IMPROVING THE EARLY DETECTION OF INVASIVE LOBULAR CARCINOMA

Dr Tivya Kulasegaran is a Medical Oncologist at the University of Queensland’s Centre for Clinical Research.

She is passionate about improving cancer services to rural and regional centres, and has a keen interest in lung and upper gastrointestinal malignancies.

This is the third year of the Breast Cancer Trials Clinical Fellowship Program and Dr Kulasegaran has been successful in receiving a fellowship in 2024. Her project involves establishing tools for the early detection of invasive lobular carcinoma and aims to improve clinical practice and treatments for patients.

“Breast cancer in the past decade has seen some great improvements in screening and treatment and this has been translated to an overall improvement in breast cancer survival. However, a proportion of women still undergo relapse and go on to develop metastatic disease and approximately 3,000 women die from breast cancer in Australia every year.”

“As a Medical Oncologist, I see firsthand how devastating this is for patients and their families. So, we need to be able to do better. And an area that my project is going to look at is biomarkers for invasive lobular cancer and how we can pick up on cancer early and hopefully be able to initiate therapy when the cancer is smaller and more manageable. And hopefully this translates to an improvement in survival.”

“Invasive lobular carcinoma is the second most common type of breast cancer. So, it forms in the lobules or the milk forming glands of the breast. And it counts for about 10 to 15 percent of all breast cancer subtypes. It has its own unique features, it responds to treatment differently, it tends to be more endocrine sensitive tumours and has a very distinct pattern of spread.”

“The treatment for lobular cancer is similar to all the other breast cancers. Generally, it involves surgery and endocrine treatment and sometimes we offer chemotherapy and radiation which depends on the tumour stage and the patient’s overall health status.”

What are some of the challenges in treating patients with this type of breast cancer?

“So, breast cancer is not a single uniform entity. Rather, it’s a very heterogeneous disease with distinct differences in their phenotype, their biology, and its molecular features. Invasive lobular cancer particularly has very unique features, but the treatment is the same.”

“What we offer lobular cancer treatment is the same if they had triple negative breast cancer. That generally involves chemotherapy. And the challenge we have is how do we personalise our treatment to both the patient and the tumour so that we’re able to target it and give us a better efficacy than just standard chemotherapy alone.”

“We don’t want to over treat a patient and expose them to all these toxicities that can have a significant long-term impact. At the same time, we don’t want to under treat. You want to be able to strike that fine balance. The other thing that we would love to do more in clinical practice is have targeted therapies, so therapies that’s targeted to the specific cancer.”

“I think circulating tumour DNA has the potential to be able to address this. It enables us to learn more about the tumour biology, its complex genomic landscape, and can be a very reliable predictive and prognostic biomarker. So, circulating tumour DNA, or CTDNA, is an emerging and promising biomarker. So, it refers to cancer DNA that’s being shed into the blood. And with a simple blood test or a liquid biopsy, we can pick up on these cancer cells.”

“The implications for patients is extensive. Firstly, if we can identify those cancer cells early, we can initiate therapy early. We can identify mutations which can open up a window of opportunity for targeted therapies. We can monitor treatment response. So as a patient progresses through their treatment, we can get real time monitoring or real time tracking of their response and identify if there’s new mutations coming through.”

“And we can identify and prognosticate patients. So, we can pick up on the patients that have a higher risk for relapse, and maybe these are the patients that will benefit from more intensive treatment and follow up.”

Would you say this is an exciting area of research?

“Yes. Very exciting. There’s so much potential, and it really is a valuable surrogate when assessing disease burden. It’s non-invasive or simple blood test makes it very appealing to patients, and it gives us an opportunity to look deep inside the tumour and learn from it and its genetic material.”

“We do have things that we need to tease out, for example, the validation and the standardisation of these procedures. But I’m very excited for what lies in the future. Results from this project and other similar trials should be made available in the next few years, and I think it’s very promising.”

What are your hopes for the future of this research?

“Well, I really hope that something promising comes out of this. I hope that we will identify new biomarkers and to help clinicians be able to learn more about the tumour, learn its mechanism of resistance, be able to tailor their treatment according to what they’re seeing, and to be able to either intensify or de-escalate treatment based on the biomarkers.”

“So, I hope that we’re able to move towards this era of precision oncology and that is tailoring our treatment according to the patient and their tumour.”