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- 4 March 2019 -

Breast international group breast cancer network Canada and BIG NABCG collaboration

Fighting breast cancer around the globe - Canada and the BIG-NABCG collaboration

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The BIG-NABCG collaboration: shared goals and shared successes in breast cancer research. 

For over a decade BIG has collaborated closely with the North American Breast Cancer Group (NABCG) – a network of major US and Canada-based research groups. The result is a highly successful, continuing programme of research that is benefitting patients with breast cancer across the globe. Jenny Bryan asked researchers contributing to the collaboration about some of the achievements of the partnership, and its ongoing challenges and future plans.

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When BIG co-founder and chair, Professor Martine Piccart, first began to meet with the NABCG in the late 1990s to share research plans and priorities between the two organisations, she did not imagine the immensely fruitful collaboration that has emerged.

Starting with small, short, early morning meetings at each year’s American Society of Clinical Oncology (ASCO) congress, the collaboration has evolved into a major international partnership with multiple research and guideline programmes under its belt, and an annual one-day meeting of its own to discuss progress and plan ahead.

“It wasn’t long before we agreed that a one-hour meeting at ASCO only gave us a very superficial idea of the capabilities of these two important breast cancer research networks. We therefore set up a forum for much more in-depth discussions about how we could work together to our mutual benefit, and held our first formal meeting during the San Antonio Breast Cancer Symposium in 2005,” recalls Piccart.

Since then, the BIG-NABCG collaboration has established joint research programmes aimed at answering major questions currently facing clinicians and patients with breast cancer. Today, these include investigating the effects of interrupting hormone treatment for young women with luminal breast cancer so they can become pregnant, optimising treatment of metastatic breast cancer, and exploring the place of immunotherapy. In addition, the collaboration has helped to standardise aspects of diagnostic and research methodology, such as Ki67 assessment [1-4] and endpoints in adjuvant and neoadjuvant trials [5,6] and led to a much-needed research initiative in male breast cancer.

Together, BIG and NABCG are addressing some of the most challenging aspects of breast cancer research, such as male breast cancer, that are not supported by the pharmaceutical industry.

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“What makes the BIG-NABCG collaboration different from other research partnerships is that it is a long-standing relationship that is particularly focussed on finding ways to improve translational and clinical research in breast cancer, and it is academically driven,” says Dr Nancy Davidson, Senior Vice President and Director of the Clinical Research Division at the Fred Hutchinson Cancer Research Center in Seattle, USA, and co-chair of the BIG-NABCG Coordinating Group.

At last year’s BIG-NABCG meeting, delegates discussed barriers to clinical trials and how these may be addressed and overcome. This year, the spotlight is on treatment deescalation, and special emphasis is being placed on the input from patient representatives.

“We’ve come to realise that it may be possible to reduce the amount of treatment some women receive and therefore lessen the side effects they experience, while continuing to maintain therapeutic success,” explains Davidson.

None of the practice-changing findings from the BIG-NABCG partnership would have been possible without the generous financial support of the Breast Cancer Research Foundation (BCRF), which rapidly recognised the benefits of such a collaboration, and has provided funding since 2010.

“The goal of the BRCF has always been to see if we could do international trials more efficiently, so the BIG-NABCG collaboration was an obvious fit. We believe that, by working together, we can answer questions more quickly and move on to the next challenge that needs to be addressed,” says Dr Larry Norton, Founder and Scientific Director of BCRF.

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He explains that the Foundation was established by philanthropist, Evelyn Lauder, in 1993 with the vision of identifying the most creative, energetic and productive breast cancer researchers and giving them the resources, freedom and security to accomplish their goals.

Norton points out that a lot of research funding is based on success, and researchers are often working with the knowledge that their funding will stop if they fail. However, not every great idea works and a negative finding can be just as important as a positive one.

“At the BCRF, we have a peer-review process through which we find and discuss the most productive areas for research and fund them accordingly, rather than going through the conventional competitive grant process through which money is allocated,” he says.

The BIG-NABCG collaboration is not without its own challenges, not least language and time differences, and regulatory and funding issues. Even so, Norton explains that, with each passing year, collaboration members are becoming more communicative and relaxed in discussing their common goals and challenges:

“We have yet to reach our goal of truly international breast cancer trials answering critical questions very quickly, but we are breaking down the various barriers and I believe we can fully realise our dream of working together as a global community,” he concludes.

References
 
1. Dowsett M, Nielsen TO, A'Hern R et al. Assessment of Ki67 in breast cancer: recommendations from the International Ki67 in Breast Cancer Working Group. J Natl Cancer Inst 2011;103:1656–1664.
 
2. Polley MY, Leung SC, McShane LM et al. An international Ki67 reproducibility study. J Natl Cancer Inst. 2013;105:1897–1906.
 
3. Polley MY, Leung SC, Gao D et al. An international study to increase concordance in Ki67 scoring. Mod Pathol. 2015 Jun;28(6):778-86.
 
4. Rimm DL, Leung SCY, McShane LM et al. An international multicenter study to evaluate reproducibility of automated scoring for assessment of Ki67 in breast cancer. Mod Pathol. 2019 Jan;32(1):59-69.
 
5. Hudis CA, Barlow WE, Costantino JP et al. Proposal for standardized definitions for efficacy end points in adjuvant breast cancer trials: the STEEP system. J Clin Oncol. 2007 May 20;25(15):2127-32
6. Fumagalli D, Bedard PL, Nahleh Z et al. A common language in neoadjuvant breast cancer clinical trials: proposals for standard definitions and endpoints. Lancet Oncol. 2012 Jun;13(6):e240-8.