By Dr. Kathy Miller
Indiana University Cancer Center
Why does Susan G. Komen support research into breast cancer? Put quite simply, because women still die. Don’t get me wrong, awareness, screening, and access to high quality care are important – but our best treatments sometimes fail. Even when treatment is effective, the toxicity can be devastating. That’s why Komen’s support of research is so important. Research puts the hope in the promise.
As a Komen Scholar, I’m grateful for the support. Your work has made these studies possible.
Chemotherapy resistance in triple negative disease
Patients with triple negative disease often receive chemotherapy before surgery. In most cases the cancer shrinks dramatically, and in some cases the cancer is entirely eradicated. But what do you do when those best treatment don’t work. Patients with lots of disease left after chemo have a very high risk of recurrence. A Komen supported trial allowed us to test two new therapies in this high risk population. Importantly we collected tumor and blood samples, so we could study the causes of drug resistance and look for biomarkers of recurrence. Data from this trial supported the development of EA1131, a randomized phase III trial comparing two different chemotherapy agents in patients with TNBC who have residual disease after pre-surgery therapy. We also found that the immune system doesn’t recognize these resistant tumors, suggesting that immunotherapy might be helpful. Indeed immunotherapy is being studied in this setting in a separate trial coordinated by the Southwest Oncology Group.
The intersection of recurrence, late toxicity, and survivorship – current and future work
As treatment becomes more successful, attention appropriately shifts to survivorship and the long-term burden of therapy. Patients frequently report ‘fatigue’ as a consequence of breast cancer therapy but the true impact of various cancer treatments on patient’s daily activities (the amount of energy they use) and their physical fitness (power generation) has not been measured. Working with Dr. Jeffrey Sledge (U. Wisconsin), we have initiated a pilot trial using state of the art technology to measure the impact of various treatments including surgery and radiation, anti-estrogen drugs, and chemotherapy during the first year after diagnosis, evaluating both the impact of acute treatment and the degree of spontaneous recovery. In addition, the study explores the relationship of these energy parameters to changes in insulin resistance, body mass index, body composition, and patient reported physical activity, fatigue, and overall quality of life. Our data documents a truly dramatic decline (some patients would be below the safe threshold to initiate physical therapy) in fitness at 6 months with no indication of ‘spontaneous’ recovery at 1 year. Data from this pilot trial led directly to an individualized intervention to decrease the impact of therapy and improve survivorship. This next trial will start enrolling patients in April.
Support for research has never been so important or so in jeopardy. I look forward to joining you in Kansas City (on March 25) to share more of our latest research results.
The Komen Scholars are an advisory group of 60 distinguished scholars and leaders in breast cancer research and advocacy. Each has made significant contributions to advancing the field or demonstrated significant promise of doing so in the future and all are committed to furthering Komen’s mission.
Led by the Scientific Advisory Board (SAB) which serves as the executive committee, the Komen Scholars are an international group with a wide range of expertise, including clinical research, laboratory research, pathology, prevention, radiation oncology, surgery, and other research disciplines and specialties, allowing them to advise Komen in a variety of capacities. While their primary responsibility is to lead and participate as reviewers in Komen’s scientific peer review process, the Komen Scholars also serve as ambassadors and experts in our communities and across the Affiliate Network.
In addition, several of the Scholars are Advocates in Science who ensure that the unique perspectives of those affected by breast cancer are fully integrated into decisions at every step of Komen’s mission.