Today, we had the chance to sit down with Dra. Bermejo, Breast Cancer Specialist and our MedSIR Oncologist of the Month. Here’s an excerpt from our conversation:
MedSIR (MS): Thanks so much, Dra. Bermejo, for being with us today. It really is a pleasure for us to interview someone of your talent and passion for the field of Medical Oncology in general and, specifically, Breast Cancer.
Dra. Begoña Bermejo (BB): Truly the pleasure is mine. It is a source of great pride for me and for the whole unit of clinical trials in breast cancer at the Clinical University Hospital of Valencia where I work. We are fortunate to have the opportunity to offer our patients the best treatment options that in the majority of cases is participating in a clinical trial.
MS: Before we jump into an excellent example of a MedSIR clinical trial, the PHERGain study, let’s get to know you a little bit better. What brought you to Oncology? When did you realize that you wanted to help in this fight against cancer?
BB: In my family, although none of my parents are doctors, there were several medical professionals. My grandfather was a male nurse, which in those days was called “a practitioner “and who really worked as a doctor in the town where he lived. My older sister wanted to be a doctor since she was a child and today she is a very good gynecologist. Although in my case it was not like that. In fact, it was not until I had to make the decision of which university career I wanted to study when I finally decided to study medicine. I am a person who loves math and physics (numbers in general) but at that moment in my life when I had to decide what to do with my future, I felt I had to do something that would make sense to my future, that would make my time in life worthwhile and I thought that if I could save someone’s life that would make it worthwhile and that was the real reason why I studied medicine. During my studies, I wanted to be a pediatrician but when I had to decide which specialty to choose and where, I finally chose Oncology at the University Hospital of Valencia and although I still do not believe in destiny, it was the best professional choice I made in my life. Today, I feel that it is the most complete medical specialty at all levels: professional, human, multidisciplinary, research…
MS: Very interesting! So, today you are currently working in the position of Oncologist at Hospital Clínico Universitario de Valencia. What were your career steps? Who were the people who most influenced you along the way?
BB: I started my training as a medical oncologist in the Clinical University Hospital of Valencia , where I completed my four years of training and from the moment I finished I have being part of the breast cancer unit of this hospital. The first two years I also worked at the Hospital Frances de Borja in Gandia, where I can say with great pride, that I was the first oncologist that started the hospital´s oncology service. It was a very nice experience to create the area of oncology, the different oncology multidisciplinary committees, the day hospital and the breast unit in that hospital with the help of other specialists, especially radiologists, and surgeons. At this moment, there are three oncologists working in this unit, maintaining weekly contact with our hospital, which is essential in these smaller hospitals to maintain the quality of assistance and to offer the participation in clinical trials to the patients. After these two I spent all my years developing my work in the breast cancer unit of the Clinical University Hospital of Valencia.
I have been lucky enough to be able to work and learn from great professionals such as Professor Andres Cervantes and Professor Ana Lluch, my great teacher in breast cancer. I am also fortunate to know and work on many projects with Dr. Antonio Llombart and to be part of the cooperative groups in breast cancer in Spain, the SOLTI group and to have worked with Dr. Eva Ciruelos, Dr Javier Cortes and Professor Baselga and currently part of the Board of Directors of the other cooperative group, GEICAM, and share my work with Professor Miguel Martin, Dr. Joan Albanell, among many other professionals.
MS: Your specialty is Breast Cancer. What are the most recent advances that have you thinking that we are close to making big steps towards even better outcomes?
BB: One of the areas where great advances in breast cancer have been achieved is in patients with the HER2-positive cancer subtype. Currently, in this subgroup very high cure rates are achieved due to the incorporation of targeted treatments such as trastuzumab and pertuzumab. Likewise, in the scenario of advanced disease, new conjugated drugs have been incorporated that combine chemotherapy treatments with targeted therapies in the same drug, such as TDM-1. All these advances not only improve survival, they do it with a good toxicity profile avoiding even alopecia.
MS: Let’s focus more on the PHERGain study. According to your opinion, which benefits does this study bring to patients in comparison with other breast cancer treatments?
BB: We know because we have observed in other trials that there is a subgroup of patients with HER2- positive breast cancer that only with targeted treatments without the need for chemotherapy gets the disappearance of the disease and we know that this correlates with survival. The great difficulty is to be able to identify this subgroup of patients in whom it would only be necessary to give targeted treatments and avoid the unnecessary toxicity of chemotherapy. It would be a spectacular advance to be able to tell this subgroup of patients with breast cancer that just a few years ago was the most aggressive subtype of breast cancer, which could now be cured without the need for chemotherapy. Identifying this subgroup is the goal of the PHERGain study
MS: Recruitment in PHERGain study is very high at your site. What do you think about the study design and objectives? Did you find some difficulties in terms of screening? Would you recommend any protocol changes?
BB: The design of the study is of a high scientific quality. All currently available means of biology and imaging techniques are used to ensure that the patients who are receiving only targeted treatment without chemotherapy have no residual tumor remaining.
Regarding screening, we don´t find difficulties, not even with the tests to be performed. We are a center that traditionally always in our clinical practice have used neoadjuvant treatment. We have a multidisciplinary team formed by pathologists, surgeons, radiologists, radiotherapists, nuclear physicians among others in which absolutely all patients are discussed to decide the best treatment strategy. In this way, all patients who are candidates for neoadjuvance and in this case to participate in the PHERGain study are seen in our unit. In the same way weekly we meet with satellite centers that collaborate with our hospital and in the same way we discuss all the recent diagnoses of patients with breast cancer.
MS: Would you recommend any protocol changes?
BB: No, I think the design of the study is perfect and every detail is carefully studied, meditated and calculated to guarantee the best treatment strategy for the participating patients. Sincerely, it is a clinical trial that you enjoy offering to patients and I can assure you that it is also a study in which patients feel very safe to participate in and with a design and main objective with which they are all very excited. It will be a pity when the recruitment end.
MS: Your site is also participating in the LINGAIN study (PHERGain sub-study). What do you think about the sub-study rational? Do you think that immunogenicity biomarkers evaluated in the LINGain study could help to predict treatment response?
BB: The LINGAIN study is a Prospective evaluation of predictive/prognostic immunogenicity biomarkers for target therapy in HER2-positive early breast cancer within the PHERGain study. It’s a very interesting study. In this stage of oncology where immunity has been shown to play a fundamental role in the genesis and in the development of tumors, I believe it is very important to search in this subtype of immune-enhancing tumors that help us to better understand these processes, including the mechanisms of resistance, the search for immune biomarkers predictive of therapeutic response is becoming critically important to identify patients who would benefit the most from adjuvant immunotherapy .The dual HER2 blockade with trastuzumab and pertuzumab in the neoadjuvant setting is considered a more robust treatment approach with significant antitumor activity. It has been suggested that the mechanism of action of anti-HER2 molecular therapy is the T cell-mediated immune activation so it would be great if we could identify these immunogenicity biomarkers.
In the choice of biomarkers I believe that there is a great work developed by an expert team of immunologists.
MS: Lastly, what’s your opinion about how we work at MedSIR? Do you find our novel concept of helping researchers “bring their idea to life” to be important to clinical research?
BB: To date in all the trials and studies in which I have participated with MedSIR the work has been excellent, not only for the quality of their studies that I consider of great value and scientific interest (the PHERGain study is a sample of it) but also for the seriousness, the scientific rigor and the professionalism of its workers. Even in those situations where some setbacks have arisen (which can always occur), they have been solved in the best way and as quickly as possible.
MS:Thank you so much, Dra. Bermejo, for your time. It was really an honor to spend this moment with you.
BB: The pleasure is mine to be able to work with you and, above all, to be lucky enough to be able to offer our patients clinical trials as interesting and as high quality as the PHERGain trial.