New clinical trial hopes to find "gold standard" for staging lobular breast cancer

“A completely new approach to imaging” is being tested as part of an exciting new clinical trial right here in Aotearoa. The trial will give New Zealanders with lobular breast cancer the chance to access world-leading innovation to help determine the best treatment for their cancer.

Dr Remy Lim, who is the medical director of Mercy Radiology, has been awarded a $550,000 research partnership grant from Breast Cancer Foundation NZ to conduct the four-year trial, which is now recruiting patients from public hospitals across New Zealand. This trial is possible thanks to generous donations from New Zealanders who are helping to support research and innovation so people diagnosed with breast cancer can live long, happy and fulfilling lives.

Lobular breast cancer is the second most common type of breast cancer, with around 450 women diagnosed in New Zealand each year. Rather than forming a lump or a mass, lobular breast cancer cells are more unnoticeable as they grow along single layers, making it harder to detect on a mammogram.

Because of the way it grows, diagnosing the stage and grade of lobular tumours can be complex. Without accurately knowing the extent of the spread of the cancer, patients with lobular breast cancer are far likelier to either receive more aggressive treatment than necessary or insufficient treatment, putting them at greater risk of their cancer returning or spreading.

Dr Lim, who carried out a similar trial in prostate cancer in 2016, says “We’ve designed a completely new approach to imaging lobular breast cancer using PET-CT with a newly discovered radioactive tracer called Fibroblast Activation Protein Inhibitor, or FAPI. By proving this is a more effective way to assess the extent of disease, patients will be able to receive treatment that is more reliably tailored to them and avoid unnecessary treatment.”

This is significant. It could help to prevent overtreatment of disease and would mean women with lobular breast cancer can avoid limiting side effects while feeling reassured they are receiving the right treatment to cure their cancer.

As a result of Dr Lim’s previous work in prostate cancer, PET-CT was funded for high-risk men in New Zealand in 2017. This adoption was long before many other developed countries and is now considered the gold standard for staging patients with high-risk prostate cancer.

The trial will involve 50 lobular breast cancer patients recruited from around the country who will receive a PET-CT scan. The radiotracer FAPI will be used during the scan which binds with cancerous cells to more accurately show the size of cancer in the breast and where it might have spread to. If there are areas of cancer that haven’t shown up on previous imaging, the clinical team will determine whether the patient was initially incorrectly staged and if a different treatment pathway should be recommended for them.

Currently, PET-CT scans are only available for people receiving private treatment. Breast Cancer Foundation NZ hopes the results from this trial will help improve equity and access to the best standard of care for all New Zealanders.

Chief executive, Ah-Leen Rayner says “by funding this research partnership, we’re hoping the results will make the case for PET-CT becoming funded for lobular breast cancer patients being treated in the public health system because currently, only women receiving private treatment can access it outside of this trial.”

Thank you again for your support. Together, we are working towards zero deaths from breast cancer. Innovation, research and new solutions are a big piece of the puzzle to achieve our vision. We are immensely grateful for the support, and we are eager to find out the results of this trial.