRI. Neo-N was a great success in recruitment completion six months ahead of target. Analysis is underway to determine the impact of neoadjuvant immunotherapy in reducing chemotherapy requirements in early stage triple negative breast cancer. The TUGETHER trial opened, for patients with pre-treated HER2-positive metastatic breast cancer using tucatinib and pembrolizumab.
The PROSPECT primary analysis was presented at ASCO, with additional presentations at EBCC and the Radiological Society of North America, to name but a few of the high profile meetings. This data suggests that MRI can be used to identify patients with sufficiently low risk unifocal early stage breast cancer, that radiotherapy may be able to be omitted. Substantial work has gone into the development of PROSPECTIVE, the international validation of PROSPECT. The CHARIOT trial in high risk treatment-resistant triple negative early stage breast cancer showed that neoadjuvant dual immunotherapy could produce a pathological complete response in 24% of patients. These data were also presented at the ASCO Annual Meeting in 2022. The ELIMINATE trial of combined neoadjuvant chemo-endocrine therapy vs chemotherapy alone was presented at the ESMO meeting. The combined chemo-endocrine therapy group did not have better downstaging than the chemotherapy alone group, however a signal was seen in higher grade tumours and younger patients. PANTOCIN, supported by BCT discretionary funding, was presented at SABCS as a poster spotlight discussion, showing that pantoprazole helps reduce chemotherapy induced nausea and vomiting in a substantial proportion of patients.
International collaboration remains central to developing and conducting high quality trials that have the potential to improve patient outcomes through practice-changing data. DECRESCENDO is a Breast International Group-led trial that opened in Australia in 2022, aiming to reduce the amount of chemotherapy needed for early stage HER2-positive hormone receptor-negative breast cancer patients. FINER, led by the Canadian Cancer Trials Group, represents a new trans-Pacific collaboration.
Results from the OLYMPIA trial of adjuvant Olaparib showed an improvement in disease-free and overall survival for early-stage BRCA-associated breast cancer. The SOFT and TEXT trials have changed practice in Australia and internationally, and continue to produce data that is the subject of high profile presentations on the benefits of ovarian suppression and aromatase inhibition in premenopausal early stage breast cancer. The PALLAS trial of adjuvant palbociclib also continues to report results at major meetings and in publications, albeit with a negative primary outcome.
The latter part of 2022 and early 2023 saw the tentative resumption of travel to national and international conferences such as ASCO, ESMO and SABCS. Face to face participation in an immersive environment enhances the experience, and the incidental conversations/collaborations are irreplaceable. Also, being there means fewer potential distractions from clinical matters compared with virtual attendance. The return to the ravages of jet lag is certainly a downside, however. If only we could have the best of both worlds!
The BCT Scientific Advisory Committee (SAC) was restructured at the end of 2022. I was honoured to have been appointed as the SAC Chair to lead the scientific priorities for BCT in the coming years. The SAC now has 20 members, eight of whom were new to the SAC, to represent the diversity of the BCT membership in setting the research agenda. Sincere thanks to outgoing SAC members for their years of dedication, consideration, wisdom and time, all on a voluntary basis. Thanks also to Professor Mann, the immediate past Chair, for having kept the SAC in good condition and for his ongoing support and advice. I look forward to the evolution of the BCT research agenda, working with our strengths and expanding our horizons in the coming years.