Angel Arnaout

Dr. Arnaout is part of the Ottawa Breast Cancer Biomarker Research Program, whose mandate is to develop patient centered translational breast cancer research to better the lives of women struggling through the diagnosis and treatment now. Working closely with Dr. M. Clemons (a Medical Oncologist) and Dr. C. Addison (Senior Scientist at OHRI), they have formulated the ACA team, whose approach of working together means that research findings can be rapidly translated to improve the care of women in the clinic and operating room. This research includes biomarker predictors of treatment response and future metastatic disease. She leads several "window of opportunity" clinical trials with the ultimate goal of expediting drug development in breast cancer and reducing the anxiety of patients who are waiting for definitive surgical treatment.   Dr. Arnaout’s research is also committed to improving access and delivery of high quality care to breast cancer patients in Ontario. She is the leader of two specialty programs for breast cancer patients in Ottawa that fast track patients from diagnosis to treatment. 

I. OTTAWA BREAST CANCER BIOMARKER RESEARCH PROGRAM
Of the 25,000 Canadian women diagnosed with breast cancer every year, nearly 1000 will come from Ottawa. Despite significant advances in detection and treatment, too many women continue to die of this disease.  Areas of translational breast cancer research include:  
A. Window of Opportunity Trials in Breast Cancer
The waiting period between diagnosis and treatment is an extremely stressful period for the patient. Innovative breast cancer treatments, customized to each individual patient, can be offered during this waiting period as the effectiveness can be rapidly evaluated at the time of surgical resection. Not only do these studies reduce the anxiety of the patient while waiting for surgery, they have the potential to expedite drug development process by improving the understanding of an agent’s biologic effect early in its development through monitoring tissue samples obtained before and after drug exposure. These trials may assess target or pharmacodynamic effects of an intervention, allowing for greater potential to select for subsets of patients who might benefit from a therapy in clinical trials that are powered to detect changes in clinical outcome. Window of opportunity trials led by Dr. Arnaout at the Ottawa Hospital currently include:
i) Neoadjuvant endocrine therapy for primary breast cancer : Investigation of Clinical and Translational Outcomes (The NEO (NEOADJUVANT ENDOCRINE OUTCOMES )TRIAL
ii) A Phase 2 Randomised, Double-blind, Window of Opportunity Trial Evaluating Clinical and Correlative Effects of Vitamin D in Patients with Breast Cancer (The ICARUS Study)
iii) A Phase 2 Randomised, Double-blind, Window of Opportunity Trial Evaluating Clinical and Correlative Effects of Chloroquine as a Novel Therapeutic Strategy in Breast Cancer (The CUBiC Study)  

B. Identification of Biologic Markers that Predict Future Metastasis in Invasive Lobular Breast Cancer 
Invasive lobular breast cancer is the second most common type of breast cancer. Despite its indolent nature, a subset of patients will go on to develop distant metastases. The ACA team is creating one of the largest respository of fresh primary tissue, distant metastatic tissue (bone and visceral organs) and blood from invasive lobular patients to look at microRNA expression patterns in the breast and blood that may predict for future metastasis. Out hope is that one day we will be able to give patients diagnosed with invasive lobular cancer their true risk of future metastasis so that they can decide on potential treatments.   

II. ACCESS TO HIGH QUALITY BREAST SURGICAL ONCOLOGY CARE FOR BREAST CANCER PATIENTS
Dr. Arnaout’s research is also committed to improving access and delivery of high quality care to breast cancer patients in Ontario. She is the leader of two innovative programs for breast cancer patients in Ottawa:  

A. Ottawa Hospital Rapid Diagnosis and Support Program, which has a goal of reducing wait times diagnosis and treatment for patients with a high probability of breast cancer. This program has reduced the breast cancer diagnosis wait time from 5 weeks to 7 days and has been features on CTV news and the Ottawa Citizen. In November 2013, she won the “Best Innovation in Cancer Care Delivery Award” at the Ontario Provincial Showcase.

B. The Advanced Multidisciplinary Program, which brings specialists of 10 disciplines simultaneously together to treat patients with advanced breast cancer, with a goal of providing multidisciplinary cancer care in a timely fashion.  

In addition, she has recently been awarded peer-reviewed funding to perform a novel 3D study to determine the most precise procedure to assess cancer removal after surgery, which could mean less chance of recurrence, fewer repeat surgeries and less stress on patients. Dr. Arnaout proposes the world’s first clinical trial ("SMART Trial") to compare commonly used breast tissue assessment techniques, with goal is to identify the most accurate and objective method for breast cancer tissue assessment to formulate best practices for the medical community worldwide.