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Professor John Forbes awarded for his precious contribution to breast cancer research

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Professor John Forbes, Director of Research at the Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), was recently honored with the 2015 New South Wales (NSW) Premier Award for Outstanding Cancer Research of the Year. The Award honors Prof. Forbes for his extraordinary work and precious contribution to breast cancer research in terms of treatment and prevention both in Australia and internationally. It was presented by NSW Minister for Health Jillian Skinner MP during an event hosted by the Cancer Institute of NSW, in Sydney. BIG had the pleasure to ask a few questions to Professor Forbes.

First of all, we would like to extend our congratulations to you on this prestigious award. How did you feel about receiving this award?


I was honoured to receive the award, particularly as it recognises members of the Australia and New Zealand Breast Cancer Trials Group (ANZBCTG) and all of our collaborators. My research achievements, publications and other awards, have all been a result of collaborations with colleagues from the International Breast Cancer Study Group (IBCSG) and the original Ludwig Institute for Cancer Research (LICR), Breast International Group (BIG), IBIS (International Breast Cancer Intervention Studies) and many others in Australia and internationally.

 

What is your primary area of breast cancer research, and why is it important for patients?


My primary area is with large randomised trials that can produce reliable and definitive data, which can lead to improved outcomes for women. This encompasses prevention, systemic and local treatment of early breast cancer and treatment of advanced breast cancer. Our first ANZBCTG trial – ANZ 7801/2 was for women with advanced breast cancer. My particular concern is to achieve better outcomes for all women, with all stages of breast cancer, and for those women at risk of getting breast cancer.

'With a molecular approach linked to clinical trials outcomes – treatment and prevention – we can approach zero deaths and no new breast cancers in the foreseeable future'

Do you think we will see practice-changing results from breast cancer research in the next decade? Which ones?

Practice changing results can occur at any time and I’m always pleased when an unexpected paper reports better outcomes. We will see practice changing results in the next decade, most certainly, in the area of targeted therapies and using treatment strategies based on molecular analysis of the tumour and the patient. I would like to see a breast cancer management paradigm similar in principle to the cardiology model - cardiac risk is managed by monitoring simple biomarkers including cholesterol, blood pressure and an electrocardiography (ECG). These are simple tests usually managed by a family doctor with referral to a cardiologist as required. This approach, together with evolving treatments, has been associated with a downward trend in mortality from cardiac disease since about 1980, projecting to zero cardiovascular deaths by 2028.

The trend for breast cancer mortality rates is towards no deaths from 2040. This is far too long, hence our enthusiasm for a personalised approach for individual treatment of women based on reliable genomics and other molecular data from clinical trials. BIG is leading with new initiatives for collecting individual biomarker data in clinical trials. There are now thousands of women treated on trials who have documented outcomes – but we have only limited molecular data beyond estrogen receptors and HER2 (Human Epidermal Growth Factor Receptor2). With a molecular approach linked to clinical trials outcomes – treatment and prevention – we can approach zero deaths and no new breast cancers in the foreseeable future. No one at risk of breast cancer and no deaths from this insidious disease.

 

As a previous member of BIG’s Executive Board – we had the pleasure to have you on board as Vice-Treasurer from 2005 to 2010 - you’ve always played a key role in shaping the international breast cancer research agenda. The ANZ BCTG (Australian New Zealand Breast Cancer Trials Group), of which you are Research Director, has been involved in BIG from the very first days. What role do you think that international collaboration has played and still has to play in the fight against breast cancer?

International collaboration is a vital component of successful breast cancer research, particularly in the area of clinical trials. Without international collaboration we wouldn’t be able to conduct adjuvant clinical trials with the large number of women required - in contrast to advanced breast cancer - just in Australia and New Zealand alone. Collaboration has been the cornerstone of international clinical trials research, particularly our partnerships with BIG and IBCSG and even earlier with the original Ludwig Institute for Cancer Research for the very first adjuvant trials. Similarly we have collaborated with our IBIS colleagues for IBIS 1 and 2 and with several groups to contribute to each of the aromatase inhibitor adjuvant trials (ATAC, IES BIG -1-98). Through close collaboration we were involved with the design, conduct and analyses of these trials and learnt much from the process and from people we worked with. Collaboration with some of the best minds and capable people internationally allowed us to take part in practice changing research, including several well-known IBCSG trials, BIG trials and the IBIS trials. I was fortunate to be part of the group including Richard Peto and Michael Baum and others who initiated the Oxford Overviews, and to work together with outstanding researchers including Jan Stjernsward, Aron Goldhirsch, Alan Coates, Rich Gelber and Hans-Jorg Senn with the LICR and IBCSG, and Dr Martine Piccart with BIG. Collaboration has been intrinsic to my research from the outset.

'If women don’t get breast cancer, they don’t need treatment and they certainly don’t die from it. So prevention is a very important goal for the ANZBCTG and we know from working with consumers that it is a priority for women'

After chairing the international IBIS-I trial (International Breast Cancer Prevention Study I), whose positive results revealed that the drug tamoxifen could be used in breast cancer prevention, you are currently involved in the IBIS-II study, an international clinical trial supported by BIG and launched in 2003. IBIS II researchers looked at whether a treatment with the drug anastrozole could prevent the development of breast cancer in postmenopausal women who are at high risk. The first results of this study were published in December 2013.
What do these two important trials mean in practice for all women at risk of breast cancer?

The IBIS I and II clinical trials and similar trials, particularly those conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP), are looking at an approach to breast cancer that is the optimal way of dealing with the disease – primary prevention. If women don’t get breast cancer, they don’t need treatment and they certainly don’t die from it. So prevention is a very important goal for the ANZBCTG and we know from working with consumers that it is a priority for women. The opportunity that prevention trials represent is also unique. We are working with women who are part of a population at increased risk, while actually individual women may be certainly going to get breast cancer or have a zero risk. To reduce the sample size when we are testing a new intervention strategy we must reliably identify risk biomarkers. 

Higher risk means more events. But beyond that, prevention research is a wonderful human laboratory for identifying more important findings with respect to the biology of breast cancer. This is seen for example with the identification of breast cancer susceptibility genes like BRCA1 and 2, where the risk is very high - up to 80% for individual women. But there will be other less common biomarkers, and even non-genetic mechanisms, that we will be able to target in the future so that every woman can have an individual specific risk rather than a “population risk” applied to her as for the BRCA genes. Dynamic risk assessment – manipulating biomarkers to change risk – may be plausible in the near future – perhaps one day as simple as managing blood pressure.

We would like to know more about you. What do you do in your free time, what are your hobbies?

I like to spend time with my family and my five grandsons. I enjoy the opportunity when I travel to be able to visit art exhibitions. I’m a passionate follower of many sports. I read a lot – novels, crime and history and I enjoy walking. I’d like to have more time for gardening. But research is never far away. It is a way of life.

 

Professor Forbes is the Director of Research at the Australia and New Zealand Breast Cancer Trials Group (ANZBCTG), which is based in Newcastle. Professor Forbes is Professor of Surgical Oncology at the University of Newcastle and is Director of Surgical Oncology at the Calvary Mater Newcastle Hospital.

 

Read the Press Release of ANZBCTG dated 11 August 2015