Big plans for MD Anderson's breast cancer program

Summer can be a quiet time at academic institutions, but things have been highly eventful for MD Anderson’s Breast Medical Oncology Department in the past couple of months.

Two significant recruitments were announced; including Debu Tripathy, M.D., an enthusiastic new chair with an optimistic view of his department’s role in improving care and expanding treatment options for patients facing the disease. And another addition made several news headlines when, in late July, MD Anderson revealed that V. Craig Jordan, Ph.D., the developer of several cancer-fighting drugs, would be joining the institution in the fall.

Jordan is best known for his key role in transforming a once-failed contraceptive medication (known at the time as ICI 46,474) into a valuable breast cancer treatment responsible for saving countless lives. The drug, later named tamoxifen, originally was created to block estrogen in the hopes of preventing pregnancy. He developed the strategy of long-term adjuvant tamoxifen therapy, as well as describing and deciphering the properties of a new group of medicines called selective estrogen receptor modulators (SERMs). He was the first to discover the preventive abilities of both tamoxifen and the drug raloxifene, both of which the Food and Drug Administration approved for reducing breast cancer incidence in high-risk women. Learn more about Jordan and his work here.

When Jordan begins at MD Anderson in October, he’ll join Tripathy, who arrives later this month. Tripathy, the new chair of Breast Medical Oncology, comes from the Norris Comprehensive Cancer Center at the University of Southern California. Tripathy recently spoke with Cancer Frontline about the ongoing mammography debate, his future vision for breast cancer care and research at MD Anderson and more.

Q: What drew you to MD Anderson?

A: MD Anderson’s rare combination of history, scientific excellence and unparalleled scope has made it the leading cancer research and care institution. From a personal standpoint, I enjoyed mentorship from senior MD Anderson faculty early in my career and robust collaborations with the institution over the years to the point that I’ve known and interacted with a majority of the members of Breast Medical Oncology as well as many from other departments. We all want to make the largest impact we can in the lives of those with cancer. I feel that I can best do that at MD Anderson. A shining example of that impact is the Moon Shots Program, which is assembling expert teams to solve difficult problems using revolutionary laboratory technology linked with clinical expertise.

Q: Tell us about your vision for Breast Medical Oncology. Where do you see the department heading under your leadership?

A: I would like to move toward a more patient-centered approach to breast cancer care and research. This approach reflects our growing understanding that the genomics and genetics of each person results in a unique type of cancer for which we need to personalize therapy. It also recognizes the human aspects of cancer care, recognizing that each affected person has a life circumstance that can dictate individual decision-making on their part. This is an amazing time of technological and biological advances, making breast cancer a more survivable disease. We are also in the midst of changes in health care delivery that aim to make the fruits of progress available as broadly as possible. We want to make sure that our services are available to those in Houston and the surrounding area, but that our impact continues to be worldwide. We can use technology and innovation to help make this happen.

Q: What are some of the most exciting recent advancements in the field?

A: MD Anderson has been a leader in the identification of genes that are altered and drive cancer growth and other characteristics. This can now be addressed by an array of drugs that are more focused and, therefore, have fewer side effects. This year we witnessed a boom in new biologically targeted cancer drug approvals and we expect that trend to continue due to sustained research efforts. While this is an important advance that is making a difference in the lives of cancer patients, we still have big challenges ahead because many cancers still have no cure. We have newer tools at our disposal to address fundamentally new scientific theories as to why some cancers may be difficult to eradicate. I believe that the coming years will be a triumph for “team science,” where multiple specialized research groups collaborate to use large amounts of population-based information and detailed testing on genes and proteins of each of their tumors to more comprehensively and efficiently develop new personalized cancer therapies and diagnostic tests.

Q: Is there a particular line of research you are excited about?

A: One area of particular interest to me personally is the identification of specific gene mutations that drive cancer, and the development of drugs that specifically target the consequences of those mutations. Because some of these mutations are shared across different cancer types, it’s possible that we’ll be classifying and treating tumors by their “genetic drivers,” and not the tissue of origin. This concept is already being tested at MD Anderson’s Institute for Personalized Cancer Therapy, and we’ll be collaborating in this area as well. I’m working with several other MD Anderson faculty members on a national trial, which is funded by the National Cancer Institute (the NCI MATCH Program), to test this on a national level.

Q: You were involved in the efforts to bring Dr. Jordan to MD Anderson. Can you tell us how his recruitment will impact the department and, more importantly, patients?

A: Dr. Jordan is a pioneer in the development of hormonal therapies, and these drugs are still among those with the biggest impact on improving the curability of breast cancer. His research continues to evolve. For instance, his team has uncovered a link between estrogen and pathways that lead to cancer cell death. Understanding the details of these pathways may lead to better therapies that may tackle breast cancers that become resistant to hormonal therapy. These findings can then be translated into clinical trials involving other members of our department. In addition, Dr. Jordan’s work extends to newer compounds that may prevent breast cancer in the first place, another area in which our department is very active.

Q: Tell us a little about your own work.

A: I am interested in understanding why breast cancer cells become resistant to drugs that initially are working. Overcoming resistance could make many of our drugs much more effective for a longer period of time, or more able to cure advanced breast cancer, which is a goal we have yet to attain. My research has focused on mechanisms of resistance to available drugs that block the function of a growth-promoting gene called HER2. We’ve discovered certain proteins that may cause resistance and we’re in the process of testing strategies to reverse their actions in the hopes that it can prolong remissions or even lead to cures in patients with advanced HER2-positive breast cancer, which account for about a fifth of all breast cancers.

Q: There has been plenty of healthy discussion about the role of mammography in detecting breast cancer. Any thoughts on that debate?

A: Mammography is still an important tool for early detection and lowers the death rate from breast cancer. However, it’s far from perfect in that it misses some cancers and also causes false alarms that may lead to unnecessary biopsies. It can also lead to “overtreatment” of very low-grade cancers that may never have caused problems over the patient’s lifetime. That’s why there’s an ongoing controversy as to who should have screening and how often. However, we cannot just throw out this screening test. We must continue to improve it and develop altogether newer ways to screen for cancers and to individualize who and how and when we screen.

Q: Closing thoughts and comments about moving to Houston?

A: I am very excited about all the possibilities at MD Anderson. The enthusiasm and talent here is unmatched. Houston is a city that embraces these qualities and has a diversity of assets — from the medical/biomedical to financial and energy industries and even newer areas such as the film industry — all while maintaining a focus on things that make life fun, such as the arts and an amazing restaurant scene. As someone who grew up in New Orleans, I also feel like it somewhat of a homecoming.