Invasive Lobular Breast Cancer: Steffi Oesterreich Shares Insightful Learning Sessions Exploring ILBC at SABCS 2022

By Steffi Oesterreich, PhD

So, I was very excited about increasing attention to special subtypes of breast cancer. There was actually a unique session, an educational session called Challenging Types of Breast Cancer: Lobular/Pleomorphic, and I was very excited because invasive lobular breast cancer, which affects approximately 10 to 15% of all breast cancers, received quite a bit of attention there.

I think in prior years that didn't happen so much here at the San Antonio Breast Cancer Symposium (SABCS), so this was really fantastic. They were two great talks summarizing and giving updates on genomics of breasts, of these invasive lobular breast cancers on what we have understood from clinical responses.

And I should say this is mostly not from trials, but often from retrospective analysis of either registries or a few trials, but ILC (Invasive lobular carcinoma) was usually in the minority of the samples, so it was sometimes hard to make solid conclusions. But again, just having more than 60 posters here, it's very exciting. It's great to, to see that the physicians, the breast cancer community pays increasing attention to invasive lobular breast cancer.

Which subtypes were discussed? 

There was a lot of emphasis on invasive lower breast cancer and a lot of emphasis on metaplastic breast cancer. We have other unique subtypes, which clearly need to be studied further. That couple of groups really leading this, a presentation from Dr. Jorge Reis-Filho, who has been studying these low grade triple negative breast cancers, which have surprisingly good outcomes, so we need to really focus more on those. Having said that, personally, I was super excited about the data on invasive lobular breast cancer.

Why is ILC important and why do physicians need to care?

I strongly believe that it is necessary that physicians have an increased interest in really understanding invasive lobular breast cancer. I think all of us, it's 10 to 15% of all breast cancer cases, which adds up to almost 40,000 new cases each year here in the US alone. And at the moment, despite that, the disease is clearly different, it looks different. On pathology, I think it is there are more late recurrences. The metastasis, the pattern is very different at the moment the treatment is exactly the same. We don't have unique treatments. I think there are, we begin to start changing management of the patients, but we don't have unique treatments, so we really need to do more. We need to understand the basic biology of this disease, of this subtypes in more detail to set up clinical trials to really target that population of patients.

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What is Invasive lobular breast cancer (ILC)?

Invasive lobular breast cancer (ILC) is a type of breast cancer that starts in the milk-producing glands (lobules) of the breast and spreads into the surrounding tissue. It accounts for about 10% of all invasive breast cancers.

ILC is characterized by a pattern of cancer cell growth that is different from the more common type of breast cancer called invasive ductal carcinoma (IDC). In ILC, cancer cells grow in a single-file pattern and often invade the surrounding tissue in a subtle, diffuse way, making it more difficult to detect on imaging tests like mammograms.

ILC is more likely to occur in women in their 40s and 50s and is typically hormone receptor-positive, meaning that the cancer cells have receptors for estrogen and/or progesterone on their surface. These hormones can fuel the growth of the cancer, so hormone therapy (such as tamoxifen or aromatase inhibitors) is often used to help prevent the cancer from recurring or spreading.

The treatment for ILC depends on the stage and characteristics of the cancer, as well as the individual patient's preferences and overall health. Surgery is usually the first step, with the goal of removing the cancerous tissue and preserving as much of the breast as possible. Radiation therapy may be recommended after surgery to help kill any remaining cancer cells.

Chemotherapy may also be recommended if the cancer is aggressive or has spread to the lymph nodes or other parts of the body. In some cases, targeted therapy may be used to target specific proteins on the surface of the cancer cells.

Overall, the prognosis for ILC varies depending on the stage and other characteristics of the cancer, but it tends to have a better outlook than IDC. With appropriate treatment, many women with ILC can survive and thrive for many years after their diagnosis.

What is next for ILC?  

At the symposium, we had quite a large number of posters. We had over 60 posters presented and very exciting. I think there were studies on metastatic dissemination. What's different? There were studies on liquid. Biopsy. There were studies, there was a survey, actually a number of organizations participated in this to really understand what would be the next most important research question. And if I think, what would be the next most important question? I think tackling liquid biopsies in patients with ILC will be very critical to use it as a measure monitoring disease progression. It's a great poster here from the Hayes study, from the University of Michigan. Showing that increased CTCs and CT DNA in patients with ILC (invasive lobular carcinoma), so I think expanding that research will be very important understanding more what's the role of e adhere. In the disease development and disease progression. And I think on the clinical side, I think to set up trials, specifically targeting what we understand, what we have learned in the lab, translate this into a clinical trial and to either have us exclusively for patient with ILC or match to 50/50 ID CLT. So enriched for patients with lobular low breast cancer so we can truly interpret the data. I think these are some of the focus areas where I hope that the number of institutions will collaborate. Get together and tackle this over the next few years.

Steffi Oesterreich, PhD - About The Author, Credentials, and Affiliations

Steffi Oesterreich, who has a PhD and works in the Department of Molecular Pharmacology at the University of Pittsburgh, is a very successful researcher and scientist. Her main research goal is to figure out how breast cancer starts and spreads at the molecular level, with an emphasis on estrogen receptor signaling.

During her academic career, Dr. Oesterreich has made important contributions to breast cancer research. Her work has been published in a number of high-impact scientific journals. Her groundbreaking research has also won her a number of medals and honors, such as the prestigious Susan G. Komen for the Cure Postdoctoral Fellowship.

Dr. Oesterreich's research has shown how complicated estrogen receptor signaling is in breast cancer and helped pave the way for the development of new ways to treat this disease. Her research has not only helped us learn more about the molecular mechanisms that make people resistant to current medicines, but it has also found possible new drug development targets.

In addition to her research, Dr. Oesterreich is a dedicated teacher and mentor. Over the course of her career, she has helped a large number of students and postdoctoral fellows. She is also an active member of the scientific community. She serves on the editorial boards of a number of important scientific journals and as a reviewer for a large number of funding organizations and scientific publications.