A just-funded Auckland pilot programme will investigate how to better deliver chemotherapy before surgery for some breast cancer patients.
Traditionally, neoadjuvant therapy (NAT), where chemotherapy is completed before surgery, has been reserved for those patients whose breast cancer is either an inflammatory subtype or inoperable.
But it's become increasingly common for patients with operable breast cancer to undergo chemotherapy first, particularly when it's likely the same chemotherapy would have been recommended for them after surgery anyway.
The approach can help shrink tumours to facilitate surgery and allows a real-time assessment of the sensitivity of the cancer to treatment.
The medical oncologist leading the programme, Dr Sheridan Wilson, said the number receiving NAT was a small proportion - no more than one in 10 of breast cancer cases who received chemotherapy.
But our health system hadn't yet set out a definitive pathway for patients treated with NAT.
Wilson said there was nothing experimental or controversial about the chemo-first approach - but it required careful up-front co-ordination and a high level of collaboration between all of the clinicians involved in the patient's care.
"We have not yet sat down to figure out the best arrangement and time course for using this approach in the New Zealand setting."
A main aim of the pilot, being supported with a grant from the New Zealand Breast Cancer Foundation, was to create new guidelines to set out a path for future patients.
"Compared with giving chemotherapy after surgery, neoadjuvant therapy is not associated with a difference in survival but it can potentially improve operability and enable breast-conserving surgery.
"And if it puts us in a stronger position to do extra research activities, that's also a win for breast cancer patients of the future."
Many drugs were now being tested in the NAT space, as it offered a shorter timeframe to establish efficacy.
"So if we have a comprehensive NAT programme, that puts us in quite a good position for doing NAT trials, which is a great way to access novel therapies for current breast cancer patients as well."
Other research projects to receive a total $370,000 worth of grants from the foundation include studies to track the spread of breast cancer with a simple magnetic tracer; to prevent spread with a new sugar-based drug; to develop a new model to locate tumours; and to direct a promising bowel cancer vaccine toward breast cancer.
"Collaboration enables us to fund better, faster, and maybe even cheaper breast cancer research," the foundation's chief executive Evangelina Henderson said.
"We want to build on successes achieved in other cancers or in other research groups, rather than reinventing the wheel."
NAT helps roller derby player battle back
As a national rep at roller derby, Jody Hare is well used to hard knocks - and she's not letting a diagnosis of breast cancer set her off her stride.
The Manawatu woman, 32, was given the news 10 weeks ago.
"When I first found it was breast cancer, I was like, just get rid of it, and if that means by cutting off my breast, then just do it."
But the plans for a mastectomy changed when her oncologist consulted with surgeons and figured neoadjuvant therapy would be a better option for her.
"It was quite scary, from my point of view ... just finally adjusting to the fact that I was going to have a full mastectomy, then to be told that there was a better alternative.
"But obviously I put my full trust in the team, and I'm definitely grateful I did, because just after one treatment, my lump had decreased in size by 73 per cent."
Hare said she was fortunate the cancer hadn't spread outside her breast - and that doctors knew where to target it.
"And because my lump was so big for the size of my breast, they said the best way to target it would be to have chemo first, as that way they could reduce its size and save the breast."
She felt the NAT alternative was something that could benefit many patients like herself, and was keen to see it offered more widely.
And despite her cancer battle, she still plans to represent New Zealand at the Roller Derby World Cup in February.
"I'm very tired, but apart from feeling a little bit nauseous here and there, I'm still living life as if I didn't get cancer."