At the 2024 ESMO BC conference, Professor Hope S. Rugo, the recipient of the 2024 ESMO Breast Cancer Award, reflected on the current challenges in the field of breast cancer during her speech.

After working in the field of malignant hematology for nine years, Professor Hope S. Rugo’s mother was diagnosed with metastatic breast cancer, prompting her to transition to breast cancer research and clinical practice. It was a difficult time for cancer patients, with limited treatment options, unfocused care, poor management of side effects, and no end-of-life support. Today, Hope S. Rugo is a Professor of Medicine at the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco (UCSF), and she has been awarded the 2024 ESMO Breast Cancer Award for her outstanding contributions to improving treatment options for future generations of breast cancer patients. Her desire to honor her mother has always been behind her professional achievements.

Oncology Frontier: What do you consider your greatest professional achievement so far?

Professor Hope S. Rugo: Witnessing the many challenges my mother had to face during her medical journey was a major motivation for me to work in cancer care. I strive to make cancer treatment easier, more effective, and particularly focused on improving patients’ quality of life. I feel very honored to have been involved in clinical trials and analyses that have significantly changed treatment options for breast cancer patients. Much of my work has focused on the clinical development of new drugs, including adding targeted therapies to endocrine and immune therapies, and recently, antibody-drug conjugates (ADCs) for metastatic and early/neoadjuvant treatments.

Earlier in my career, I entered the emerging field of biosimilars, where I led a clinical trial with my international colleagues (JAMA. 2017;317:37-47) and developed the first approved trastuzumab biosimilar in the United States. Before starting my internship at UCSF, I taught community health workers in the Philippines as a Luce Scholar for a year, so I understand the significant impact biosimilars can have in providing more effective treatments for patients worldwide.

Recently, my research has focused on understanding the mechanisms and timing of treatment toxicities, as well as their prevention and management. My team’s work (JAMA. 2017;317:606-614) led to the first approval by U.S. regulators of a scalp cooling device to prevent chemotherapy-induced hair loss. Our work also contributed to developing a simple steroid mouthwash to prevent stomatitis associated with everolimus and similar drugs (Lancet Oncol. 2017;18:654-662), and we are now investigating its use with novel ADC drugs.

For the I-SPY2 trial of neoadjuvant therapy, I will assist the safety working group. In this team, we are working to update safety data collection methods to improve and streamline the process. I am proud to be involved in efforts that help reduce the cancer burden for many women, and I am excited about the future direction of this work.

Oncology Frontier: Can you tell us more about your passion for patient education?

Professor Hope S. Rugo: I have always been passionate about patient education and training the next generation of researchers, helping them understand our past and future while inspiring and encouraging innovative research. As an Associate Editor for the ASCO Educational Book, I help promote the widespread use of this important educational tool. As Co-Chair of the Working Group for the Translational Breast Cancer Research Consortium in the United States, I provide advice for many investigator-initiated research projects led by my colleagues. It is an honor to work with international colleagues to promote effective and collaborative work practices and guideline development, which are crucial for advancing the field and helping our patients.

Oncology Frontier: At the 2024 ESMO BC conference (May 15-17, Berlin, Germany), your speech topic is “How future therapeutic research is shaped through lessons learned from treatment development for metastatic breast cancer.” How do you see the future of breast cancer treatment evolving?

Professor Hope S. Rugo: The main message of my speech is that our lessons should build on past and present failures and successes to improve our understanding of breast cancer biology. Based on our findings, we should tailor treatments to breast cancer biology, individual risk, and clinical response. For example, we learned from the RxPONDER (N Engl J Med. 2021;389:2336-2347) and CONFIRM (J Natl Cancer Inst. 2014;106:djt337) studies that differences in endocrine therapy efficacy can hinder effective treatment availability in clinical trials questioning chemotherapy. The same theory should extend to smaller, more flexible trials using registry-type datasets, potentially providing more appropriate treatments to patients faster than traditional large-scale, long-follow-up trials.

Looking ahead, we face more questions about treating early hormone receptor-positive (HR+) breast cancer, needing to identify patients at higher risk of recurrence, and exploring tumor-associated circulating tumor (ct) DNA in this regard. One major challenge we face now is managing resistant patients, including those with triple-negative breast cancer and rapidly progressing HR+ breast cancer. ctDNA, genomic RNA, and protein sequencing are helping us gradually understand these areas, but we still need to know how to incorporate this data into treatment models. I believe artificial intelligence will help us address this issue by leveraging large datasets, and solve many other challenges we will face in the future.

Considering the role of minimal residual disease in progression and recurrence, another important avenue is exploring non-hormonal treatments in neoadjuvant therapy. Identifying which treatments work for which patients in the neoadjuvant phase could significantly increase patient benefits. Currently, the I-SPY2 trial (JAMA Oncol. 2020;6:1355-1362) and other trials are exploring such methods. Finally, next-generation ADCs represent an exciting drug mechanism that can deliver chemotherapy more effectively and have already shown efficacy across breast cancer subtypes and stages. I hope ADCs will become the primary chemotherapy approach in the future, and I look forward to seeing these high-activity drugs enter early treatment stages faster.

References:

• Rugo HS. How future therapeutic research is shaped through lessons learned from treatment development for metastatic breast cancer. ESMO Breast Cancer 2024 Award Lecture, 16.05.2024, h. 14:10 – 14:40, Berlin Hall.

• Professor of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF)
• Director of Breast Oncology and Clinical Trials Education, UCSF Helen Diller Family Comprehensive Cancer Center