Advocate’s Report ASCO 2019: Q & A with Dr. Peter Lucas

by LBCA Steering Committee member Diane Mapes (aka @double_whammied)

Diane Mapes

At the 2019 American Association of Clinical Oncology (ASCO) annual meeting in Chicago, the LBCA was able catch up with Dr. Peter Lucas, molecular pathologist with the University of Pittsburgh and UPMC Hillman Cancer Center. Dr. Lucas gave a talk during the morning educational session on Uncommon and Rare Cancers, focusing on pathology and covering invasive lobular carcinoma along with other subtypes.  His presentation before this important audience of oncology professionals emphasized the differences in ILC’s biology, tumor characteristics, response to therapies, and that ILC as a subtype is understudied.

Dr. Peter Lucas

Dr. Lucas collaborates on lobular research with Dr. Steffi Oesterreich and Dr. Adrian Lee and many others at UPMC Hillman Cancer Center, but as I learned while chatting with him, he does much, much more. He’s part of a huge national clinical trial network known as NSABP/NRG Oncology (more on that below) and he’s also professor of pathology and pediatrics at the University of Pittsburgh School of Medicine. You can read more about his research on protein signaling pathways at UPMC Hillman Cancer Center via his lab’s website.

Below, a brief interview with Dr. Lucas on how lobular is finally getting some long overdue molecular scrutiny and how we, as members of the LBCA, can help get the word out about ILC’s quirks.

Wonderful presentation on lobular breast cancer, Dr. Lucas. And thanks so much for making time for the LBCA. Can you tell me a little about what you’re working on right now?

We have multiple things going on right now. We have a basic research lab looking at mechanisms of cancer development. I’m also involved with the NSABP, the National Surgical Adjuvant for Breast and Bowel Project, which is one of the major clinical trial cooperatives for breast cancer.

Tell me about the NSABP. It sounds kind of like SWOG.

NSABP is an entity that works closely with University of Pittsburgh and the UPMC Hillman Cancer Center and many other cancer centers around the country to develop clinical trials in breast and colorectal cancer. There’s a 60-year history to this organization. It’s one of the longstanding NCI-supported clinical trial cooperatives. It’s now part of NRG Oncology, which is a larger umbrella clinical trials group. (Editor’s note: read more on NRG Oncology and this new national clinical trials network here.)

There’s always another acronym.

Yes. [Laughs] So we work on clinical trials in breast cancer. And then we also work with Drs. Steffi Oesterreich and Adrian Lee and others at the UPMC Hillman Cancer Center to really try to understand the biology behind lobular breast cancer and try to understand the unique features of this cancer, and how we can leverage that knowledge to treat patients with lobular breast cancer more effectively.

Because lobular has different targets, yes? And you folks are all trying to find something that will work on those targets?

Exactly. There was a time when people felt that lobular and ductal breast cancers were exactly the same. People thought “Yeah sure, they look different under the microscope and that’s a curiosity. They should be considered the same, treated the same, the outcomes and everything will be the same and anything you learn in a clinical trial on ductal cancer can just be applied to lobular breast cancer.”

But we’ve come to realize more recently with work from folks like Steffi and others, that lobular is different. This is a special type of breast cancer and deserves a deeper understanding of its molecular drivers, its response to therapy and its natural history.

We need to pay attention to those things. We need to understand them better so that we can fine tune our approach to that.

I really appreciate that.  Although is it accurate to say “There was a time …” ?

That’s a very good point. This is moving. This is a movement that has not yet been completed.

It seems oncologists in the academic or institutional settings are more aware of the key differences between lobular and ductal BC. But maybe not as much in the community care centers?

Yes, and this is where your group, Lobular Breast Cancer Alliance, is doing great work to educate everyone from patients to clinicians. You are educating everybody who is affected by this. (Editor’s note: Just learning about lobular? Check out the LBCA Resource Library.)

How does a patient make sure their oncologist is up on the latest research and treatment?

When you’re dealing with something that’s less common, the more patients can be their own advocate … the more they can push for more nuanced responses from their caregivers to make sure their particular situation is being considered more carefully.

The more patients can know about their own disease, the more they can advocate for themselves. You wish it didn’t have to be that way. You wish caregivers were always be on top of every aspect of cancer. But when it comes to something that’s more rare … 

It’s the nature of the beast. I know, plus their time is limited; they’re spread very thin already and it’s hard to keep up on all the new research. However, patients need somebody who’s up to speed. Can a patient “fire” their oncologist and find someone more receptive if need be?

Absolutely, if you don’t feel like you’re being heard, you can always get a referral.

(Editor’s note: check out the LBCA’s vetted research for studies to share with your oncologist if they’re unfamiliar with lobular’s oddball nature. And check in with NCI Designated Cancer Center if you want a second opinion; some oncologists even do them via Skype.)

It’s wonderful to meet you, Dr. Lucas. And we at LBCA so appreciate hearing about all the work you’re doing, and thank you for sharing information about ILC at ASCO.