Breakthroughs in targeting different types of cancer continue to be the cutting edge in breast cancer therapy.
Renowned oncologists and cancer researchers gathered in Sun Valley last week to share their latest findings at an event sponsored by the Expedition Inspiration Fund for Breast Cancer Research. The event, called the Laura Evans Memorial Breast Cancer Symposium, included a two-hour open forum at which an audience questioned the panel of experts.
This year marked the 11th annual symposium.
Questions included where one can send tumor tissues, how to get into clinical trials, and how long a cancer survivor should stay on a drug such as tamoxifen.
The open forum, entitled "Transformation of Breast Cancer Management from Clinical Care to Clinical Science," was held Thursday, March 1, at the Sun Valley Inn's Limelight Room. Dr. Julie Gralow, of the Fred Hutchinson Cancer Research Center in Seattle and the medical board chair of the EI Foundation for Breast Cancer Research, opened the forum.
"This is the dawning of a new era," she said. "We're looking at lots of different genes and proteins. We can design therapies against them. I think of it as personalized treatment. Individually it's not just thinking of it as one disease. The most exciting advance to cancer is that we can individualize treatment; we can target HER 2 and 1," two different forms of breast cancer.
The room was scattered with a couple dozen women and a few men, including Wood River Valley physician Dr. Carl Barbee. On the panel sat two of the late Laura Evan's oncologists, Dr. Kathleen Grant from San Francisco and Dr. Ron Dorn of the Mountain States Tumor Institute in Boise. They are both members of the EI Medical Advisory Committee.
"I'm your local oncologist, if you will," Dorn said. "It was Laura's express wish that an important part of the annual symposium would be this public forum to explain exciting new areas of cancer research."
Medical Advisory Committee board member Dr. Angela DeMichele said the symposium always generates ideas. The most common question she hears is always, "What can I do to keep it from coming back?"
DeMichele said an accepted alternative to the drug tamoxifen, which may be given for as many as five years post treatment, is raloxofine.
"There are ongoing tests regarding these drugs and aromatase inhibitors. It's generally one drug or the other, depending on other patient issues. I think it is a really exciting time in terms of diagnosis and follow-up.
"But the biggest factor in staying healthy is lifestyle. We have to make sure we don't give women drugs that cause more problems. There is a role of (low-fat) diet and exercise, and that is something women have control over."
Dr. Daniel Hayes, professor and director of the Breast Cancer Oncology Program at the University of Michigan Medical Center, said genetic testing is leading to better-targeted treatments.
"It's not one-size-fits-all. Should you take tamoxifen, then switch over to an aromatase, or the other way around? There is a large clinical trial in place. Please tell your friends and have tissue tested. The verdict is still out."
Lippman put it this way.
"Sadly, you need bad things to happen to find out if things are working," he said.
Breast cancer physician-scientist Dr. Joyce Slingerland, the director of the Braman Family Institute at Sylvester Comprehensive, University of Miami, said, "It's important to go to academic hospitals. The sad part is that very few people get into clinical trials," often because their doctors don't know about trials and aren't associated with research facilities.
"If I treated my patients with what I learned in medical school, God help them," Lippman said. "Clinical trials are not clinical experience. Is the therapy effective or not? It's what has transformed the medical community in the last 30 to 40 years."
Gralow continues work that has been funded over the years by EI (among others) in dissecting the reasons why 40 percent of breast cancer recurrence metastasizes to the bone.
"We're looking for ways to disrupt that and find ways to keep cancer from setting up shop in the bones," she said. "Osteoporosis drugs inhibit bone breakdown. Given in higher doses it may decrease the occurrence of bone metastasis in those at risk."
Gralow said the study she's conducting was first written in 1999 and didn't open until late 2005.
As always, Lippman, the chair of Internal Medicine at University of Michigan, put things into perspective.
"Sick cells know how to do the noble thing and kill themselves. Take sunburn. The body sheds the sick part. Same with diarrhea or vomiting. It's the body ridding itself of the bad stuff," he said. "Cancer cells don't do that. They are resistant to the notion of killing themselves. They need to learn to do the noble thing."
Along with his colleague, medicinal chemist Shaomeng Wang, Lippman is working on three different trials. Wang's laboratory designs and develops "small molecule drugs targeting specific oncogenes," which are usually involved in early stages of cancer development, Wang said.
In order to break down the different kinds of breast cancers, Lippman deferred to Charles Perou, saying, "the person who invented them is here."
Perou is a researcher with the Department of Genetics and Pathology at the University of North Carolina. He and his team discovered that breast cancer is not a single disease, but instead represents a series of diseases that each has a unique biology.
"There are different kinds of breast cancer," he explained. "Estrogen Receptor (ER) positive has two kinds—luminal A and B. Luminal A is the most numerous of all, accounting for 40 percent of breast cancers. It's slow-growing. Luminal B is a low estrogen receptor and is fast-growing. It accounts for 10 to 15 percent of all. The third one is ER negative with a Her-2 positive group. Number four is a basal-like group or triple negative. Number five is ER positive. That has none of the markers of any of these groups. I don't know what it is."
Dr. Jenny Chang, of Baylor University, is working with a poor clinic in Houston where she's able to access "residual cancer stem cells," which can "replenish" when the cancer is not caught early. James Rae, a researcher at University of Michigan, is working on the "variability in elimination of drugs."
As an example, Rae cited an enzyme in the liver that turns codeine into morphine. The same enzyme, he has discovered, activates tamoxifen.
"I can't impress enough the importance of what Jimmy is doing," Lippman said. "It will change the Byzantine and stupid way to dose drugs we've seen in the past."
Drs. Julie Gralow and Marc Lippman, standing, open the Expedition Inspiration breast cancer research forum in Sun Valley to questions from the audience. Photo by David N. Seelig
