We know that one 1 in 8 women will develop breast cancer in her lifetime. The Susan G. Komen Foundation envisions a world without breast cancer. Their goal is to reduce the current number of breast cancer deaths by 50% in the U.S. by 2026. Helping them in this pursuit are Komen scholars—men and women who are leaders in breast cancer research and advocacy and who are making significant contributions in the search for a cure. Meet two of them.
PRA Health Sciences is honored to be a corporate sponsor for the “Finding Solutions Through Science, Scholars, and Science Research Luncheon” on November 9, 2017 in Chapel Hill, NC. This event brings together researchers, advocates, corporate and private philanthropists, breast cancer survivors, and individuals impacted by the disease to learn how their donations are being used in laboratories in North Carolina and across the country to help find cures for breast cancer.
Dr. Kimberly Blackwell is a Professor of Medicine and Assistant Professor of Radiation Oncology at Duke University Medical Center. She serves as the Co-Director of the Duke Cancer Institute’s Women’s Cancer Program, Associate Director for Strategic Relations at Duke Cancer Institute Global Research Scholar for Susan G. Komen and the Senior Strategist for the Duke Innovation and Entrepreneurship Program. Because of her work, TIME Magazine named her one of their 100 most influential people in the world in 2013.
Tell us about the current research you are working on.
Currently, I am working on novel therapies for the treatment of triple negative breast cancer, the most difficult form of breast cancer to treat. This work includes using knowledge we gained through the treatment of HER2+ breast cancer and applying similar approaches to target triple negative breast cancer.
Triple negative breast cancer is when breast cancer cells test negative for estrogen receptors, progesterone receptors, and HER2. These negative results mean that the growth of the cancer is not supported by these hormones or the presence of too many HER2 receptors.
What inspired you to do that work that you do?
How has being a Komen scholar helped you?
Being a Komen Scholar has allowed me some freedom to pursue some high risk/high gain projects that were really important foundational questions which then could lead to larger projects.
What work are you most proud of in your career?
I am most proud of being a part of teams that have led to new drugs being available to patients, including lapatinib, T-DM1 and biosimilar products.
What are some of the biggest challenges we currently face for breast cancer patients/research?
The biggest challenges are getting more drugs to the patients that need them faster—this includes lack of funding for innovative trials and making it easier for patients to enroll and participate in clinical trials.
Why are clinical trials important and what would you say to someone considering participation in a trial?
It takes about seven years from the time a medication is used in the first patient to the time it is approved for wide spread use. The drugs that move into the clinic as part of a clinical trial are the cutting-edge of therapy and are usually better than the one we have today. Clinical trials allow patients to get cutting-edge treatments that are biologically sound.
When it comes to advancements for breast cancer treatments what are you most hopeful for 10-20 years from now?
I hope that in 20 years we will be able to take a piece of the cancer and custom design a therapy that will cure everyone. I don’t think we are that far off, but it will take full collaboration of science, industry, groups like Susan G. Komen and government to make this happen.
When it comes to breast cancer prevention, what do you want everyone to think about?
We really need to think about lifestyle and health and how it contributes to one’s risk for breast cancer. In particular, diet and maintaining a healthy weight are difficult subjects to address but do contribute to one’s risk for breast cancer.
Medical Director of the UNC Breast Center and Associate Director for Clinical Science at the UNC Lineberger Comprehensive Cancer Center
Dr. Lisa Carey is Medical Director of the UNC Breast Center and Associate Director for Clinical Science at the UNC Lineberger Comprehensive Cancer Center. Her research interests focus upon breast cancer, including examination of different subtypes of breast cancer, evaluation of new chemotherapy agents in early breast cancer, and examination of tumor characteristics that predict response to therapy. Dr. Carey is a world-wide expert in triple negative breast cancer, and she led the first trial looking at a new drug regimen in this breast cancer subtype.
How has being a Komen Scholar helped you?
Through Komen’s support we’ve created a rapid autopsy program. This allows us to “serially” collect samples of the breast cancer, during therapy or of metastatic disease. Patients that want to help us understand the biology of metastatic disease basically contribute their tumors to science.
Metastatic breast cancer is advanced breast cancer which spreads to other parts of the body.
We know that the tumor that comes back five years later is different from how it was in the breast. There has been relatively little research on this. Historically we didn’t always biopsy them. Now we do more of that because we recognize they can change. This is an opportunity to get a much more detailed understanding of what exactly happens in tumors. How much do they look like the primary tumor? How much do they look like each other? Does the lung metastasis look like the liver metastasis?
We’ve had 60 women participate so far which has been an incredible resource. We’ve found that in some breast cancers they look different genomically in the metastasis than the primary tumor. In some of these if you know what to look for you can go back and find it to a minor degree in the original cancer—meaning that the original cancer is more heterogeneous than we are giving it credit. This is important because we may be able to identify really “ugly features” genetically, or using other molecular mechanisms, and we may be able to go back to the primary tumor and say if you find any of this you have to be more aggressive with the patient or treat them in a different way.
Another part of Komen supported research I’m working on is trying to understand how drugs work before and after therapy and how cancer can evade the effect of certain drugs. Komen is helping us understand drug resistance and what happens when cancers evade treatment and become metastatic. One study looked at how triple negative breast cancer can evade a targeted therapy, and it turns out they can evade it fairly quickly—the cancer can quickly marshal the cavalry to save itself. And that cavalry is done through non-genetic mechanisms.
You change gene behavior through epigenetic mechanisms, meaning something gets attached to the gene and either turns it on or off. If all you look for is a mutation you won’t see it. It is not a genetic change—the light switch itself works just fine you just turned it off, or turned it on using a different mechanism. Those are major contributors to resistance to drugs, particularly after the drug is applied, what is known as acquired resistance.
Epigenetics is the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.
What are you most encouraged by?
There is some predictability about how some cancers evolve and become metastatic and that may help us with preventing it better. I also think these studies we are doing looking at before and after treatment are incredibly important in terms of identifying resistant patterns and figuring out which drugs might be best and which we should avoid.
Why are clinical trials important?
Mortality for breast cancer has dropped about 38% in the past decade. That is a big change. We are not that good in preventing it yet, but of the patients who get it, the ones who die of breast cancer, or have reoccurrences of it, that has gone done remarkably. Everything we do; minimizing surgery, optimizing chemotherapy, all the new targeted therapies, everything we do is based on women participating in clinical trials. Not only are we curing more people but metastatic patients are living longer and overall, we’ve also improved quality of life, and minimized toxicity and side effects. This has been equally transformative.
What about prevention?
Prevention is hard. It is complicated and we don’t have wonderful strategies. What we must remember is that breast cancer is not one disease, it is a bunch of diseases and each has different risk factors. We need to understand those better.
Do racial or ethnic disparities exist in breast cancer?
We know triple negative breast cancer effects African Americans and younger women more than other groups. Komen also collects data on how patients are treated. Sometimes access to healthcare and how soon someone gets treated makes a big difference.
I think it’s also important to recognize that resourced countries have seen significant improvements in breast cancer mortality rates and improved treatments but that is not true outside of developed nations. Those with far fewer resources haven’t seen any of this benefit. We need to pay more attention to these disparities.