Joseph A. Sparano, MD, FACP, has been named a 2024 Giant of Cancer Care for his significant contributions to breast cancer and HIV-associated cancer research, as well as his dedication to addressing racial disparities in cancer care. Sparano's work has led to groundbreaking advancements in treatment strategies and improved outcomes for patients, particularly in underserved communities. His career, inspired by his grandmother's battle with breast cancer, has been marked by a commitment to precision medicine and personalized care.
Landmark Contributions to Breast Cancer Treatment
Sparano's most notable contribution is the phase 3 TAILORx trial (NCT00310180), a landmark study that enrolled over 10,000 women with estrogen receptor (ER)-positive, HER2-negative breast cancer. The trial utilized the 21-gene expression Oncotype DX assay to assess the risk of disease recurrence. TAILORx demonstrated that many women with low to intermediate recurrence scores (RS) could safely avoid chemotherapy without compromising their prognosis. Specifically, the trial found that patients with a very low RS of 0 to 10 had excellent outcomes with endocrine therapy alone, and chemotherapy provided no benefit for most women with an RS of 11 to 25. This research has spared thousands of women from the adverse effects of chemotherapy and has significantly impacted clinical practice guidelines worldwide.
Addressing Racial Disparities in Breast Cancer
Sparano's research also focuses on understanding and addressing racial and ethnic disparities in breast cancer outcomes, particularly among Black women. His analysis of the phase 3 E1199 trial revealed that Black patients with ER-positive, HER2-negative breast cancer experienced worse outcomes compared to White patients, even when receiving standard of care. This led to the development of the phase 2 ECOG-ACRIN EAZ171 trial (NCT04001829), the first NCI-sponsored trial designed specifically for Black women with early-stage breast cancer requiring adjuvant taxane chemotherapy. Although genetic predictors of taxane-induced peripheral neuropathy could not be confirmed, the trial showed higher neuropathy rates with weekly paclitaxel compared to docetaxel every 3 weeks, informing novel risk reduction strategies.
Advancements in HIV-Associated Cancer Treatment
In addition to his work in breast cancer, Sparano has made significant contributions to the treatment of HIV-associated cancers. As chair and principal investigator of the NCI-Funded AIDS Malignancy Consortium since 2020, he has been instrumental in developing new treatment protocols for HIV-positive patients with non-Hodgkin lymphoma and anal cancer. Sparano and his colleagues developed the regimen of rituximab plus etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, and doxorubicin hydrochloride for the management of HIV-associated lymphomas, which has become a standard of care. Furthermore, he led an international team in a meta-analysis of HIV-lymphoma trials, resulting in a new prognostic score for this disease, the AIDS-related lymphoma International Prognostic Index.
Mentorship and Future Directions
Beyond his research, Sparano is deeply committed to mentorship. He is currently the chief of the Division of Hematology and Medical Oncology and deputy director of the NCI-funded Tisch Cancer Institute at the Icahn School of Medicine in New York. His current research aims to investigate the molecular foundation of breast cancer recurrence and the role of clonal hematopoiesis and genetic determinants in breast cancer outcomes. Sparano's dedication to his patients, groundbreaking research, and commitment to addressing disparities in cancer care solidify his legacy as a leader in the field of oncology.
