Laura J. Esserman, MD, MBA

2008-2009 BCRF Project:
The ultimate intervention for breast cancer is prevention. It indeed would eliminate suffering and death due to breast cancer. Dr. Esserman’s work has been focused on the discovery of agents that might work to prevent breast cancer. Any preventive agent has to be safe, well tolerated, and preferably health promoting, since it would be given to healthy women. However, rather than give such an agent to all women, it would be best to identify women at high risk. Women with in situ cancer or DCIS do not have invasive cancer. In particular, high-grade DCIS is thought to be a precursor to high grade more aggressive disease that is estrogen receptor negative (ER-negative).

Unlike estrogen receptor positive (ER-positive) disease, we do not have agents to prevent these cancers or reduce the chance of progression other than chemotherapy. The Esserman team has identified a very promising class of agents, statins, that may indeed work to prevent ER-negative or high-grade breast cancer and reduce recurrence. This class of drugs, commonly used to lower cholesterol to prevent heart attack and stroke, has the capacity to inhibit cancer cells. This effect likely has been missed because only certain types of statins, ones that cross the cell membrane (lipophilic statins), work to inhibit cancer pathways, and the effect seems to be predominantly in ER-negative tumors, a relatively small subset of cancers.

BCRF previously funded Dr. Esserman to run a multi-center window trial to determine the effect of 3 to 4 weeks of statin use prior to going to the operating room for surgical removal. Indeed, her laboratory found that fluvastatin (a lipophilic statin) can inhibit growth of cells, promote cell death, and reduce the size of tumors as measured by MRI. These effects are mostly apparent in high-grade breast tumors (most of which are ER negative). On this basis, the researchers will continue to work to understand the specific mechanisms by which statins are working and will partner with the collaborative groups to launch a national clinical trial to determine if statins prevent progression of high-grade disease. Over the course of the next year, they will also try to develop another class of agents for treatment of women with DCIS or very early breast cancer, drugs that target macrophages, cells in the immune system that may be recruited by tumors or serve to stimulate tumors to invade the tissues and enable growth of metastatic disease.

Bio:
Laura Esserman is Professor of Surgery and Radiology at the University of California, San Francisco (UCSF) and the Director of the UCSF/Mt. Zion Carol Franc Buck Breast Care Center. Dr. Esserman received her undergraduate degree from Harvard and her MD from Stanford University, where she completed her surgical residency and an oncology fellowship. After completing her medical training, she was awarded a Hartford Fellowship to enable her to pursue her MBA at the Stanford University School of Business. Dr. Esserman has a joint appointment in the Departments of Surgery and Radiology and is affiliate faculty for the Institute for Health Policy Studies and Medical Informatics Program. She is also the Co-leader of the Breast Oncology Program of the UCSF Cancer Center.

Dr. Esserman's practice is devoted to diseases of the breast, particularly breast cancer. At the Breast Cancer Center, patients are looked at as a whole person, and are not identified by their disease. This philosophy is behind Dr. Esserman's interest in helping women become more involved in their own decision making process. The Center is designed to advance the state of the art of delivering breast healthcare through better tools for risk assessment, better prediction of benefit from intervention, knowledge integration across the many disciplines and providers involved in care delivery, and integration of clinical research into the patient care process. The Center was created as part of a multi-million dollar grant, one of three awarded nationally, from the Department of Defense. Novel approaches include the introduction of a collaborative care decision focused model, where patients and physicians make decisions together, and the introduction and testing of tools to use risk assessment and new biological markers explicitly in therapeutic decision making.

Dr. Esserman is also involved in research and furthering the knowledge of providers as well as patients. Current projects include: the development of a vaccine for treatment of ductal carcinoma in situ; clinical trials designed around biomarkers; and developing MRI imaging as a surrogate marker of disease and response in order to improve cancer staging and enable the introduction of novel therapeutics. She also speaks extensively at many public and private forums and has published numerous articles covering a broad range of topics, from immunology to health policy and health care delivery. The philosophy underlying Dr. Esserman's research and practice is to ensure that a patient’s sense of comfort, knowledge, and participation are central in delivering the best care possible.