Once you get beyond pink, what is the best path to help put an end to breast cancer – the most common cancer in women worldwide and second leading cause of cancer death in American women, exceeded only by lung cancer? Talk to many people who dedicate their lives to finding a cure, and the answer you’ll hear most often: Research. So where are we with global scientific research into breast cancer – its causes and cures? Which latest findings offer the best hopes, biggest surprises, most frustrating obstacles? How can the research go faster – find hidden clues more quickly? If science is the key to a cure, what steps can we all take to help researchers open the lock? Dr. Marc Hurlbert is Chief Mission Officer of the Breast Cancer Research Foundation, overseeing the foundation’s global research grants program and a nearly $50 million annual research-granting budget. Marc previously helped launch the Metastatic Breast Cancer Alliance, and has served as the Chairman of the Board of the International Cancer Research Partnership, the Health Research Alliance and is also the former chairman of the Cancer Committee Advisory Board for the New York Presbyterian Hospital
Chris: I’m Chris Riback. This is BCRF Conversations. From our local soccer fields, to store shelves, to NFL stadiums every October, we see the pink and we know what it stands for. We all also seemingly know someone who has suffered from the disease, but what about a cure? Once you get beyond pink, what is the right, best, path to help put an end to breast cancer? The most common cancer in women globally and second leading cause of cancer death in American women exceeded only by lung cancer.
Talk to many people who dedicate their lives to finding a cure and one answer you’ll hear most often, research. Where are we with global scientific research into breast cancer? It’s causes and cures. Which latest finding offers the best hopes, biggest surprises, most frustrating obstacles? How can the research go faster? Find hidden clues more quickly? If science is the key to a cure, what can we all do to help researchers open the lock?
Dr. Marc Hurlbert is the Chief Mission Officer at the Breast Cancer Research Foundation, overseeing its global research grants program and the nearly 50 million dollar annual research granting budget. Marc previously helped launch the Metastatic Breast Cancer Alliance and has served as the chairman of the board of the International Cancer Research Partnership, The Health Research Alliance, and the Cancer Committee Advisory Board for the New York Presbyterian Hospital.
Marc, thanks for joining me. Why research? You’ve clearly dedicated, at least your professional life, to breast cancer, and breast cancer prevention, and helping people once they have it. You’ve focused on the research component. Why that area?
Dr. Hurlbert: Thank you Chris. I believe research and medical research is the key to making advances for all human diseases, but specifically in the fight against cancer, funding, medical research, and investing in medical research is an important endeavor and the United States is the leader in investing medical research both at the governmental level from industry and from non-profits like BCRF.
My excitement and commitment, I’ve been interested in science and medicine since I was about in the third grade. I do believe that a deeper understanding of science, and in our case, what causes a healthy cell to turn into a cancer cell, understanding that process, how a cancer cell grows, and divides, and then spreads throughout the body, and understanding those very basic steps, the very basic research, is what’s going to be crucial to finding the important discoveries and we’ve made a lot of progress.
Chris: Why is the U.S. the leader in that? Do you know? It was just as you were discussing that, it occurred to me it certainly feels like we are. You’ve got breast cancer, and awareness around breast cancer obviously becomes such a core component of American culture, but what is it about the United States? Why do you think that we’re the leader in funding and driving research?
Dr. Hurlbert: Well, just to put it into perspective, in the United States, we have the National Institute of Health, which is a large government investment of about $30 billion every year across all the sciences, all the diseases, and about 5 billion of that is focused on cancer research each year. The National Institute of Health and the government funded research, it all comes from your and my taxpayer dollars.
It’s very uniquely a United States thing. Other governments around the world don’t invest in science and technology quite to the same level and you ask why is that? Well, actually it all came about around World War II when the US was trying to make advances to obviously have a good outcome for World War II, but they established the NIH about the 1940’s. I can’t remember the exact year, but from that initial push into science and technology and quickly over the upcoming decades made the US the leader and then similarly a lot of foundations were established around the same time.
The 1940’s, 50’s, 60’s where Americans that had the ability to give back to society wanted to do so through ways investing through medical research. Really the combination of the government investment and the philanthropic sector growing 50 or more years ago really has now carried us to being in a lead position.
Chris: What is a Chief Mission Officer?
Dr. Hurlbert: It’s actually quite interesting. It’s a quite literal definition. The mission of BCRF is to prevent and cure breast cancer and my role as Chief Mission Officer is to make sure that we achieve that mission of preventing and curing breast cancer. I have the best job in the world. My job is to come to work and cure cancer.
Chris: Yeah, and I’ve seen where you have said that your job as well is to make sure that the BCRF-funded researchers succeed. What do you mean by that? What can you do and what does success mean?
Dr. Hurlbert: BCRF is very unique in that we fund people, not projects. BCRF seeks out the best and brightest scientists in the world and we’re investing in them. Not necessarily in a specific project. We’re funding the best and brightest scientists. Of course we ask, “What are you working on today?” and we want to know what that project is.
My role is to work with them. We have 240 scientists we’re funding this year in 13 countries and my role as BCRF Chief Mission Officer is to work with them. Science is science. It’s research, and discovery, and they don’t know from one hypothesis until they do an experiment in the lab exactly how it’s going to go. It’s just their best hypothesis, their best guess, or their best estimate of how something might go.
My role is when they’ve conducted an experiment in the lab, let’s say they have an interesting discovery that maybe didn’t pan out as they had guessed or estimated it might. They want to shift directions mid-stream. Well, my role is to understand when they make these shifts, work with them to make sure they have the resources needed to make the appropriate shifts, and quite often it’s the cases where a scientist goes down a path, they do some experiments in a lab, and they make a discovery. They find something they were never expecting.
Again, in traditional funding agencies, you might have to wait another year, apply for more funding in a different capacity to pursue that new side discovery that you just found. With BCRF we can shift gears immediately when interesting breakthroughs are found.
Chris: I can totally understand why for a scientist such as yourself a role like this really does have to be incredible. You spend, I don’t know what percentage of your time, but I imagine a great deal of your time interacting with scientists around the world, here in the U.S., and elsewhere. From your science point of view, as you have done that lately let’s say over the last 6 months, 12 months, 24 months, what’s interested you the most or you may not want to choose? You likely love all of your children equally, but what are some highlights? What is some research that’s interested you, or surprised you, or it was unexpected? Anything that you see out there that’s really making you excited?
Dr. Hurlbert: Absolutely, Chris. BCRF funds the whole spectrum from very basic biology of how a healthy cell turns into a cancer cell and starts dividing, to genetics understanding of the disease, to developing new treatments, but also working with patients as they get treatment, ensuring they have the optimal survival from those treatments. That they have a high quality of life and not a lot of side effects from the treatments.
The last point is that BCRF works towards ensuring optimal survival for all patients, trying to reduce disparities in access to any of the latest medical breakthroughs. I have to say, for me the most exciting part is developing new treatments and this goes to in part why I love working with BCRF and why I came to this organization. Also why I’m chair of the Metastatic Breast Cancer Alliance. People and patients living with metastatic breast cancer today, and I choose the word people because men and women both get breast cancer, although it’s mostly a disease of women. People living with metastatic breast cancer today, they need more treatment options urgently. When you’re diagnosed with metastatic disease, that’s stage four out of four possible stages of breast cancer, it’s spread from the breast to the other parts of the body and quite often once you’re diagnosed with stage four disease or a metastatic disease, that’s two words for the same thing, you’re in constant treatment for the rest of your life.
The average lifespan from time of stage four diagnosis is only three years. Our goal, our dream at BCRF, is “Could we turn that into 20 years, 30 years?” That would make it more of a chronic condition, but we don’t have that as a reality today. My most exciting research to me is looking at developing new treatments. How do we develop them more quickly? Again, if you’re looking at it from the shoes of a metastatic patient, they’re on a cocktail of drugs today that is keeping the cancer at bay for a while.
Maybe a few months, then they go in for a scan, they find out the cancer is now no longer responding to the current treatment regimen. It starts to grow again or they have a new spot that’s shown up in another part of the body. So they’re switched to a different cocktail of drugs and so on and so on. They might have one, two, three lines of therapy. Quickly their options are running out and so we urgently need new treatments for people living with metastatic disease. I hope that’s clear and why that’s my favorite part of my role is looking at developing new treatments.
Chris: Yeah. Exceptionally clear why. You’re talking about people who are in an urgent, the most urgent, battle. It’s easily understandable and extremely human to understand why finding treatments that can, as you put it, extend potentially time frames from 3 years to 20 years. That would be highly motivating.
A couple of questions that come into my mind off of that. One is what might new treatments look like? What are the types? In terms that I can understand which means necessarily extremely simplistic what would those treatments look like? What does science need to be focusing on? How do you turn 3 to 20?
Dr. Hurlbert: We know over the last decade or so that breast cancer is not a single disease. There’s about five major sub-types of breast cancer. When we say sub-types, what we mean is there’s one type that’s called ER positive and what that means is it expresses that sub-type of breast cancer cells expresses the estrogen receptor and we have drugs that target the estrogen receptor or ER.
Again, there’s about five major sub-types. I won’t go into the biology of all of them, but the question is, can we target what’s gone awry in that specific cancer cell, that specific cancer sub-type? In the last couple of years with all the advances in genomics, and sequencing of tumors, and tumors from thousands of breast cancer patients, we have what’s called the Cancer Genome Atlas.
By sequencing cancer cells from thousands and thousands of patients, we now have identified a lot of targets within the cancer cell that have gone awry. That maybe there’s too much of a specific gene being expressed in a cell or maybe a gene’s missing. Beyond just knowing that there’s five types of breast cancer, we’re drilling down even deeper within, for example ER positive, what else could be going wrong?
Just over the last year there was a new drug approved that targets another protein within cancer cells. You don’t need to know what that is. It’s called CDK-416. It quite often has too many copies of that protein in cancer cells that are ER positive. Just last year a new drug was brought out onto the market that in people who have ER positive cancers that are getting one set of drugs to target ER.
Now we’re adding a new drug that inhibits CDK-46 with that. There’s a combination added into it. What this means for you, or to explain it in a more lay-friendly way is we were discovering, have discovered, a lot of the molecular changes in cancer cells and now we’re developing new therapies to target those specific changes. This is very different than how cancer treatment was developed 50 years ago, so for example, we in the past had developed chemotherapy therapeutic agents and they primarily target cells that are rapidly dividing.
Just generally cells that are rapidly dividing, so that’s why when you get chemotherapy, cells that are rapidly dividing such as your hair follicles, and in your stomach and GI tract, that’s why you get nausea, that’s why you get hair loss and some of the other challenges with chemotherapy. This next generation of treatments that I just described, CDK-4 inhibitors, and others that are just on the cusp of being developed are very targeted. They don’t target the whole body. They very specifically target molecules that scientists discovered to be over expressed, to have too many copies of it within cancer cells.
Chris: How does the science and the research enter this aspect? There are so many areas of research into heredity and prevention in others. Does the science and the research into treatment, is there a cross-pollinization with the other areas of breast cancer research where learning in one discipline can then effect and other or is the research so specific and so hyper-focused that the learnings in one area, while potentially and we all hope to be fantastic, may or may not apply to some of the other areas. How does that aspect of research work?
Dr. Hurlbert: Absolutely. Discoveries in one area do cross-pollinate in other areas. The research in very basic biology of cancer cells, sequencing them, that kind of thing, that’s very basic research have now identified targets we can develop drugs and test those new drugs in clinical trials and see if they work. Testing this new treatment for example in clinical trials, whether they work or whether they work for a little while and stop working, we can then feed back and understand more of the biology.
It is quite a circle. I would point out that often it’s not a circle within breast cancer. It’s not basic research in breast cancer feeds new treatments for breast cancer that then feed back to breast cancer research. Research into breast cancer, research at BCRF, by my estimation about 30% of our portfolio is applicable to all cancers. If you could understand the mutations in a cancer cell at a cellular level, it doesn’t really matter so much where in the body the cancer started, the breast for example. It matters more what mutations are expressed and in what cancer cells.
If we can understand that, which we’re making great progress at, it’s relevant just beyond breast cancer to many others. The other factor is if we can understand how a cancer cell in our case gets out of the breast. It grows from one cell to two, to four, to eight and imagine exponential. There has to be millions of cells before you even feel a lump, but how does a couple of those healthy cells get out of the breast into the lymphatic system and spread to other parts of the body. If you understand that spreading process, it’s called metastasis. If we can just understand that process, it’s relevant to nearly all cancers that spread from one organ to another.
Chris: Yeah. You can certainly see how that would be the case and how it would be relevant. I was also interested as I was researching more and reading more for this conversation, obviously we talked about you helped launch the Metastatic Breast Cancer Alliance. I believe, correct me if I’m wrong, is that now part of, or I guess BCRF is now related and is part of, the Metastatic Breast Cancer Alliance? Is that right?
Dr. Hurlbert: Yeah, BCRF is a member of the Alliance. The Metastatic Breast Cancer Alliance is a membership organization. We have about 35 cancer non-profits that have joined together to try and improve the outcomes fro patients with metastatic breast cancer. The Alliance is now physically housed here at BCRF with me. There’s one staff person for the Alliance and she’s the director of the Alliance. She sits here at BCRF in our offices with me.
Yeah, I helped found this group because it’s so critical, it’s such a complicated, it’s like the final frontier for breast cancer. If we can understand how to stop metastasis and how to treat it, we can turn that three-year survival to 20, 30, to the dream that we have. Such a complicated thing we do have to work together because it involves the research part that BCRF is the leader in. It involves some of our Alliance members are expert at communicating about the disease and treatment options to the public. To patients and their families with the disease.
There’s some of our Alliance members that focus on that education component. Understanding what your treatment options are, becoming educated on the power to make your own decisions or work in partnership with your healthcare team to make decisions. Other Alliance members provide direct support to patients. Whether they need holistic therapies to overcome some of the treatment side effects. Whether they need financial support if they have insurance challenges. The Alliance covers the whole spectrum from research, again which BCRF is the leader in, but it’s also supporting the patients, and then improving the educational materials for those patients.
Chris: On that front, on the educational materials front, I guess there was the report that you guys put out in 2014 changing the landscape for people living with metastatic breast cancer in the report. One of the key findings I guess was highlighting the gaps in knowledge about the true number of women and men living with metastatic breast cancer today. How many early stage survivors go on to experience a recurrence, the quantity of life and the quality of life.
Again, as a lay person, it struck me that it’s even so hard just to get that basic information. Is that still the case? How many people have this? How big is the problem? What is the range of the problem? Is that still one of the areas? If we have trouble putting our arms around the size of the problem, just that just speak to how hard finding answers and finding solutions can be if we can’t even necessarily get a full accounting of how many people have this?
Dr. Hurlbert: Absolutely. We still have challenges getting the best numbers around. The number of people with metastatic breast cancer, our best estimate is about 250,000 people living with metastatic breast cancer in the United States today. Again, our best estimate is there’s about 20 to 30% of people who had early stage breast cancer, they thought they did all their treatment, they thought they were done, they thought they were survivors, but our best estimates are that between 20 and 30% might experience a recurrence at some point in their life.
We still don’t know who those people are at this point until symptoms arise. The Metastatic Breast Cancer Alliance and BCRF, me in my role, are working with the National Cancer Institute, the government, and they have what they call the SEER Registry. It’s a registry system where they track all cancer cases. In the past they only had the ability to track cancer patients the first time that someone was diagnosed.
They did not have a way of keeping records of those that had an early disease that was treated and then had it return later because sometimes it can recur or return 5 years later, 10 years later, 15 years later. It’s still not fixed but we’re working with the SEER Registry and the National Cancer Institute to try to improve that tracking. We’re also working with a couple of individual hospital systems.
There’s a few of them around the country that they for example were early adopters of electronic medical records, and they have really robust data around the patients that come to their hospital. It’s only a single hospital which is a very narrow view. It’s not a full population registry like here, but there’s a few of them that have really long-term followup for 20 or 25 years of all the cancer patients treated in their hospital. We’re working with a few of them to see if we can get that better numbers. We hope to have a few reports coming out towards the end of 2015.
Chris: Marc, I’m going to follow up on that part of the work. You mentioned some of the role and some of the work that the government does and what you had mentioned earlier, the NIH, and the founding of that, and going back to World War II, and the role of government. With that in mind, the role of an organization like BCRF, and was we start to think about what drives or what enables an organization like the BCRF.
Obviously there’s corporate involvement, and fortunately there are businesses and organizations that provide support, but there are also individuals who provide all kinds of support from the extremely large to just very small providing that type of support. What is the importance, what’s the need, for a BCRF? What’s the need for the private organizations?
You’ve got the NIH. You’ve got President Obama recent called for a moon shot to end cancer. What’s the role of the private organizations in addressing something this big and where, as we’ve said, the U.S. government, luckily, thankfully, does play a role? What’s the importance of an organization like the BCRF in all that?
Dr. Hurlbert: Every dollar donated to BCRF is critical to advancing breast cancer research no matter how small or how many dollars are donated. Every dollar counts. The critical role for BCRF is we invest in scientists with the best and brightest minds all over the world. We have projects and scientists in 13 different countries.
What BCRF funding allows them to do is focus on their most innovative ideas. Let them test some hypotheses that might be high-risk, but might also be high reward. The things you can’t necessarily do with government funding. The government, if you think about it, the government has a fiduciary responsibility to all the taxpayers and what is our tax rate that we all complain about how much we have to pay in taxes from time to time.
Today they have a fiduciary responsibility to not be taking too many risks. To focus only on the most sure bets. What philanthropy and specifically what BCRF allows scientists to do is to pursue their most creative ideas. It gives them the freedom to pursue innovation, testings, to partner with other scientists they might not otherwise be able to collaborate. BCRF is very unique in bringing all of our funded scientists together and in a space that’s pretty competitive.
They’re willing to share their ideas, they’re willing to share their raw data with each other. Essentially every major breakthrough for breast cancer in the last two decades has been touched either directly by BCRF funding or by one of the scientists in our network that we’ve been funding.
Chris: Do they talk to you about that? Do the scientists talk about the culture and the connectivity of being able to work in that type of environment with other scientists?
Dr. Hurlbert: Absolutely. All the time. When I read our BCRF progress reports, I’m reading about how the specific projects emanating from a scientist in Kansas that came to our annual meeting two years ago and as a matter of fact, more scientists I’ve never met before, they shared some ideas at our in-person meeting, went back to their labs, began a collaboration, and now a year or two later, they’re really producing results.
All the time I read about this and I hear about this from BCRF funded scientists is that the BCRF network of grantees and network scientists from around the globe really does provide a safe space for them to work together, to share ideas, to share raw data at some points. That’s not the norm in science. They’re all competing and they all want to have the next Nobel Prize. They all want to have the next major breakthrough, so openly sharing isn’t necessarily the status quo, but I find in my short time here at BCRF that is one of the very unique things that BCRF and our philanthropy allow scientists to do.
Chris: Well, if there’s any effort that really cuts across cultures from science, to business, to just about anything if you’re about to help cut through bureaucracies, or channels, or lanes and get people to work together across, or communicate, or connect across efforts, that’s where true collaboration comes in and it’s so hard really in any, I called it a bureaucracy, but in any organization or global effort like that.
Marc, as I close out, I’m left wondering you’ve dedicated your life to science research and obviously in particular breast cancer research. You’ve talked with scientists, and patients, and survivors, and funders, and public policy officials. Really everyone. What do folks just not understand? What part of the battle to cure breast cancer do you just wish people heard better?
Dr. Hurlbert: I don’t think that people get how complex science is. It’s like an artist painting a masterpiece. When they buy that canvas, open that first can of paint, and begin painting, they don’t necessarily know how it’s going to turn out at the end. They might have a vision, they might have some ideas. Science is very similar.
A scientist is very knowledgeable about what is going on in the field before them. They learned about prior scientific discoveries and theories when they were in school. They get to running a lab, they have some ideas, they write that down. They begin to design what experiments they need to do to test those hypotheses, but it really is a discovery process. It’s very complex.
If we knew all the answers, we’d be done. We wouldn’t have to keep funding this. Science is very complex, but I feel like we’re unraveling granular details about how a cancer cell divides, how it stops being controlled by the normal functions that control cell growth. We’re understanding how at a very granular level, what genes are turned on, what genes are turned off, and how that cancer spreads to other parts of the body.
I believe we are going to see in the two years this generation of very targeted therapies that are less toxic than chemotherapy that are very targeted and we hope better controlling cancer cells. It’s likely that it’s not going to be one magic silver bullet. It’s going to take combinations of treatments. It’s going to take essentially a cocktail of multiple treatments to control cancer.
We might not ever be able to get rid of cancer altogether. It might be that we have to keep controlling it and turning it from that deadly scary disease that is today to something that’s more chronic and long term that could be managed like diabetes for example. I do wish people understood that researching very complex cancer specifically is highly complex. It occurs in almost every organ in the body. The cells gain the ability to spread from one part of the body to others.
Again, if we knew all the answers, we wouldn’t have to do research, but unfortunately we don’t know every answer. That’s why we’re funding so much research here at BCRF all over the globe. This year our budget was about $54 million. We hope to grow that this year and in the coming years to really begin to make a immediate difference in the fight against cancer.
Chris: Well, growing that budget and making that difference, and seeking those answers. Those are among the role of Dr. Marc Hurlbert, the Chief Mission Officer of the Breast Cancer Research Foundation overseeing its global research grants program and advocating and communicating, as you said at the very beginning the mission, of the organization.
Marc, thank you so much for your time. I’m Chris Riback. This is BCRF Conversations. To learn more about breast cancer research or to subscribe to our podcast, go to BCRFcure.org/podcasts.
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