Scientists in the lab and in the clinic can help patients with metastatic breast cancer make informed choices.
Martha lives in Illinois and was diagnosed with metastatic breast cancer in January 2015. She has a husband and three children, ranging in age from 12 to 18, a dog and a lizard.
“Eat the kale.”
“Have you tried positive thinking?”
”I heard drinking apple cider vinegar cures cancer.”
These are statements I hear regularly from strangers and friends alike, who are both worried about me and certain they know the secret to a healthier life.
I’m not going to argue about the power of positive thinking—I know it can improve my mood and ability to cope, but it is not going to cure me. Ditto with the kale and other healthy behaviors. The apple cider vinegar? Just no.
I’ll take my science from scientists, and I heard a lot of really great research at the Metastatic Breast Cancer Conference in Houston. As someone with that disease, I’m informed about my options, but it was interesting and invigorating to be in a room with a couple hundred brilliant minds who all have one goal: a cure for breast cancer.
I believe in the science behind modern treatments. At this point, those treatments won’t be enough to cure me, but they may be enough to keep me alive. As a patient, I was struck by many things these experts said, but two ideas that I can apply immediately or remember for future changes in treatment have remained on my mind and may be useful for a lot of us.
One oft-repeated point, made by several speakers, was about the importance of getting genetic testing to possibly identify genetic mutations that could affect treatment. In addition to BRCA1 and BRCA2, there are other possible genetic drivers of metastases including PALB2, RAD51D and more. Bringing home that fact, recent analyses
by over 300 researchers led to the discovery of 65 genetic mutations that can affect the development of breast cancer.
Knowledge of mutations can help lead researchers to more effective clinical treatments and, hopefully, better lives for patients. At the conference, Fergus Couch, Ph.D., of the Mayo Clinic, discussed preliminary findings, but made the unequivocal statement that patients should get tested and, “make sure they know the results of their genetic tests.”
With breast cancer metastases, the cancer moves to other parts of the body including bones, lungs, liver and brain. But cancer has all sorts of other tricks to play on us. The second point to stick with me was summarized in a couple of talks about blood-based testing. Ben Ho Park, M.D., Ph.D. of Johns Hopkins Medicine, said, “Cancers are not static. They are always mutating.” This point is critical for those of us with metastases, although it can be difficult to put that knowledge into practice since there is sometimes reluctance on the part of patients to undergo a tissue biopsy, which are frequently painful or simply not feasible due to tumor location. It can also fall on the part of medical personnel, who may have misgivings about the usefulness of biopsy information versus the pain and expense for the patient.
But the message was clear: Biopsy information has the potential to improve clinical outcomes. Minetta Liu, M.D., of the Mayo Clinic, believes in the future of blood sampling or “liquid biopsies,” which entail a blood draw rather than an invasive needle biopsy or surgery. Liquid biopsies may allow clinicians to, “monitor the evolution of an individual patient’s cancer,” she said. For example, in her experience, the circulating tumor cells found in patients with metastatic breast cancer at a given time in the treatment course, “don’t just correlate with treatment response, they can predict it.” This is a crucial need for patients who must change treatments.
Charles “Chuck” Perou, Ph.D. of the University of North Carolina Lineberger Cancer Center, in a keynote speech that addressed several topics, also reiterated the need to know how a patient’s cancer could be changing. Clinicians need to, “sample the metastatic disease when making therapy decisions,” he said, “and do so as close as possible to treatment.”
If cancers are evolving within the body, treatments and treatment ideas are also constantly adapting to new knowledge. Right now, even though we can test for hundreds of genetic mutations, we can't use the vast majority of them to improve treatment outcomes. But there is enough knowledge for how to adapt drugs and treatment decisions to make the testing useful and, as research continues, there will likely be more. Similarly, even though blood-based biopsies will be wonderful when they are widely used and understood, I can better appreciate the need for tissue biopsies when cancer progresses if I also understand that cancer mutates.
As a patient, I now have these important ideas to keep with me as I continue treatment: 1. Don’t just get genetic testing, but know the results and be aware of how they could affect my treatment; and 2. Don’t be afraid of biopsies—the changes they uncover could improve my treatment. I'll take that kind of science.