Bold Goals in the Fight against Metastatic Breast Cancer

By Suzanne Stone, Executive Director of Susan G. Komen Greater Central & East Texas
Also published in Austin Medical Times, September 2019

This year, more than 40,000 women and men in the U.S. (2,980 of those in Texas) will die from breast cancer, most of those from metastatic breast cancer (MBC). That’s one death every 13 minutes. While our focus remains ensuring every person, regardless of income or geographic location, has access to the breast health care they need, we are also passionately pursuing ways to change the outcome for those patients whose cancer has metastasized outside the breast.

Komen currently funds more than 540 research teams in 39 states and 10 countries to end breast cancer. Since our organization’s founding in 1982, we have awarded nearly $1 billion in research grants, making Komen the largest nonprofit funder of breast cancer research outside the U.S. government.

MBC research initiatives

Our current MBC research teams are working at every level from genetics to big data. Komen-funded researcher Nikhil Wagle, M.D., leads the Metastatic Breast Cancer Project, a patient-driven initiative that asks MBC patients to share their cancer experiences, medical records, and tumor tissues to accelerate research discoveries. The project released the first publicly accessible data set into cBioPortal, with more to come, and will soon be sharing raw data in the Genomic Data Commons (GDC). The goal of this growing data set is to allow as many researchers as possible to make discoveries that accelerate our understanding of MBC.

The detection of circulating tumor DNA (ctDNA) is a promising way to potentially monitor treatment response and to predict metastatic progression. In a recent NPJ Breast Cancer publication, Komen-funded investigator Gaorav Gupta, M.D., Komen Scientific Advisory Board member Lisa Carey, M.D., and colleagues developed a new blood test that can monitor changes in tumor mutations over time. This test may be used to predict response to therapy in estrogen receptor-positive (ER+) metastatic breast cancer, and it could help guide treatment decisions for patients.

Some tumor cells can spread to distant parts of the body where they lie dormant. These disseminated tumor cells (DTCs) are difficult to eliminate and can eventually develop into metastatic tumors. In a Nature Cell Biology publication, Komen-funded investigator Candice Grzelak, Ph.D., Cyrus Ghajar, Ph.D., and colleagues show that DTCs residing near blood vessels are protected from the killing effects of chemotherapy. They demonstrate that targeting the area around blood vessels can sensitize breast DTCs to chemotherapy and stop the development of metastatic tumors arising from DTCs.

Advocacy successes and goals

Our pursuit of solutions to MBC isn’t limited to the lab; we are also advocating at all levels of government for policy change that will positively impact care. Thanks in part to our lobbying efforts, the Texas Legislature passed Senate Bill 680 during the 2019 session. This bill would prohibit insurance companies from requiring step therapy. Often step therapy requires that the most affordable therapy or drug be utilized before a newer, more expensive—and perhaps more effective—treatment will be authorized by an insurance company, even when a physician believes the newer form of treatment will be the most effective. MBC patients typically don’t have this kind of time. Texas is now one of 25 states to prohibit the use of step therapy protocols for advanced stage-four cancer or metastatic cancer.

We aren’t stopping there. Among our current legislative priorities are expanding federal funding for biomedical research through the National Institutes for Health and Department of Defense, increasing federal funding and clinical trials for MBC, and keeping therapies affordable for all breast cancer patients.

Your expertise and support are critical to the success of these efforts. Apply for a Komen grant at komen.org/ResearchGrants. Contact me at sstone@komengreatercetx.org to discuss how you can be a part of the Komen family. Our largest fundraiser of the year, the MORE THAN PINK WalkTM, will be held at the Palmer Events Center on September 29. You can register and fundraise to support breast cancer research and treatment at komenwalk.org.