Australian cancer breakthrough could mean an end to relapse for thousands, including Colette

3 months ago 9

Collette Chase says the hardest part of finishing breast cancer treatment is the fear that the disease will return.

“Even Princess Kate said it recently ... you just live in a ball of anxiety,” said Chase, who is in her 50s.

Colette Chase had no family history or any genetic factors that would predispose her to breast cancer.

“People will say to you, ‘Ah look, you could get hit by a bus tomorrow’. I’d choose that because if this comes back metastatic as stage 4, what’s [the treatment] going to do to me?”

Australian scientists are hoping to alleviate this fear and halve breast cancer recurrence by utilising new technology that allows them to find, isolate and study the rare cancer cells lying dormant in people’s bones.

Garvan Institute researchers have discovered how to find the previously undetectable cells, and their technology will be used in a $25 million research project to learn how they hide, how they are different, why they “wake up” and how they can be destroyed beforehand. It has potential to be applied to our understanding of why other cancers return.

Despite dramatically improved survival rates, about 15 per cent of breast cancer patients will experience a recurrence of it within 10 years, which can be fatal. This is because rare “seeds” of cancer can conceal themselves, most often in bones, and remain dormant for years, sometimes decades.

A team of 60 researchers from seven Australian institutes and organisations, the Universities of Sydney and Newcastle, multiple Australian hospitals and universities, plus Yale and Washington universities, have been awarded the National Breast Cancer Foundation’s biggest grant for the project, dubbed AllClear.

It will run clinical trials alongside research, to bring advances to patients in real time.

Joanne Gilson says research that can alleviate the worry of cancer relapse is very welcome for patients.

“Studying these ‘seeds’ of relapse will allow us to understand what is driving recurrence, which could transform how breast cancer is understood and treated, and also help us understand other cancers, giving hope to more people,” said Professor Peter Croucher, co-director of the Cancer Plasticity and Dormancy Program, and lab head at the Garvan Institute of Medical Research.

Once the seeds have woken up, they are enormously difficult to treat. But the AllClear team hopes to be able to create ways to predict which patients may get cancer recurrence, and develop targeted therapies to prevent it.

Breast cancer patients were heavily involved in the project’s design, and said it was difficult living with the knowledge that their cancer might return.

“One of the huge challenges for individuals is living with that uncertainty,” said Croucher.

“That’s the thing they’ve been looking for, ‘when will we get the all-clear?’”

About 21,000 Australians are diagnosed with breast cancer annually, and about 3300 Australians die of the disease, or nine a day.

Melbourne woman Joanne Gilson had children in years six, seven and 11 when she was diagnosed with invasive breast cancer in 2021. Though her cancer was caught relatively early, like Colette Chase, she says the question of relapse is difficult to live with.

Gilson, who works in digital transformation, has been informed that with her type of cancer, the chance of a return increases with time: “My breast surgeon said, ‘I want to get you to 20 years’. I’ll be 67 and you kind of go, ‘what happens after that?’.

“It’s frightening. You go for different check-ups, and they tell you you’ve got a spot on your liver or a nodule on your lymph node – but it’s all right. You’re constantly living with ‘what does that mean? Is it metastasis, what’s going on?’”

She is keen to be involved with the project. “We don’t know how many dormant cells that escaped are in your body that are asleep and are just going to wake up.”

Professor Nicholas Huntington, cancer immunotherapy head at the Biomedicine Discovery Institute, Monash University, said the project would examine how the immune system might be impaired or suppressed by cancer cells that travelled to the bone marrow.

“They’ll be able to develop pathways that would be druggable, to help eradicate these cells in bone marrow to prevent them from coming back,” said Huntington, who is not part of the project.

“This is really the goal; the death rate still remains unacceptably high and this is a really promising approach to try and slash that death rate and have insight into which patients need more follow-up.”

National Breast Cancer Foundation chief executive Dr Cleola Anderiesz said the project’s potential to stop breast cancer recurrence could “unlock insights for other cancers as well, offering hope to more people”.

For Chase, the project has the potential to offer cancer survivors a sense of control.

Before diagnosis, aged 51, she had run marathons and her Instagram was full of “a bunch of shops and celebrities”. But after surgery, which involved chemotherapy and five weeks of radiation for triple-negative metaplastic cancer, she felt “like an imposter in my own life”.

“That assumption you’re going to live to a certain age is taken away from you,” says Chase, who works in the water industry.

But at least while receiving treatment, “you have a sense of control; you are fighting it”.

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