Lisa A. Carey, MD, ScM, FASCO
Chapel Hill, North Carolina
L. Richardson and Marilyn Jacob Preyer Distinguished Professor in Breast Cancer Research
Deputy Director of Clinical Sciences, Lineberger Comprehensive Cancer Center
University of North Carolina
Chapel Hill, North Carolina
Understanding the evolution of breast cancer metastasis to improve therapeutic strategies and identify new drug targets.
There is no cure for metastatic breast cancer (MBC)—cancer that has spread from the breast to distant organs. Most of our knowledge about breast cancer comes from studying tumors in the breast, not their metastases in other sites, but there can be important changes after spread that affect treatment outcomes. Dr. Lisa Carey and her team address this by comparing primary breast tumors with metastases, performing cellular and genetic analyses to reveal their differences. Dr. Carey’s team also studies de novo MBC, which is cancer that has already spread by the time it is diagnosed. Several datasets suggest that de novo disease—which represents almost 30 percent of metastatic breast cancers—is associated with substantially longer survival when compared to recurrent metastasis (when cancer spreads after treatment), but it is still incurable. Dr. Carey and her team will analyze samples from de novo metastasis to help design therapeutic strategies for these patients, who may require care that differs from the standard practice for recurrent metastasis.
In the last year, Dr. Carey and her team tested the performance of genetic prognostic tests in metastatic breast cancer to help guide treatment decisions. Typically, these assays are performed on tissue from the original (primary) breast tumor. Dr. Carey’s team explored whether the results of these tests differed when using samples from metastases. They found that there were variations between that tests that reflected the unique environments of each metastatic site. The results of this may affect how these prognostic assays are used for therapeutic decision making in metastatic breast cancer. In addition, the team continued their exploration of de novo metastasis, assessing their 1,000-patient metastatic cancer database with clinical information for 232 patients with de novo disease. They confirmed that de novo breast cancer has a better prognosis, independent of other contributing factors including treatment type and clinical subtype. This raises important biological questions—why do breast cancer patients who experience recurrent metastasis fare worse than de novo metastasis patients? They will continue to explore this question as more information may shape how breast cancer is treated, especially breast cancers that are likely to spread.
In the coming year, the team will continue their efforts to clarify the biologic changes that occur during metastasis, and to characterize variations in molecular profiles across multiple metastatic organ sites. They will also proceed with studies in conjunction with the HARMONY study, an ongoing clinical trial in which patients with newly diagnosed metastatic breast cancer undergo diagnostic testing. Their research will continue to explore the differences between diagnostic results for primary breast tumors and metastatic tumors, as this affects treatment decision-making. This trial has accrued over 200 of the planned 500 patients.
“Most of our knowledge comes from studying the original cancer, not the metastatic cancer, and it’s increasingly clear that there are important differences after cancer spreads that may be important in improving treatment.” – Dr. Carey
Lisa A. Carey, MD is the Richardson and Marilyn Jacobs Preyer Distinguished Professor in Breast Cancer Research in the Department of Medicine at the University of North Carolina (UNC). She graduated from Wellesley College, then received her medical degree from the Johns Hopkins University School of Medicine where she remained for her residency in Internal Medicine followed by a fellowship in Medical Oncology and an advanced degree in Clinical Investigations. Dr. Carey joined the UNC faculty and Lineberger Comprehensive Cancer Center in 1998. She was the Chief of the Division of Hematology and Oncology and Physician-in-Chief of the North Carolina Cancer Hospital from 2012-2020. In 2020, Dr. Carey assumed the role of Deputy Director of Clinical Sciences at Lineberger Comprehensive Cancer Center.
Dr. Carey has a longstanding research interest in the clinical application of laboratory findings in breast cancer, with a particular interest in the clinical implications of different molecular subtypes of breast cancer. She designs and leads clinical trials of novel drugs and approaches, and is a close collaborator with several laboratory investigators and epidemiologists. Dr. Carey has served in many roles for the American Society of Clinical Oncology (ASCO), the American Association for Cancer Research (AACR) and the NCI. She is a member of the Johns Hopkins Society of Scholars, the recipient of the NCI Director’s Service Award, and honored to be a Fellow of the American Society of Clinical Oncology (FASCO). Dr. Carey serves as the co-chair of the Alliance National Cooperative Group Breast Committee since 2016.
The Pink Promises Award in Memory of Sue Decina
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