Invasive Lobular Breast Cancer requires different Clinical Management to Invasive Ductal Cancer

This week The Royal College of Surgeons hosted The Breast Cancer Ireland Dublin Steroid Cancer Conference. This prestigious event featuring presentations from world leaders in Oncology drew lots of media attention and was extremely well attended.

On Thursday 20th October a Lobular Breast Cancer Session was introduced and moderated by Professor William Gallagher, deputy director of Precision Oncology Ireland and AICRI All Island Cancer Research Institute.

Professor Adrian Lee at The Dublin Steroid Cancer Conference – Lobular Breast Cancer Session

The fabulous #Lobmob duo who are Professor Steffi Oesterreich and Professor Adrian Lee gave outstanding presentations on Invasive Lobular Breast Cancer, the 2nd most common subtype of Breast Cancer which until recent years has been understudied. Their most recent ILC Research gives fantastic insights into Lobular Breast Cancer as a distinct and unique subtype.

Published on 14th October in The Journal of The National Cancer Institute

Background: There is increasing interest in better understanding the biology and clinical presentation of invasive lobular cancer (ILC), which is the most common special histological subtype of breast cancer. Limited large contemporary data sets are available allowing comparison of clinicopathologic features between ILC and invasive ductal cancer (IDC).

Conclusions: This large, retrospective, collaborative analysis with 3  clinical centers identified meaningful differences in clinicopathological features between ILC and IDC, providing further evidence that these are 2 different entities requiring different clinical management.

Oncologists do know that the difference exists, but it would be helpful if knowledge were even more widespread. “It’s important for oncologists to be aware so they can educate their patients,”

Lobular Session 20th October RCSI An accompanying editorial on the research by three French experts said that the study confirmed previous findings, but “brings further robust evidence of the clinical specificities of ILC.”

In conclusion, Oesterreich and colleagues (1) present a highly informative study for ILC. In addition, this large series of ILC paves the path for future biological and genomic analyses. In particular, a better understanding of ILC microenvironment will be crucial, as tumor-infiltrating lymphocytes showed a negative prognostic impact in ILC (12,13), and the presence of immune transcriptomic signature appears to be a biological feature defining at least a portion of lobular carcinomas (14-16). These insights will hopefully reveal new therapeutic strategies and will help set up new trials specifically dedicated to ILC. Future trials in early ILC setting will also have to provide substantial follow-up to account for the late onset of metastasis in ILC and thus assess treatment efficacy as accurately as possible. Ultimately, the complete elucidation of the mechanisms involved in lobular cell dormancy, their mechanisms of metastatic spreading, and their therapeutic targeting is an important issue to cure ILC. To overcome this situation, several consortium efforts together with patient advocacies have been created over the past few years to better characterize lobular carcinoma, such the European Lobular Breast Cancer Consortium and the Lobular Breast Cancer Alliance in the United States, and will help improve the management of this disease in the very near future.

Professor Steffi Oesterrich
The Royal College of Surgeons Dublin Steroid Conference – Lobular Breast Cancer Conference October 2022

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