Genomic studies will play an important role in precision medicine for metastatic breast cancer.

Metastatic Breast Cancer: How Can We Accelerate Progress?

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For a long time, there has been a critical need for research that is focused specifically on metastatic breast cancer. That means understanding what causes metastasis and how we can intervene to shut down this process even after it has started. Although a true “cure” may not be possible, the question is whether we can treat the disease in such a way that patients live for a very long time with good quality of life.

That should not be so far-fetched an idea. HIV/AIDS not long ago was usually fatal, and now this disease can be managed as a chronic condition with a combination of drugs that patients take for the rest of their lives. Could something like this be possible for breast cancer that has become metastatic?

There have been some amazing advances in the treatment of metastatic melanoma and metastatic lung cancer using immune system therapies. Why have we not seen similar advances in treating metastatic breast cancer?

A major new report, Global Status of MBC: A Decade Report,  examines the global MBC landscape from 2005 to 2015. This is a large report (160 pages) covering a wide range of subject areas. But it’s also a very reader-friendly report, and well worth spending some time looking through.

New study on the global status of MBC

The goal of the project was to understand where there has been improvement and where there have been gaps in MBC care, patient support and research progress over the last ten years.

The report was prepared under the auspices of the Advanced Breast Cancer Third International Consensus Conference.  A global steering committee of multidisciplinary leaders in the MBC community included scientists, clinicians and several leading MBC advocates.

Input for the study came from a series of surveys examining current perceptions of the state of MBC in 34 countries around the world, as well as a review of more than 3,000 previously published articles and abstracts.

The first part of the report is all about patient care–how well the needs of patients with MBC are being met in many areas including, for example, information and communication needs, quality of life and supportive care. A second section focuses on the impact of society on MBC–this includes the public understanding of MBC, how health policy affects patients with MBC and the economic burden of MBC. And the final part of the report is a review of progress in research over the last decade.

We’ll focus here on some of the highlights of that final section on what’s going on in MBC research.

Why is progress against MBC lagging?

There was more progress made in the 1990s and 2000s in MBC than there has been in the past decade, according to the report. Here are a few points that sum up the story:

Mortality: Metastatic breast cancer is responsible for nearly all breast cancer deaths. Globally, both incidence and mortality rates for breast cancer are increasing. In developed countries, mortality rates have declined somewhat as a result of a combination of earlier detection and better treatment, but absolute numbers of deaths from breast cancer remain very high. Clinical studies in developed countries suggest that 20%-30% of women diagnosed with early stage breast cancer may progress to MBC.

Overall survival: Scientific advances in the 1990’s and 2000’s, including the introduction of aromatase inhibitors for hormone receptor-positive MBC and targeted therapies for HER2-positive MBC led to some improvement in survival after diagnosis for patients with these subtypes. Survival after a diagnosis of MBC now varies widely, but median survival has remained for decades at 2 to 3 years for patients in developed countries.

Pace of innovation: Most of the major advances in treatment of MBC occurred more than a decade ago. In the past decade, most innovations in treatment have been for HER2-positive breast cancer, which represents less than 15% of all patients with MBC. In the last two years, advances in immunotherapy and targeted therapies for several other metastatic cancer types including lung cancer, melanoma and kidney cancer have outpaced advances in MBC treatment.

MBC research: Over the last decade, only about 7% of research publications about breast cancer each year have been specifically about MBC. Research efforts to date have failed to achieve the goal of  turning MBC into a chronic disease with the potential to achieve lasting remissions.

What needs to be done to accelerate progress?

The report includes a number of recommendations on what needs to be done to accelerate progress, including the following:

Precision medicine: Efforts to personalize treatment for MBC to the genetic profile of a patient’s tumor and its metastases have been hampered so far by a lack of necessary data from patients. However, the report notes this is beginning to change, with efforts like the Metastatic Breast Cancer Project, which aims to create a national database of patients’ blood and tumor samples for use in genomic studies.

Specific MBC populations: A better understanding of MBC in specific subpopulations–including subsets of triple negative MBC, patients with HR-positive MBC, and older patients and men with MBC–will be essential to matching targeted treatments with the appropriate patients.

Clinical trials: New and ongoing clinical trials will need to address such issues as the optimal sequencing of treatments and whether novel combinations of new drugs or therapies can further improve outcomes beyond what could be possible with a new drug alone or combined with an older treatment. Innovative clinical trial approaches, similar to the design of the I-SPY2 trial for early breast cancer, need to be used to help screen promising new drugs for MBC as well.

Data registries: Registries of MBC patients are another essential to improving understanding of the patient population and its needs. We don’t have data, for example, on the actual prevalence of MBC because most existing databases (including the U.S. SEER database) only capture data on patients with metastatic disease at initial diagnosis.

The good news is there are signs that things are beginning to move in the right direction. The report notes that the recognition that much more needs to be done in MBC is gaining momentum. There is a “robust pipeline” of new drugs currently in all stages of development, including many in Phase III clinical trials that may become options for MBC patients in the future. The largest number of ongoing Phase III clinical trials are for HR-positive MBC, with 13 trials involving seven new targeted drugs. For triple negative MBC, there are five open Phase III trials and numerous earlier phase trials.

For More Information

A recent two-part series by the Fred Hutch News Service focuses on metastasis. The first article in the series, ‘I feel like this is the year,’ looks at how patients currently living with the disease have made an impact advocating for more awareness of and research funding for MBC. And the second article, The Science of Cancer Spread, focuses on the biology of metastasis and some of the fascinating things researchers are learning about how cancer cells travel from their original homes and seed new tumors in other parts of the body. It looks at how scientists hope the be able to use that knowledge to develop targeted treatments that will stop metastasis.

For more insights on the Global Status of MBC study, particularly the first two parts of the study not discussed in detail here, see Report Gives Low Marks to Metastatic Breast Cancer Care on Medscape.

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Metastatic Breast Cancer: A Look at the Critical Need for Focused Research
Breast Cancer: How Much Progress Have We Made?

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