In the ever-changing landscape of breast cancer research, Komen Scholar Sara Tolaney, M.D., M.P.H., is leading innovative clinical trials and studies that are bringing new treatment possibilities to patients. Her novel treatment approaches include the use of antibody-drug conjugates (ADCs), immunotherapies and CDK 4/6 inhibitors, and also tailoring therapy for patients with early-stage HER2-positive disease.
Dr. Tolaney is receiving Komen’s Rising Star Researcher Award this year for her innovative research optimizing breast cancer treatments to make them more effective and less toxic to patients. Dr. Tolaney is chief of the Division of Breast Oncology at Dana-Farber Cancer Institute, associate director of the Susan F. Smith Center for Women’s Cancers and associate professor of medicine at Harvard Medical School.
Dr. Tolaney says she was thrilled to hear that she would be receiving Komen’s Rising Star Researcher Award.
“I think we all do what we do because we love being able to make an impact on patients’ lives and we are constantly driven to do more to improve breast cancer outcomes,” she says. “It’s really touching to be recognized for my work in this way.”
A Promising Career Path
Dr. Tolaney says that she knew early on in her career that she wanted to go into oncology, mainly because she saw an opportunity to develop unique relationships with oncology patients that were not commonly found in other areas of medicine.
“You get to meet a patient when they’re going through a pretty vulnerable time in their life; you get to help them through that and you get to see them very regularly – sometimes over the course of many years,” she says. “I really enjoyed being able to help someone through that time and developing such a close relationship.”
After graduating from medical school, Dr. Tolaney began her residency in internal medicine at Johns Hopkins, where she soon developed a passion for breast cancer research.
“I became more interested in breast cancer because I felt like it was a unique cancer where we had already started to understand its unique biology in a way that could help us develop better therapies,” Dr. Tolaney says.
With new advances in drugs that could target specific proteins on the surface of tumor cells, also called biomarkers, researchers found a way to develop treatments that met the unique needs of each patient.
“We knew if the markers were ER-positive [estrogen receptor-positive], we could develop hormonal therapies, or for HER2-positive, we had HER2-directed therapies,” Dr. Tolaney explains. “Over the years, [the biology] has only gotten more and more complex, but it has allowed us to really better tailor therapies for the patients.”
Harnessing the Power of Antibody-Drug Conjugates
Through a Komen-funded grant, Dr. Tolaney is investigating whether the use of an ADC called sacituzumab govitecan could make ER-positive metastatic tumor cells more sensitive to immunotherapy, which is not a current standard treatment for metastatic, hormone receptor-positive disease.
“We haven’t been able to figure out a way to make immunotherapy work in hormone receptor-positive breast cancer, and so part of our interest was trying to see if we could bring in a very potent drug called sacituzumab, to see if it could cause enough change in the tumor cell and immune microenvironment that we could make immunotherapy effective,” Dr. Tolaney says.
In this randomized, phase two study, Dr. Tolaney is testing the effectiveness of sacituzumab govitecan with or without an immunotherapy drug called pembrolizumab. She is also evaluating tumor biomarkers, which may help predict the benefits of therapy.
“I think this is going to be a really rich set of data that hopefully will have impact on our understanding of how we may be able to get immunotherapy to work in ER-positive breast cancer,” Dr. Tolaney says.
Personalizing Future Treatments
Looking back on her career, Dr. Tolaney considers her development of a new treatment regimen for patients with early-stage, HER2-positive breast cancers to be her greatest accomplishment. After giving these patients an abbreviated form of the chemotherapy along with trastuzumab, very few have experienced recurrences after their treatments, even with a follow-up of 10 years.
“That is probably one of the things I am proudest of, because that regimen has now been incorporated into national and international guidelines for breast cancer treatment,” she says.
Dr. Tolaney says that in the future, her efforts in breast cancer research will be focused on personalizing treatments to the needs of each individual patient.
“Over the next decade, we’re going to see lots of new therapy options for patients and we’re going to continue to make huge progress in improving outcomes, but I also hope that we’ll be able to understand enough about the biology to help tailor therapy to the right patient at the right time.”
