Projects / Strategies for the next years
The BCG plans to focus its future research on three distinct but overlapping areas: local therapy studies, neo-adjuvant trials, and metastatic niche trials. For each of these areas the group has considered the prevailing EORTC Headquarters strategy of focusing on large practice changing studies and translational research with an emphasis on niche trials.
The future strategy of the BCG is to be built on the success of the group in the area of local therapy studies with an increasing focus on improving local control and the understanding of biology of local relapse. In addition, our priority is also to establish a fruitful and close collaboration with other EORTC groups that can contribute substantially to both the scientific and quality assurance (QA) issues in such projects. A good example of such collaboration is the collaborative work with the EORTC Radiation Oncology Group on the design and conduct of AMAROS and SUPREMO trials, and the detailed discussions that have taken place around the QA and treatment planning aspects of the proposed follow-on POWER trial. The BCG has just started, together with the EORTC Radiation Oncology Group, BIG, and TROG, a study in patients who receive breast conserving treatment for DCIS (ductal carcinoma in situ). The value of a boost irradiation is evaluated after whole breast irradiation given in a hypo- or conventional radiation fractionation schedule.
It is increasingly clear that further improvements in the systemic therapy of early breast cancer will require international collaboration between different groups. Over the past 15 years, BIG has formed a powerful platform for such collaboration and successfully delivered two large adjuvant trials in HER2+ breast cancer, ALTTO and HERA. The BCG has enrolled in these studies and plans to be an active contributor to such important international, inter-group collaborations as evidenced by its leading role in the EORTC-BIG MINDACT study. In the neo-adjuvant arena, the BCG has successfully conducted the p53 trial (EORTC 10994) and is currently in the midst of opening a smaller randomized Phase II study comparing Lapatinib with Trastuzumab in the HER2+ sub- population which will also collect prospective samples for translational research.
Future work in the area of metastatic disease is likely to focus on niche trials, which is perhaps best evidenced by the current intergroup project in male breast cancer. A second example would be the proposed trials of concurrent radio- and targeted therapy in patients with triple negative and in patients with HER2+ metastatic breast cancer with brain metastases as well as numerous NOCI projects to be conducted in breast cancer population. Collaboration with the EORTC task force in elderly, can also be considered a niche, as although there is an ever increasing population of elderly patients with breast cancer, design and recruitment to such studies is more challenging and almost always only done by academic groups such as the EORTC.