Caring for patients while working to find a cure ‘brings incredible meaning’ to her work
A conversation with TBBCF 2018 grant recipient, Adrienne G. Waks, MD
By ELLYN SANTIAGO
Over a telephone, even with a bit of a summer cold making her delivery raspy, in her voice one can hear, and feel even, the passion she has for her work. Work that will make a difference in finding a breast cancer cure.
In 2018, the Terri Brodeur Breast Cancer Foundation awarded medical oncologist Adrienne G. Waks, MD, a $100,000 research grant.
Now completed, her clinical trial study assessed the feasibility for oncologists to use reduced levels of breast cancer medications post-successful breast cancer surgery. Its attainability has been borne out by her work.
Waks is a staff physician in breast oncology at the Dana‐Farber Susan F. Smith Center for Women’s Cancers, and an Assistant Professor of Medicine at Harvard Medical School. She earned her degree at Harvard Medical School and completed her residency training in internal medicine at Brigham and Women’s Hospital in Boston and has completed a clinical and research fellowship in medical oncology at Dana‐Farber/Partners Cancer Care.
This isn’t the first time we’ve shared news about Dr. Waks’ research study, supported in part by a TBBCF grant. In 2021, she presented her research at a conference in San Antonio. Read all about that here.
The DAPHNe study
Funded in part by TBBCF and completed in 2021, Waks recently published papers on her study which was focused on patients with non-metastatic, HER2+ breast cancer. One was featured in the Journal of the American Medical Association’s monthly peer-reviewed oncology journal and another in npj Breast Cancer, a multidisciplinary breast cancer research journal.
The study known as DAPHNe: De-escalation to adjuvant antibodies post-pCR to neoadjuvant THP (paclitaxel/trastuzumab/pertuzumab) – a pilot study in HER2-positive breast cancer, can be read on the National Institutes of Health site here.
The study’s overarching goal was to see if it’s feasible to reduce the amount of chemotherapy needed for patients with non-metastatic, HER2+ breast cancer, thereby minimizing side effects.
Patients were treated before surgery with a chemotherapy drug and two anti-HER2 antibody therapies. After surgery, patients whose cancer was successfully obliterated from the breast and lymph nodes, a pathological complete response, or pCR, got HER2-targeted medications but no additional toxic chemotherapy medicines.
The ultimate trial goal was to “determine whether participants who experienced a pCR after this pre-operative treatment combination could receive trastuzumab and pertuzumab after surgery, without any more chemotherapy,” Waks wrote.
Ninety-eight people from age 24 to 78, including one man, received treatment over 12 weeks. Of those, 84 had stage II breast cancer, and the rest had stage III. All got pre-surgery trastuzumab, pertuzumab, and chemotherapy med paclitaxel, the latter “prevents cancer cells from dividing, which eventually results in their death,” according to Waks.
It concluded deescalating chemo drugs for patients who had a pCR was a feasible treatment.
“The idea behind the DAPHNe trial: if patients are given medications before surgery, and if at surgery those drugs have obliterated the whole tumor from the breast and the lymph nodes, meaning they had a perfect response, they are very likely to have a good outcome long term. That’s the sort of overarching premise,” Waks told TBBCF. “So that was the premise of the trial, to see if we could give them some medicines before surgery and some medicines after surgery—we’re probably never going to get away from that—but if you could give fewer medicines with fewer side effects, would that be viable.”
Waks pointed out that the trial “wasn’t the definitive trial to show that that approach is effective for the overall population of patients.”
“The goal was to establish the feasibility, but not the efficacy and establish whether patients and their doctors and treatment team were comfortable with that approach, an approach that just makes intuitive sense,” she said. “Everyone wants more individualized treatment where they have the potential for fewer side effects.”
Bringing “incredible meaning” to her work
Balance is key: combine clinical care of patients and breast cancer research.
“I love taking care of patients. It brings incredible meaning to my work. The other portion of my time is fully dedicated to research, time that is dedicated to answering important questions,” Waks said. “But the only way to accomplish that is to apply for and get grants. Then you carve out time to answer those questions.”
“As a junior investigator, I’m interested in asking the questions that I hope are going to help patients. What is so wonderful about the Terri Brodeur model is how it specifically prioritizes supporting people who are just starting out. I’m grateful I’ve been able to, with TBBCF funding, dedicate time to this study.”
Walking for a Cure has a direct impact on this disease
Waks expanded on how seed funding from TBBCF, made possible by walkers and donors, can lead to potentially life-changing discoveries.
“There’s no way to build up to a practice-changing breast cancer research effort without the initial smaller efforts,” Waks said, referring to the essential grant funding that supported her work. Work that may lead to much larger, wide-scale federal and pharmaceutical research studies.
“I think it’s pretty fair to say that before the federal government or a pharmaceutical company would commit millions of dollars to a large trial, there needs to be evidence that it’s an idea that’s worth pursuing,” Waks said.
“Nobody’s going to spend millions of dollars on an idea that hasn’t been looked at by a number of different investigators in a number of different ways. You do this work hoping that, if the results are compelling, if your hypothesis works out, then it will sort of snowball into something that turns really impactful,” she noted. “There’s no way to build up to a practice-changing research effort without the initial smaller efforts.”
Those vital albeit “smaller efforts,” like Waks’ DAPHNe research trial, are made possible by those who care and care deeply.