• Breast Cancer Metastasis: Are We Making Progress?



    Guest blog by Cheryl Jernigan, C.P.A., F.A.C.H.E., a Komen Scientific Advisory Board Member, Advocates In Science Steering Committee Member and an 18-year breast cancer “thriver.”

    Metastatic disease (breast cancer that has spread beyond the breast to other organs in the body) is what kills cancer survivors – like my two friends earlier this year. Why can’t we stop it?! Despite what we learn, what we throw at it, metastatic disease all too often finds a way to immediately or eventually evade our efforts.

    Maybe it was the loss of these special friends that had me on high alert. But as I attended the 2014 San Antonio Breast Cancer Symposium (SABCS), it seemed to focus a lot more on metastatic breast cancer this year.

    I didn’t hear many answers; only more questions. Except, unlike previous years, there were an amazing number of conversations and presentations aimed at understanding and tackling this multifaceted and perplexing disease.

    Most metastatic breast cancer cells go unnoticed

    In a pre-SABCS advocate conference sponsored by the National Breast Cancer Coalition, Komen grantee Dr. Alana Welm from the University of Utah shockingly noted that about 30 percent of breast cancers have already spread beyond the breast (spread to nearby lymph nodes) at the time of diagnosis[1].

    To date, our most successful attempts to stop these undetectable cancer cells has been with chemotherapy and anti-hormonal therapies, like tamoxifen. Yet some still evade treatment and pop up in the not-too-distant future. Some others lie dormant for years. What wakes them up?! Can’t we just keep them sleeping… or at least not growing?

    Even within our own bodies, breast cancer is diverse

    First up, as possible solutions, were targeted therapies that interfere with specific targeted molecules cancer cells need to grow. Targeted therapies are usually less toxic and more effective than conventional chemotherapy.

    Four different markers (CD44, CD24, BAC and CEP) were used to stain cancer cells in the lung and spleen from the same patient. Slide image courtesy of Dr. Judy Garber. Paper reference: Almendro et al. Cancer Research 2014

    Four different markers (CD44, CD24, BAC and CEP) were used to stain cancer cells in the lung and spleen from the same patient. Slide image courtesy of Dr. Judy Garber. Paper reference: Almendro et al. Cancer Research 2014

    Sounds simple enough to just “target” what’s driving the cancer. Except breast cancer isheterogeneous, meaning the cancer cells are very diverse at the genetic level (even in the same person and in the same tumor site).

    In a special presentation forAdvocates in Science, Komen Scholar and grantee Dr. Judy Garber explained that distant metastases have a much higher genetic diversity than those cells in the breast or in the surrounding lymph nodes. I was struck by how vastly different (molecularly) cancer cells could be in a woman’s liver vs. her spleen. Just take a look at this image from SABCS! (Figure 1)

    We now know EVERY tumor is different. So much so, it’s impossible to develop drugs that will be effective in a large number of people. Gone are the days of hoping for a “magic bullet.” The good news from SABCS is there are a growing number of targeted therapies that may present new effective treatment options for metastatic breast cancer.

    But what if a person’s cancer has multiple, evolving targets?

    Enter the hope of immunotherapy

    Immunotherapy is a treatment that uses our bodies’ own natural defenses to fight the disease. These treatments train our immune system to recognize viruses and cancer cells in our body in order to seek and destroy! The research to-date on immunotherapy holds a lot of promise, as well as some cautions.

    On the plus side, when compared to chemotherapy, immunotherapy may have more therapeutic potential for patients such as being able to get treatments for longer periods of time with less possibility of developing resistance to the therapy.

    Some questions that still need to be answered are: how do we more effectively identify patients at higher risk for metastases vs. those whose cancers are unlikely to become problematic? What are the short, intermediate and long-term immune-related side effects or toxicities?

    More research is needed

    As mentioned several times during SABCS, no one can yet predict if I (or you) will develop metastatic disease. Over 40,000 women and men die each year from breast cancer. Metastasis is the cause for virtually all. The majority of newly diagnosed metastatic breast cancer patients had early-stage disease 5, 10, 15, or even 20 years earlier.

    Because metastatic disease is very different from early stage disease, more research aimed specifically towards metastatic breast cancer is needed. Only seven percent of the $15 billion invested in breast cancer research from 2000-2013 was focused on metastatic breast cancer. Komen has invested more than $98 million in over 200 research grants and 25 clinical trials focused on metastatic breast cancer since 2006.

    Yes, advances are being made – just not fast enough. We need to put an end to metastatic disease before it puts an end to more of us!

    [1]Percent of Cases by Stage, Regional Cases, SEER 18 2004-2010, All Races, Females by SEER Summary Stage 2000

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