From the Duke Cancer Institute archives. Content may be out of date.
Suzanne Wardell
Research that originated in a Duke Cancer Institute (DCI) laboratory contributed to Food and Drug Administration (FDA) approval of the first new endocrine therapy for breast cancer since 2002, and the only drug designed to target mutations in estrogen receptor 1 (ESR1).
Donald McDonnell, PhD, associate director For translational research at DCI and the Glaxo-Wellcome Distinguished Professor of Molecular Cancer Biology, directed the research team that led to the development of elacestrant (Orserdu, Stemline Therapeutics, Inc).
The new therapy, a selective estrogen receptor down-regulator (SERD), is indicated for the treatment of postmenopausal women or adult men with estrogen-receptor-positive/HER2-negative ESR1-mutated advanced or metastatic breast cancer who have been treated unsuccessfully with at least one previous endocrine therapy.
The FDA approved the therapy in January 2023.
Meeting a Need
Erik Nelson
The drug is the only SERD that can be taken orally, which makes it more convenient for patients. McDonnell said it fills a significant unmet need because up to 40% of patients diagnosed with ER-positive/HER2-negative breast cancer will acquire ESR1 mutations as the cancer advances. In most cases, these mutations will trigger resistance to standard endocrine therapies.
During the past decade, the McDonnell Lab has been focused on identifying and developing new endocrine therapies to treat advanced ER-positive breast cancer. This initiative has included revisiting older hormone therapies originally developed to treat osteoporosis or menopause symptoms.
Elacestrant, for example, was developed initially to treat hot flashes in post-menopausal women but was never approved for that use. Clinical trials demonstrated that RAD1901, as the therapy was known, stopped hot flashes at low doses but increased them at higher doses. McDonnell and researchers in his lab were intrigued by the pharmacology. “It turns out that the reason for RAD1901’s failure as a treatment for hot flashes was a useful property for a breast cancer drug,” McDonnell said.
Investigators who were trainees in the McDonnell Lab at the time, Suzanne E. Wardell, PhD, and Erik Nelson, PhD, determined that RAD1901 was effective at blocking the estrogen driving cancer cell growth by binding to its receptor, like a selective estrogen receptor modulator(SERM), and degrading the estrogen receptor, like a SERD.
Wardell and Nelson went on to demonstrate that RAD1901 inhibited tumor growth in mouse models. This was the springboard for continued investigations worldwide; culminating in the successful multicenter phase 3 clinical trial (EMERALD 2018–2022) that led to FDA approval. Wardell is now an assistant professor of pharmacology and cancer biology at Duke, in McDonnell’s lab. Nelson is now a professor of molecular and integrative physiology at the University of Illinois Urbana-Champaign.
“We’re already prescribing elacestrant for our patients,” said Heather Moore, CPP, PharmD, a clinical pharmacist with Duke Health, noting that the drug is currently being distributed nationally by two specialty pharmacies.
A team at the Duke Cancer Institute (DCI) is launching a first-of-its-kind study that could bring new hope to patients living with advanced colorectal cancer.Led by medical student Cheryl Chang and DCI medical oncologist Nicholas DeVito, MD, the project explores why some colorectal cancers that spread to the liver respond well to chemotherapy while others do not. The team recently presented this research at the American Association for Cancer Research (AACR) Immuno-Oncology (IO) Conference.This type of cancer can be especially challenging to treat. Patients often face fewer effective options, and outcomes can vary widely. By taking a closer look at what’s happening inside the tumor before and after treatment, the Duke team hopes to uncover clues that could one day guide more personalized and more effective care.When colorectal cancer spreads to the liver at the time of diagnosis, it often means a tougher road ahead. Doctors know that these patients typically do not respond to chemotherapy the same way others do, but the reasons behind that difference remain unclear.“If we can understand why some patients don’t respond well, we may be able to adjust treatment earlier, or develop new options altogether,” Chang said.To do this, the team is studying tissue samples taken from patients before treatment, when the cancer is first discovered, and after about six months of chemotherapy, when surgeons remove part of the liver or colon.Looking at these pairs of samples gives researchers a rare opportunity to see how cancer and the immune system around it changes during treatment.This is the first known study to compare liver metastasis samples before and after chemotherapy in this specific patient group. Despite decades of using chemotherapy to treat colorectal cancer, surprisingly little is known about how treatment affects the immune environment inside these tumors.“This is an area that’s been largely unexplored,” DeVito said. “We’re excited to contribute something new that has the potential to change how we approach treatment.”A big focus of the study is the tumor microenvironment, the community of immune cells, cancer cells, and other structures within and around each tumor. Using two advanced technologies, the team examines the tumor at both the protein and RNA levels.Working with John Hickey, PhD, assistant professor of biomedical engineering at the Pratt School of Engineering, the team employed the Codex assay in the study. By using special antibodies to highlight different cell types, the assay lets researchers map where various immune cells are and how close they are to the tumor.The team also partnered with Erika Crosby, PhD, assistant professor in the Duke Department of Surgery, to use the Xenium assay, which analyzes the RNA within cells. This helps confirm the protein‑level findings while revealing additional details that might not show up at the protein stage.Early results show meaningful differences between patients who respond to chemotherapy and those who don’t. Some immune cells appear in higher numbers in people who respond well, suggesting these may serve as early indicators of how effective chemotherapy might be.“Without this collaboration between surgery and biomedical engineering, locating and reviewing patient records and samples would have been far more time‑consuming,” DeVito said. “Everything came together at the right time: the technology, the expertise, and access to the right samples. That’s what makes a project like this possible.”A major boost for this work also came from CRUSH Colorectal Cancer, which supports early‑stage ideas that need initial funding before they can compete for larger grants.“CRUSH provided the seed funding that allowed us to get started,” DeVito said. “An added benefit is that any data generated becomes a shared resource for the entire GI oncology team at Duke.”Looking ahead, the team plans to expand their research into mouse models in collaboration with Jatin Roper, MD, that mimic how colorectal cancer spreads to the liver. This could help them test the biomarkers they discover and explore new treatment strategies in the lab.“Ultimately, everything we’re doing comes back to the patient,” Chang said. “We want to find better ways to treat this cancer, especially for patients who don’t have many options today.”The annual CRUSH Colorectal Cancer 5K will be held on March 14. Learn more about the event.
A team at the Duke Cancer Institute (DCI) is launching a first-of-its-kind study that could bring new hope to patients living with advanced colorectal cancer.Led by medical student Cheryl Chang and DCI medical oncologist Nicholas DeVito, MD, the project explores why some colorectal cancers that spread to the liver respond well to chemotherapy while others do not. The team recently presented this research at the American Association for Cancer Research (AACR) Immuno-Oncology (IO) Conference.This type of cancer can be especially challenging to treat. Patients often face fewer effective options, and outcomes can vary widely. By taking a closer look at what’s happening inside the tumor before and after treatment, the Duke team hopes to uncover clues that could one day guide more personalized and more effective care.When colorectal cancer spreads to the liver at the time of diagnosis, it often means a tougher road ahead. Doctors know that these patients typically do not respond to chemotherapy the same way others do, but the reasons behind that difference remain unclear.“If we can understand why some patients don’t respond well, we may be able to adjust treatment earlier, or develop new options altogether,” Chang said.To do this, the team is studying tissue samples taken from patients before treatment, when the cancer is first discovered, and after about six months of chemotherapy, when surgeons remove part of the liver or colon.Looking at these pairs of samples gives researchers a rare opportunity to see how cancer and the immune system around it changes during treatment.This is the first known study to compare liver metastasis samples before and after chemotherapy in this specific patient group. Despite decades of using chemotherapy to treat colorectal cancer, surprisingly little is known about how treatment affects the immune environment inside these tumors.“This is an area that’s been largely unexplored,” DeVito said. “We’re excited to contribute something new that has the potential to change how we approach treatment.”A big focus of the study is the tumor microenvironment, the community of immune cells, cancer cells, and other structures within and around each tumor. Using two advanced technologies, the team examines the tumor at both the protein and RNA levels.Working with John Hickey, PhD, assistant professor of biomedical engineering at the Pratt School of Engineering, the team employed the Codex assay in the study. By using special antibodies to highlight different cell types, the assay lets researchers map where various immune cells are and how close they are to the tumor.The team also partnered with Erika Crosby, PhD, assistant professor in the Duke Department of Surgery, to use the Xenium assay, which analyzes the RNA within cells. This helps confirm the protein‑level findings while revealing additional details that might not show up at the protein stage.Early results show meaningful differences between patients who respond to chemotherapy and those who don’t. Some immune cells appear in higher numbers in people who respond well, suggesting these may serve as early indicators of how effective chemotherapy might be.“Without this collaboration between surgery and biomedical engineering, locating and reviewing patient records and samples would have been far more time‑consuming,” DeVito said. “Everything came together at the right time: the technology, the expertise, and access to the right samples. That’s what makes a project like this possible.”A major boost for this work also came from CRUSH Colorectal Cancer, which supports early‑stage ideas that need initial funding before they can compete for larger grants.“CRUSH provided the seed funding that allowed us to get started,” DeVito said. “An added benefit is that any data generated becomes a shared resource for the entire GI oncology team at Duke.”Looking ahead, the team plans to expand their research into mouse models in collaboration with Jatin Roper, MD, that mimic how colorectal cancer spreads to the liver. This could help them test the biomarkers they discover and explore new treatment strategies in the lab.“Ultimately, everything we’re doing comes back to the patient,” Chang said. “We want to find better ways to treat this cancer, especially for patients who don’t have many options today.”The annual CRUSH Colorectal Cancer 5K will be held on March 14. Learn more about the event.
