National Breast Cancer Coalition

Prevention

Though preventing breast cancer metastasis is crucial to decreasing the mortality from breast cancer, the ultimate goal is to prevent breast cancer development all together, to avoid not only the mortality from the disease, but also the mortality and morbidity from treatments for the disease.

Though the increasing focus on the development of targeted treatments may lead to more efficacious and less toxic treatments, we will not make more than incremental progress over the next eight years unless we shift some resources to understanding the causes of breast cancer and learning how to prevent development of the disease. NBCC is doing just that through the Primary Prevention summit and workshops and the Artemis Project®.

NBCC’s Primary Prevention Work

The Summit on Primary Prevention of Breast Cancer was held October 1-3, 2011, in Aspen, CO. A diverse group of 35 breast cancer advocates, scientists, and clinicians, with a variety of perspectives on cancer prevention, attended the Summit. Participants included long-time advocates in women’s health, a biomedical engineer, epidemiologists, biochemists, evolutionary biologists and endocrinologists, along with breast cancer clinicians and surgeons. The group included a director of a center for the study of breast cancer and the environment, as well as principal investigators from several major studies in prevention, including studies of chemoprevention, exercise and diet and breast cancer risk, and a large study of cancer and diet in China.

During the meeting, participants divided into multidisciplinary groups to debate and discuss strategies for breast cancer prevention. Strategies discussed included:

  • Targeted prevention—broaden the concept and change the conversation around chemoprevention by developing validated and more precise risk tools, mechanisms to target, and agents.
  • Transformative lifestyle change (TLC)—modifying lifestyle factors, such as diet, exercise, and stress, particularly in combination, would provide some prevention benefit with no harm.
  • Pseudo-pregnancy to mimic hormonal changes that offer protection against post-menopausal breast cancer.
  • Develop a strategy to avoid the harmful effects of persistent ovulation.
  • Caloric restriction—developing drugs or lifestyle that lead to or simulate caloric restriction.
  • Windows of vulnerability, to determine common changes that occur; study normal human processes, then compare that information with tissue from diseased individuals.
  • Develop delivery systems, using nanotechnology to directly target breast epithelium.
  • Vaccine approaches.

All of the conversations and issues raised during the various meetings of 2011 have informed NBCC’s future plans and contributed to decisions about the next immediate steps needed to accelerate an end to breast cancer. NBCC is currently developing the foundation for several additional catalytic projects and other collaborative meetings of stakeholders in the next six to twelve months.

NBCC’s Artemis Project®

NBCC’s Artemis Project® brings together a collaborative group of advocates and scientists to take a strategic, systematic, yet broad approach to the development of a breast cancer preventive vaccine within five years, one primary project in our plan for meeting the deadline. Through the Artemis Project®, NBCC has created an innovative, advocate-led, mission driven model, which ensures appropriate focus on the end result. This model will be replicated to advance other identified priorities within the two key areas.

The Artemis Project® was chosen as the first focus area because the potential impact toward ending the disease is great and because recent scientific progress has created an opportunity. Increased knowledge about immunology, genomics, the molecular basis of tumor genesis and vaccine technology, including design, synthesis, and delivery, have together created an unprecedented opportunity for development of a preventive vaccine for breast cancer. A broad, systematic, collaborative approach is needed to ensure the safest, most efficacious vaccine is pursued in a timely manner.

A Plan for a Breast Cancer Preventive Vaccine

The first project to arise from this work brings together a collaborative group of advocates, scientists and other stakeholders, to take a strategic, systematic, yet broad approach to the design of a five-year development plan for a breast cancer preventive vaccine. NBCC chose a preventive vaccine as the first focus area because the potential impact toward ending the disease is great and recent scientific progress has created an opportunity. This project is not about taking the first possible vaccine target and accelerating it forward. Rather, it takes an unbiased look at what is already known and builds upon and harnesses that knowledge to create the safest vaccine that actually works to prevent breast cancer in women.

Four issues were identified as central objectives for the development of a vaccine. NBCC established a project team of scientists and advocates to work on each and across all:

  • Search for a virus(es) or antigen target(s) that will be safe, effective, and provide broad coverage for a diverse population of women.
  • Determine how the immune system responds to breast cancer with the aim of determining what the vaccine needs to accomplish.
  • Design appropriate clinical trials taking into account the optimal time for intervention and the appropriate population in order to achieve the highest impact and maximum results for those at risk of breast cancer.
  • Develop a plan to address safety issues across all steps of the project.

In April 2011, the National Breast Cancer Coalition convened scientists from academia and industry, including epidemiologists, immunologists, and computational biologists, as well as providers, clinicians and advocates, for the first annual Artemis Project® vaccine meeting. At that meeting, the participants began to develop the initial research agenda within the four primary identified focus areas.

Following the first annual meeting, NBCC prepared a detailed strategic work plan for the vaccine project, based on the outcomes of the meeting and follow-up interviews with attendees. This Project Plan was completed in December 2011.

In January 2012, NBCC issued a Call for Proposals to address the initial steps in antigen identification and prioritization, asking investigators to use computational and bioinformatics approaches to carry out a systematic analysis of existing and developing human genomic, proteomic, glycomic, or immune system profiling data within the context of human breast cancer. Letters of Intent were solicited in three areas:

1) Identification of breast cancer antigens in genomic and RNA expression data;
2) Viral and microbial gene expression in breast cancer; and
3) Identification of breast cancer antigens in human data obtained by proteomic, glycomics, or immune system profiling.

The second annual meeting was held March 3-5, 2012, in Calistoga, California, to assess progress in the field and within the project, and to adjust teams, projects, and focus as necessary. Meeting participants took a comprehensive look at antigen identification and developed strategies and models for determining what the vaccine needs to accomplish. The specific needs for antigen identification were refined and are reflected in the Call for Full Proposals issued to selected investigators in spring 2012. NBCC is working with National Philanthropic Trust to award initial grants for antigen identification by early summer 2012, and to issue a second call for proposals for antigen evaluation by the end of the year.

The third annual meeting will be held March 8-11, 2013.