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As a PhD student in tumor biology, Jamie Holloway survived long hours researching breast cancer in the labs of Georgetown University. Ten years later, after being diagnosed with triple-negative breast cancer, she survived that too. Now with no evidence of disease, she shares a patient's perspective with scientists and clinicians as a breast cancer research advocate. A wife, mother, runner, and lipstick addict, she shares her story from the perspective of both a patient and a scientist.

An Extraordinary Approach to Metastatic Breast Cancer

An academically trained skeptic, this single project has turned me into a raving optimist.
Talk about this article with other patients, caregivers, and advocates in the General Discussions CURE discussion group.
Imagine you are a big drug company, testing out a new drug. You pick a group of people who you think are most likely to respond to the drug. If you give the new drug to ten cancer patients and nine of them have progressive disease — their tumors continue to grow — then you’re probably going to shelve that drug. You wouldn’t possibly want to give a drug to a group of patients when 90 percent of them will continue to get worse. But what about that one patient? While the other nine progressed, one patient improved remarkably. You’re probably still going to have to shelve the drug. A 90 percent failure rate is unacceptable. And yet 10 percent of the patient population might be missing out on a phenomenal treatment for their specific tumor.

That one patient is the extraordinary responder — her response was different than the expected, ordinary response based on statistics. If researchers could figure out what made her extraordinary — why she responded to the drug and the others didn’t — perhaps they could tailor a trial to patients with only that “extraordinary” characteristic. By better selecting a target patient population, they could take a drug with a 90 percent failure rate and turn it into a drug with an exceptional success rate!

The current initiatives embracing precision medicine will benefit greatly from the study of extraordinary responders. In fact, Pfizer almost scrapped the drug Xalkori (crizotinib) because of a high failure rate, despite a small group of extraordinary responders. Late in the early stage trial, the identification of the ALK gene and its mutation in non-small cell lung cancer (NSCLC) led to the discovery that Xalkori was actually a specific ALK inhibitor and that the extraordinary responders had an ALK mutation. Because doctors now know how to better select patients, Xalkori is a successful treatment in NSCLC patients whose tumors carry a mutated ALK gene. (N Engl J Med 2010; 363:1693-1703)

Talk about this article with other patients, caregivers, and advocates in the General Discussions CURE discussion group.
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