Pink October

Innovative treatments and early detection: the essential role of research in the fight against breast cancer

Every year, more than 11,000 new cases of breast cancer are diagnosed in Belgium, highlighting the crucial importance of research. 
Alexandra Van Keymeulen is an FNRS Research Fellow and Senior Television Promoter at ULB. She is a biochemist in the Stem Cells and Cancer laboratory. 
In this month of Pink October, and on the occasion of World Breast Cancer Day, we asked her about the advances, challenges and hopes linked to research against this disease.

• What are the major advances in breast cancer research?

There have been a lot of recent advances regarding breast cancer!

First of all, in terms of tumor classification, it has recently been shown that triple negative cancers can be divided into different subcategories, which will make it possible to better anticipate which therapy will be most suitable for each of them. In terms of precancerous lesions, we can now also classify them into different subtypes.

Then, in terms of therapeutic approaches , understanding the mechanisms involved in tumor development has made it possible to develop new strategies: a new targeted treatment has recently been put on the market, it is a molecule targeting the PIK3CA mutation, very frequently found in breast cancers. This treatment concerns ER+ type breast cancers at an advanced stage. THE targeted treatments  against HER2 type cancers have been improved and are more effective. Immunotherapy treatments have been shown to be effective against triple negative cancers in the early stages. A new class of molecules  exploiting the iron dependence of resistant cancer cells eliminates metastases in mouse models of breast cancer constitutes a promising lead  to be tested in patients. For women carrying a BRCA mutation predisposing them to breast cancer, a vaccine, which would attack cancer cells at an early stage, is being developed. And many other basic research studies have identified potential new targets.

In terms of cancer detection, there have also been major advances, both in terms of imaging, which is more precise and allows earlier detection, and in terms of liquid biopsies. These seem to make it possible, through a simple blood test, to detect the presence of metastatic cells and therefore to detect a relapse or resistance to treatment. Studies are underway to validate this method.

• What are the biggest challenges you encounter in your research?

The biggest challenge is definitely research funding! If the technologies developed in recent years allow impressive advances in the understanding of the mechanisms leading to cancer, their costs are enormous and often difficult to cover.

Then, it is sometimes complicated for the general public to understand the interest of fundamental research, for which it is difficult to directly see concrete applications. However, understanding the early mechanisms involved in the appearance of a tumor is crucial and will allow the identification of new therapeutic or diagnostic targets.

• What role does artificial intelligence play in your research work today?

Artificial intelligence is mainly used for the analysis and quantification of images, which saves significant time. It constitutes a third eye in the diagnosis, which sometimes allows us to detect small changes that we do not see. We hope that it will soon make it possible to predict the response to treatments for patients.

• We hear that AI would allow more personalized support, is your research going in this direction?

I don't think it's AI itself that will allow more personalized support. It is the understanding of the particularities of each tumor and each patient that will allow this personalized care. AI is accelerating our research, but we have been moving towards more and more personalized support for years.

• What are the research objectives for breast cancer in the coming years?

Fundamental research will allow a better understanding of the disease and the mechanisms involved, which will lead to the achievement of our objectives. We aim to better assess the risk of cancer relapse and the risk of progression of benign lesions, in order to allow therapeutic de-escalation for low-risk patients. Preventative treatments for people with a genetic predisposition are also a goal. Improving treatments, with fewer side effects and better quality of life for patients, remains crucial. Understanding the mechanisms involved in the reactivation of dormant metastases and in resistance to therapies still remains a major challenge for the years to come.