Headlines & Helpful Information, Research
By: Dr. George Sledge and Dr. Jennifer Pietenpol
Komen Chief Scientific Advisors
Breakthroughs in breast cancer research happen every single day – just ask the researchers, postdoctoral fellows and physicians working long hours and late nights, cracking the code to this millennia-old killer.
But unless you spend your free time in the lab, it can seem like progress in breast cancer research is slow. How could it not? Our mothers, grandmothers, wives, sisters and friends – and generations to come – are waiting for those discoveries.
Enter Komen’s Chief Scientific Advisors: Drs. George Sledge and Jennifer Pietenpol. With decades of experience from the lab to the clinic, these two are not only the guiding forces behind Komen’s global research program, but are widely known and respected throughout the field of breast cancer research. We caught up with them recently to ask about the state of research: what we may have missed in 2017, what’s exciting now, and how Komen is poised to tackle the most exciting and important questions in breast cancer.
Q1: What are some recent examples of Komen-funded research that are gaining new ground?
Dr. Sledge: Well, I should start by saying that we’ve learned more about breast cancer in the last two decades than we had in the previous thousand years. It’s incredible. Just recently, at the annual San Antonio Breast Cancer Symposium, we had several Komen researchers presenting the results of their research. Two of these findings were especially exciting.
Imagine if we could predict which patients are at high risk for a late relapse, then maybe we could intervene earlier and improve outcomes. That’s the hope behind work led by Dr. Joe Sparano of the Eastern Cooperative Oncology Group. Dr. Sparano presented an analysis of a very large study in which patients had their blood drawn five or more years out from diagnosis, and then analyzed the blood to see if we could detect tumor cells circulating in the blood (known as “circulating tumor cells,” or CTCs). The analysis showed that the presence of these CTCs was a very powerful predictor for late relapse of breast cancer. This has already led an international group of investigators to convene to discuss potential ways of using this knowledge to prevent late recurrences.
Another study presented at the conference could help inform patient’s treatment decisions. Work done by two Komen grantees, Dr. Dan Stover and Dr. Heather Parsons (with their study team), is helping improve our understanding of aggressive triple negative breast cancer (TNBC) – a subtype of the disease for which there are currently no targeted therapies. Their work showed that bits of tumor called "cell-free tumor DNA," which can be found in blood, could identify which TNBCs are more aggressive.
Dr. Pietenpol: Another great example is a global study, funded in part by Komen, which discovered over 70 previously unknown gene mutations that can lead to the development of breast cancer. How incredible is that? It was not that long ago that we first discovered these risk-related genes even exist, starting with the discovery of BRCA1. In less than 30 years, teams of investigators have discovered over 100 genetic variants that are common among women with breast cancer.
Another important area of research that’s gaining deserved attention from Komen and the scientific community is the need for more and better treatments for metastatic breast cancer (MBC). Many people don’t realize that there are currently no reported data on the number of people living with MBC. As a member of the MBC Alliance, Komen played a role in the first-ever study to provide an estimate of the people living with MBC today, and it’s more than 150,000. The report found that while survival rates and survival time had increased, the number of people living with MBC grew by 4 percent from 1990 to 2000 and 17 percent from 2000 to 2010. The researchers estimate that number will increase by 31 percent between 2010 and 2020. The need for MBC research advancements is becoming more urgent by the day, and Komen is laser-focused on serving these women and men.
Studies aside, another unique thing Komen did last year was launch its first-ever research grant crowdfunding platform, allowing people to donate online, directly to grants focused on MBC. That was a different kind of “gaining ground,” but an important way to bring everyone into the fight against MBC.
Dr. George Sledge
Q2: What are some of the most exciting/intriguing developments in breast cancer research?
Pietenpol: Never has it been such an exciting time in research and discovery. There is so much enthusiasm around technologies we can bring to bear – from imaging to early detection to new modalities to actually track early stages of metastatic disease.
Another thing that’s exciting is our knowledge of the immune system. The discoveries that have been made in the past few years – in breast cancer and in all cancers – are tremendous. We can bring these discoveries to the table in battling MBC, but further, in doing this research, the discoveries we will make about the human immune system and the power of it will be amazing.
Sledge: CTCs and circulating tumor DNA (ctDNA) may one day allow us to predict the presence or potential for breast cancer to return, with just a blood test. You may have heard this referred to as “liquid biopsy.” It allows us to analyze bits of a tumor that may have been unleashed either by a primary tumor or by a microscopic metastatic tumor. This offers the prospect that we will be able to do a much better job of identifying who’s at high risk for recurrence, and use this information to prolong the patient’s life or even prevent recurrence.
Q3: What will Komen’s research program focus on moving forward?
Pietenpol: Komen declared a Bold Goal in September of 2016 – to reduce the current number of breast cancer deaths in the U.S. by 50 percent by 2026. To realize this goal, we identified the two areas in breast cancer with the biggest gaps and the biggest promise: 1) Achieving health equity by ensuring everyone has access to quality, timely care and 2) investing in breakthrough research aimed at finding new and better therapies for MBC and aggressive breast cancers. That is exactly how we will invest our research dollars moving forward. Last year alone, 40 percent of our entire grants portfolio was focused on MBC. This year, we asked specifically for grant applications investigating new treatments for drug-resistant breast cancers or new approaches to combat MBC.
Dr. Jennifer Pietenpol
Sledge: Research cures cancer. Nothing else does. Finding out about the biology of the cancer, finding the Achilles’ heel, where we can intervene and treat – that’s the nature of cancer research, and Komen’s research program. Still, there are real challenges to combating this devastating disease, especially MBC. Metastatic tumors, by and large, are more resistant (or can become resistant) to the standard therapies we have. That’s why it’s going to take many tools to target MBC. Some of these are going to be better diagnostics that allow us to detect smaller deposits of microscopic metastatic disease and intervene earlier. Some of these are going to be tools that are attached to specific molecular characteristics that the cancer has. Collectively, though, we can do this. We can treat this disease.
Pietenpol: Komen has built an amazing and comprehensive framework across the world that brings community, breast cancer patients and survivors, families, investigators, Affiliates all together with a single, common mission – end breast cancer.
Sledge: That’s right. Breast cancer, we’re coming after you. We’re coming after you with every tool in our armamentarium. We’re coming after you as a group of patients, physicians, and laboratory researchers – all with the common goal of eradicating you. These are your last days.
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