Brian Leyland-Jones, MBBS, PhD, director, Edith Sanford Breast Cancer Research, discusses the development of breast cancer risk assessment tools.

Leyland-Jones says all of medicine is becoming personalized. Currently, patients are treated based upon their tumor classification and are then characterized into groups based on tumor size and nodal status. Physicians are now adding genomic layers to other classifications to better treat patients with breast cancer, Leyland-Jones says.

Risk assessment is now beginning to follow the same trend, Leyland-Jones says. A demographic survey is given, mammographic density is assessed, and a new OncoChip, which covers 600,000 single-nucleotide polymorphism (SNPs) of particular risk genes, is used. These three approaches will form a new algorithm that individualizes the risk for each individual.

The idea, Leyland-Jones says, is that every woman will be given the risk assessment test instead of receiving a mammogram in the future.

Videos

Dr. Leyland-Jones on Breast Cancer Risk Assessment Tools

Brian Leyland-Jones, MBBS, PhD, director of Edith Sanford Breast Cancer Research, discusses results from an 8 year follow-up of the phase III HERA trial that compared 2 years of adjuvant trastuzumab to the standard 1 year in 5102 women with HER2-postive early-stage breast cancer.

Leyland-Jones believes that the length of time needed to reach the expected 725 events needed to power a survival analysis provides great news for patients with breast cancer. Many believed these results would be available sooner than 8 years. In general, the results for the two arms of the trial were similar, showing no additional benefit for 2 years of trastuzumab. Prior to this trial, Leyland-Jones believed an added benefit would be observed.

The adjusted hazard ratio (HR) for disease free survival for two years versus one of adjuvant trastuzumab was 0.99. The HR for overall survival between the two arms was 1.05. The overlapping of these curves demonstrates no benefit for an additional year of trastuzumab, Leyland-Jones explains.

Brian Leyland-Jones, MBBS, PhD, discusses results from the phase III HERA trial that compared 2 years of adjuvant trastuzumab to the standard 1 year in HER2-postive early-stage breast cancer.


Dr. Leyland-Jones Discusses the Phase III HERA Trial

Brian Leyland-Jones, MBBS, PhD, Cancer Therapies, Professor of Medicine, Emory University, discusses the use of whole-genome sequencing, describing that the cost has recently reduced, which makes it a more attractive option for many physicians.

Despite the reduced cost, Leyland-Jones believes that many institutions are not prepared to handle the amount of information gained from a complete sequence. He states that the complexity of looking at 3 billion base pairs, 30 fold, is a lot of genetic information to interpret.

Three approaches to genome sequencing, each progressively more complex, are used today. The first approach takes a snapshot of the genome and compares it to the 200 currently known oncogenes and mutations, the second option sequences the full exome and RNA, and the last looks at the entire genome.

Sequencing will eventually drift toward the whole-genome approach but for now a full exome and RNA sequence will suffice. This will change as more information is gained into the genome and as institutions and centers become better prepared.

Dr. Brian Leyland-Jones from Winship Cancer Institute Discusses Genome Sequencing

Brian Leyland-Jones, MBBS, PhD

Articles

Dr. Leyland-Jones on Breast Cancer Risk Assessment Tools

Dr. Leyland-Jones Discusses the Phase III HERA Trial

Dr. Leyland-Jones Discusses Genome Sequencing