> How Komen’s research investment has changed the breast cancer landscape: Perspectives from Komen’s Chief Scientific Advisors
Eric Winer, MD, Director of the Breast Oncology Center at Dana-Farber Cancer Institute and George W. Sledge, Jr., MD, Co-leader of the Breast Cancer Program at Indiana University Simon Cancer Center are two of the most respected names in the breast cancer field today. These accomplished researchers and clinicians serve as Susan G. Komen for the Cure's Chief Scientific Advisors. As such, they lead Komen's Scientific Advisory Board (SAB), which helps determine Komen's scientific strategy and guides and prioritizes Komen's global research investments. The SAB also serves as the executive committee of the Komen Scholars – a scientific brain trust of the country's most respected breast cancer researchers. During a recent interview, Drs. Winer and Sledge shared their passion and their visions for Komen's mission to end breast cancer.
Changing the Way We Think About Breast Cancer
In the past 30 years, “There have been few, if any, advances in breast cancer research that have not been touched by Komen funding,” says Dr. Winer.
The research agenda in breast cancer has changed tremendously over the past 10-15 years, as we’ve come to understand more about the biology of breast cancer. It was once viewed as a single disease and treated with a one-size-fits-all approach. We now understand that breast cancer is a family of diseases for which we will need different cures. “Komen recognizes this and funds its research accordingly,” says Dr. Sledge. With this understanding, Komen’s research focus, as well as its relationship with the research community, has changed over the years. “Komen has always had a good reputation in the breast cancer community because it has focus and it has always cared about doing what’s right for cancer research,” he adds. What has changed, agree the Chief Scientific Advisors, is the type of research that Komen focuses on – from more basic biology – to research that will have a real clinical impact on reducing mortality within the decade. "This change has been embraced by the scientific community," adds Sledge.
How Komen funds research has also changed. While Komen continues to fund – and feels it's important to fund – individual research awards, it also recognizes that breast cancer is a complicated problem and has created the Promise Grant award system, which uses team science to look at larger, critical issues in breast cancer. Dr. Sledge elaborates, “In one of our Promise Grants, we have a superb group of researchers working on the problem of inflammatory breast cancer – a rare subtype of breast cancer – but an important one because it’s a virulent, dangerous, rapidly growing tumor. Other Komen research teams are using genomics to better understand the genetic basis of breast cancer, as well as the genetic basis of side-effects from certain treatments.” Komen not only funds team research through its Promise Grants, but also through its Opportunity Grants and Sponsored Programs & Partnerships. One example, describes Sledge, is Komen’s support of the Translational Breast Cancer Research Consortium, which brings together numerous universities to carry out innovative, high impact, biologically-driven clinical trials.
Preparing a New Generation of Breast Cancer Researchers
Komen’s research funding is also directed towards cultivating young researchers. Komen’s special focus on this group is already paying off, according to Dr. Winer, “I think if you were to look at who is doing good research now, many of them started out receiving Komen grants as trainees 10-15 years ago.” The Chief Scientific Advisors agree that Komen has a unique responsibility and duty as part of its overall mission to support emerging investigators. “Without Komen funding we would lose the next generation of breast cancer researchers. I actually feel that very strongly,” says Sledge. A recent Komen evaluation has shown, in fact, that this investment has been successful. Nearly 90% of former Komen postdoctoral fellows are still in the field of breast cancer, most of them as independent researchers.
Excellence in Science
According to Dr. Winer, one of the strengths of Komen’s research program is its very rigorous, structured peer review process, which brings the Komen Scholars together to review research proposals. “The value of this process cannot be overstated,” says Winer. “The very simple fact that we can bring such a talented group of people together to talk about common issues means that we are going to move forward,” he adds. In addition to the Komen Scholars, research advocates, who are often breast cancer survivors themselves, participate in peer review. “When we go to a [peer review] study section at Komen we have a breast cancer advocate there at the table with us,” describes Sledge. “That is part of the [process] that excites, informs and inspires breast cancer researchers. We are particularly inspired by the patients whose support makes the research possible,” says Sledge.
A Sustained Commitment
“People should understand how critical the mission [of Komen] is – both in terms of providing services to people who have and are at risk for breast cancer – but even more importantly for providing funding for research,” says Dr. Winer.
With the decline in funding from the National Cancer Institute, Komen has become viewed “more and more as a safe harbor that will continue to support breast cancer research, come what may,” comments Sledge. “Komen has funded a tremendous amount of research in the past decade, both clinical and basic research, “says Winer. “Without Komen support there are many researchers who simply would not have been able to accomplish the work that they have done,” he adds. In Dr. Sledge’s opinion, the single most dominating factor that Komen brings to scientific research is the passion of its supporters. “Institutions like NIH rely on taxpayer dollars. Komen relies on and benefits from the people who are actually in the trenches, and are passionate about curing this disease,” says Sledge. “Whether you are a Komen researcher or an SAB member, you cannot help but be impressed by the passion that Komen supporters bring to both Komen and the breast cancer problem,” he adds.
Where Do We Go From Here?
The ability to classify breast cancer into different genetic subtypes has opened up new research opportunities and has allowed research to focus on more narrow groups of women rather than the general population. As a result, “There will be a whole host of clinical trials and other types of clinical research that will be conducted in the next few years trying to hone in on which treatments are best for each subtype of patients,” says Dr. Winer. “There is a real opportunity at the moment to make tremendous progress because we understand breast cancer to a much greater extent than we did before. We also have many new drugs available that target very specific molecular pathways, which can be used alone or in combination with other therapies,” explains Winer. “I think this is really a time – in the next 5-10 years – that we are going to see very, very dramatic improvements in targeted therapies, [an approach] that has been heralded by some of the work that has been done in HER2+ breast cancer,” adds Winer.
However, along with new opportunities come new challenges. Genomic studies have revealed that instead of one factor, there may be several factors in cancer cells simultaneously driving the growth of cancer. Dr. Sledge predicts that this will dramatically change the way research is conducted. “Being able to measure that [factors driving cancer] at a truly individual level is both exciting – in that it actually gives us a way forward – but also daunting [because] we have never, for instance, done a trial where we tried to target six different factors simultaneously,” says Sledge “This will present a challenge in research, in that we will not be able to perform the types of trials that we have in the past –that is large, multi-thousand patient trials which look at several new treatment regimens,” he adds. “This is a very smart, very complex, and very nasty disease, which in many cases we will have to be very creative about attacking,” says Sledge.
Komen currently funds over 540 research teams in 39 states and 10 countries to help end breast cancer.
Komen Promise Grant awardees (from left to right) Dr. Beverly Laird (Patient Advocate), Dr. Donald Buchsbaum, Dr. Andres Forero (Principal Investigator), Dr. Patsy Oliver and Dr. Tong Zhou (Co-Principal Investigator), from the University of Alabama at Birmingham, are working together with their colleagues at UAB, and Dr. Steven Isakoff (not shown) at Dana-Farber Cancer Institute, Dr. Paul Haluska, Jr. (not shown) at the Mayo Clinic and Dr. Daniel Hayes (not shown) at University of Michigan Health System to develop new targeted therapies for triple negative breast cancer. (Photo courtesy of Steven Wood, UAB).