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Our Commitment to Metastatic Breast Cancer Research

By BCRF | October 30, 2020

As Breast Cancer Awareness Month comes to a close, BCRF’s Chief Scientific Officer reflects on the progress we’ve made against metastatic disease—and the urgency of our mission now.

We have made tremendous gains against breast cancer. Since BCRF’s founding in 1993, breast cancer mortality rates in the U.S. have declined by 40 percent. Today, early-stage breast cancers have a five-year survival rate of more than 90 percent, and now—at 3.8 million—there are more breast cancer survivors in the country than ever before.

Research is the reason more women and men are being diagnosed earlier, and then surviving and thriving after breast cancer. It’s the reason we have refined diagnostics, molecularly targeted therapies, and, more recently, precision treatments—all developments that have improved outcomes and saved millions of lives. And BCRF-funded investigators have been a part of every major breakthrough in breast cancer.

But why is research still the reason? The numbers paint a heartbreaking picture: One in eight women will get breast cancer in her lifetime, and an estimated 168,000 women in the U.S. are living with metastatic breast cancer, meaning it has spread beyond the breasts and lymph nodes. Of all women diagnosed with breast cancer, 25 to 30 percent will experience a recurrence. Despite our progress, metastatic breast cancer remains incurable, and tragically, more than 42,000 women and men will die from it this year.

Twenty-five years ago, my 37-year-old aunt Omaima, a mother to two young daughters, was diagnosed with metastatic breast cancer. She died at the age of 39 having spent most of those two years in treatment, trying new therapies and changing drugs until they failed and eventually there were no more options. A few years later, a second aunt of mine, Oot, died from metastatic breast cancer, less than one year after her breast cancer metastasized to her liver. This is why, when I first became a researcher, the focus of my laboratory was metastatic breast cancer.

BCRF has made deep investments in metastatic breast cancer research. Currently, metastatic research comprises 40 percent of our investment, including the flagship Evelyn H. Lauder Founder’s Fund for Metastatic Breast Cancer Research. Since our founding nearly three decades ago, progress, real progress, has been made to optimize treatments and develop new therapies that extend both response to treatment and lives. 

But despite these advancements, women—young women—and men are dying from metastatic breast cancer. Like my aunts 25 years ago, they are monitored and treated until there are no more ways to treat their disease. This year, Erin, the woman for whom one of my research grants is named, died from metastatic breast cancer five years after her diagnosis. She was 35 and the mother of three young children. Emily, a BCRF ambassador and dear friend to many of us, died in March, two years after her diagnosis. She was 35 and the mother to a young son.

Having spent my research career working to discover the role of non-cancer cells surrounding and supporting breast cancer cells to drive metastasis, and then coming to lead the scientific program at BCRF, an organization that has made long-term, deep investments in metastatic research, these two women’s deaths were a gut punch this year. But I find hope in where research is now—and what is on the horizon.

Research is the reason that in the last five years, nine new drugs have been approved for metastatic breast cancer. Nine! The two most recent approvals, earlier this year, were for treatment of brain metastases from HER2-positive breast cancer and for metastases from triple-negative breast cancer, an aggressive subtype.

Just a few weeks ago, the team on one of our flagship Founder’s Fund projects in Europe, known as AURORA EU, announced that they had accrued 1,000 patient samples. Data from these samples—along with samples from AURORA US—will define, for the first time, deep molecular alterations specifically in breast cancer metastases compared to primary tumors. The AURORA patient sample collections are unprecedented in scale. Through these multi-disciplinary analyses, we will not only better understand metastasis, but identify new therapeutic targets to treat it.

And in a very recent conversation with BCRF investigator Dr. Nancy Lin, she noted that for HER2-positive breast cancer, we have made such progress in treatments to reduce the risk of early-stage patients ever developing liver and lung metastases—pause here for a minute; this is significant—that now brain metastases were an increasing proportion of metastases that still occur. Dr. Lin was a lead investigator in the trial of tucatinib (Tukysa®) in HER2-positive breast cancer and championed allowing patients with brain metastasis, who she described as “almost universally excluded” from trials, to enroll. Earlier this year, tucatinib was approved for the treatment of patients with HER2-positive breast cancer, including those with brain metastases. Now, there are plans to test tucatinib in patients with high-risk, early stage breast cancer, to see if it can reduce the risk of cancer ever spreading to the brain in the first place.

This is the power of research.

Only research will accelerate progress and save more lives. Looking forward, I see two ends of the spectrum that research needs to target: On one end, we must urgently find curative treatments and precision therapies for those who are living with metastatic breast cancer today. On the other end, we have to think about tomorrow—and how we can prevent breast cancer in its entirety. To best aim for these two goals, we must support the entire spectrum of research—from basic science studying the very roots of the disease, to clinical trials moving treatments from the lab to the bedside.

BCRF remains committed to the women and men who continue to be diagnosed with, and are living with, metastatic breast cancer. And with estimates of a rise in advanced breast cancer cases as a result of delays in diagnosis and treatment during the COVID-19 pandemic, the research we fund today has the potential to save even more lives tomorrow.