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NYU School of Medicine
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$5 Million Award Establishes Center at NYU for the Study of an Often Lethal Form of Breast Cancer in Medically Underserved Women

NEW YORK, November 16, 2004 -- NYU School of Medicine received a $5 million government grant from the U.S. Department of Defense to establish a Center of Excellence for the study of an often lethal form of breast cancer called locally advanced breast cancer (LABC) that is prevalent among medically underserved women.

“LABC remains insufficiently studied,“ says Silvia Formenti, M.D., the Sandra and Edward H. Meyer Professor and Chairman of Radiation Oncology and Professor of Medicine at NYU School of Medicine, and principal investigator on the grant. She attributes part of the problem to the barriers many women with the disease face in getting access to care and enrollment in clinical trials.

LABC is defined as breast cancer in which the tumor is 5 centimeters in diameter or larger and may have spread into the surrounding lymph nodes or other tissues, but hasn't yet spread to more-distant areas of the body. In the United States LABC is fairly uncommon, representing only about 10 percent of those women who are diagnosed with breast cancer. But among socially disadvantaged and minority women, it is far more prevalent, accounting for about 30 percent of breast cancer cases.

Center of Excellence
The grant, which is funded by the U.S. Department of Defense, will establish a Center of Excellence at NYU School of Medicine that will bring together top clinicians and basic scientists in an international translational research program aimed at improving the understanding and treatment of LABC.

NYU‘s relationship with Bellevue Hospital in New York City makes it the ideal institution to host this center, explains Dr. Formenti, because the underserved women she treats at NYU and Bellevue represent a wide spectrum of races and ethnicities. “We have Polish women, Israeli women, women from the Dominican Republic and other Hispanic countries, African-American and Caribbean-American women, and many Asian women,“ she says. “The face of LABC in New York is much more international and multi-ethnic, and that gives us a unique base of genetic diversity. We couldn‘t do this project anywhere else.“

LABC is pervasive in developing countries, notes Dr. Formenti. Although precise data are scarce in many areas, it is thought to make up as much as 70 percent of breast cancer cases in developing countries, where public education is poor, screening is not widely available, and treatment is far from state-of-the-art. In such places a diagnosis of LABC often amounts to a death sentence.

The bottom line is that women with greater access to care, including mammographic screening, get diagnosed and treated earlier. But for women facing cultural barriers, economic hurdles, and other limitations, a tumor may have grown to the size of a tennis ball by the time they finally see a physician. Without treatment, explains Dr. Formenti, fewer than 20 percent of patients are still alive five years after their diagnosis. Even when appropriately treated, LABC is deadlier and less responsive to treatment than breast cancer that's detected earlier, for reasons that are not clearly understood.

The Center‘s Partners
The NYU team will partner with Stellenbosch University in South Africa and Instituto Oncologia in the Dominican Republic (with possibly more international sites to be named later), to recruit some 750 multiethnic, multinational women with LABC to participate in clinical trials. Information on the patients' histories, tumors, blood and tissue samples, and treatment will be collected in a database focusing on LABC, the first of its kind.

Patients at each of the program‘s sites will initially undergo identical treatment, a standardized chemotherapy/radiation protocol using the drug paclitaxel (Taxol). Both before and after treatment, each patient‘s tumor will be analyzed for genetic expression signatures (the biochemistry unique to specific types of cells), as well as genetic, molecular, and biochemical alterations in key pathways that control tumor growth.

The ultimate goal is to create tailored treatments that are designed to respond to the unique genetic and molecular characteristics of an individual woman‘s tumor. “We hope our findings will also provide targets for diagnostic information,“ explains Dr. Schneider, “so that we will know how to monitor women and better understand who's at risk for metastasis (spread of cancer), whom we have to be aggressive with and whom we don‘t.“

The NYU Team
The new center builds on results from a previous collaboration of Dr. Formenti and Robert J. Schneider, Ph.D., Professor of Microbiology and Co-Chairman of the NYU Cancer Institute‘s Translational Cancer Research Task Force, that was funded by the Breast Cancer Research Foundation and focused on LABC in the diverse population served by Bellevue. The center‘s research team includes Judith Goldberg, Sc.D., Professor and Director of the Division of Biostatistics, and Paolo G. Toniolo, M.D., Associate Director for Epidemiology and Prevention at the NYU Cancer Institute, who together provide statistical and epidemiological expertise. On the clinical side, they are joined by medical oncologist Matthew Volm, M.D., Assistant Professor of Medicine, surgical oncologists Karen Hiotis, M.D., Assistant Professor of Surgery, and Kristin Skinner, M.D., Associate Professor of Surgery, and breast pathologist Dr. Baljit Singh.

Leading scientists at other institutions--cancer genomics experts Anold Levine, Ph.D., Professor at The University of Medicine and Dentistry of New Jersey, and Robert Lucito, Assistant Professor, and Michael Wigler, Ph.D., Professor, both at Cold Spring Harbor Laboratory--also are collaborating on the LABC project.

A Better Treatment Paradigm for All Breast Cancer Patients
In the long run, notes Dr. Formenti, a better understanding of locally advanced breast cancer may lead to better treatments for all breast cancer patients. “We‘ve chosen LABC as a model to understand what kills women with breast cancer, and to study the international breast cancer problem,“ she says. “Right now, almost everyone gets the same first-line treatment, the same second-line treatment, and so on. We want to learn enough about breast cancer and how it metastasizes (spreads) to change that paradigm. With that improved understanding, we hope to have a significant impact on the mortality of the disease.“