Breast cancer is the most common female cancer worldwide. Women who are at high-risk of developing the disease have few chemoprevention options and often resort to invasive prophylactic surgery.
Leading data and analytics company GlobalData, feels that new non-invasive chemoprevention strategies for women who are genetically predisposed to breast cancer are sorely needed.
While selective estrogen receptor modulators (SERMs) such as tamoxifen are formally approved for chemoprevention purposes, it is widely recognized that many women do not choose to take SERMs in this setting.
Alison Casey, Medical Device Analyst at GlobalData, says: “The lack of uptake of tamoxifen as a breast cancer chemo-preventive agent has mainly been attributed to the adverse side effects of the drug, although it has been suggested that poor patient and physician awareness may also contribute.”
While research focused on discovering new breast cancer chemoprevention agents is ongoing, substantial hurdles need to be overcome in order to translate promising findings to the clinic. Many physicians and pharma companies are wary of conducting clinical trials centered around prevention as they require long-term patient follow-up, thus creating additional logistical issues and financial considerations.
Currently, the University Hospital of South Manchester in the UK is carrying out a pilot-phase clinical trial to explore the feasibility of using ulipristal acetate (UA) to prevent breast cancer in high-risk women. It is hoped that results from the trial will shed light on whether this drug represents a viable future option for chemoprevention.
Another promising avenue for breast cancer chemoprevention is denosumab. There is a large body of pre-clinical research suggesting that this inhibitor can prevent key mitogenic and morphological changes, which occur in the breast in response to sex hormones or BRCA1 mutations.
Recently, a window-of-opportunity trial conducted in Australia showed that biopsies from BRCA1 mutation carriers treated with denosumab for three months had reduced levels of proliferation markers such as Ki-67.
Casey concludes: “While more work in this area is clearly needed, the trials of UA and denosumab take pivotal first steps towards discovering much-needed non-invasive options. Looking beyond breast cancer, the advent of DNA testing services, which offer to assess genetic risk for various different diseases, means that finding ways to measure prevention in a clinical setting is becoming more and more relevant. It stands to reason that as the number of people deemed to be at risk of a disease increases, so will the demand for safe and effective interventions.”
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