Like most major medical conferences planned for 2020, the San Antonio Breast Cancer Symposium kicked off on December 8 in an all-virtual platform. Just as the meeting adapted to these challenging times, so too must cancer research. That was the message of Norman E. Sharpless, MD, Director of the National Cancer Institute (NCI), during his plenary lecture “Advancing Cancer Research During Challenging Times.”

Dr. Sharpless began his lecture discussing the current status of the NCI, its budget, and leadership updates, but quickly focused in on the role of the NCI during the COVID-19 pandemic.

“NCI has specific expertise and capabilities that are useful to the nation’s pandemic response,” Dr. Sharpless said. That includes its broad portfolio of serology research, a large study of COVID-19 in cancer patients called NCCAPS, and providing guidance and special procedures for cancer clinical trials, among other things.

Adapting Trials

In consultation with the Food & Drug Administration, Dr. Sharpless said the NCI quickly did a number of things to allow cancer clinical trials to continue during the pandemic. These changes included transitioning patients to receive care at more local sites to minimize travel and exposure to the virus, and shipping orally administered cancer drugs straight to patient’s homes. In addition, informed consent was allowed to be obtained remotely, and telehealth allowed clinicians and researchers to do things by phone or internet that used to have to be done in person.

“People have really liked these changes and we have learned how to do more things with trials distantly,” Dr. Sharpless said. “Some of these changes are going to be positive changes that we are going to want to keep, because they benefit patients and make accrual to trials simpler.”

NCI is also researching how the pandemic will affect cancer in the future through delayed diagnosis, deferred care, and reduced screening, as well as its impact on cancer advances.

Data by week from the NCI’s National Clinical Trials Network showed that prior to the pandemic about 300 patients per week were accrued to its largest trials. In April, that was cut in half, but is slowly recovering.

“These trials will now take longer to finish, report out and, therefore, longer to be of benefit to patients if they show active new therapies,” Dr. Sharpless said, adding that accrual in industry-sponsored trials is as bad or worse than what is seen in NCI.

Cancer Research Updates

Dr. Sharpless also discussed several updates related to cancer research, including a study of “exceptional responders.” This was a comprehensive analysis of patients with cancer who had exceptional response to therapy. For 26 of 111 patients (24%), researchers were able to identify molecular features that could potentially explain exceptional response to treatment such as the co-occurrence of multiple rare genetic changes in the tumor genome or the infiltration of the tumor with certain types of immune cells.

“This gives us hope that we can understand how these drugs work and which patients are likely to benefit from them, but also shows us that we have a way to go to really understand why patients respond and to predict who will respond with greater reliability,” Dr. Sharpless said.

Finally, Dr. Sharpless also highlighted two ongoing studies looking at health disparities in breast cancer research. The first is the Breast Cancer Genetic Study in African-Ancestry Populations initiative, a breast cancer genetic study that will look at the genomes of 20,000 Black women with breast cancer and compared them with 20,000 Black women who do not have breast cancer. The second is the Detroit Research on Cancer Survivors (ROCS) study, which will investigate the myriad factors that may affect cancer survival including type of treatment, coexisting disease genetics, social structure, support, neighborhood context, poverty, stress, racial discrimination, literacy, quality of life, and behavioral factors such as smoking, alcohol use, diet, and physical activity.

The NCI is also looking within its own walls to address inclusion and equity in cancer research across its whole portfolio. It has established an Equity Counsel and tasked it with enhancing research to address cancer health disparities, ensuring diversity of thought and background in the cancer research workforce, and promoting an inclusive and equitable community at NCI.

SABCS registrants have exclusive on-demand access to this and other virtual SABCS programming until March 13, 2021.