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. They are particularly interested in organ tropism: why different subtypes of breast cancer tend to metastasize to specific organs. For example, ER-positive breast cancers often metastasize to bone, whereas ER-negative and HER2-positive breast cancers typically spread to major internal organs. Dr. Carey’s team also studies de novo MBC—cancer that has already spread by the time it is diagnosed. These patients live longer than those with recurrent MBC (when cancer spreads after treatment), which reveals potential differences in the biology of their tumors. Their research could help inform therapeutic strategies for recurrent versus de novo MBC.
The team recently examined molecular disparities between de novo and recurrent MBC, uncovering a propensity for specific breast cancer subtypes: de novo is more likely to be HER2-positive, and less likely to be triple-negative. Dr. Carey’s team also explored metastatic organ tropism and found a molecular signature in ER-positive patients that predicts metastasis to the lung, liver, and brain. The genes associated with this signature could inform the development of new therapies.
Dr. Carey’s team will continue exploring the biology of de novo metastatic breast cancer, observing if prolonged survival seen in these patients is explained by differences in the immune system’s response. They will also assess the performance of genetic prognostic tests on metastatic tissue samples when compared to breast tumors—looking for discrepancies in results, as that could reveal two different therapeutic strategies for a patient. Their findings may initiate a larger clinical trial to test the use of prognostic assays for therapeutic decision making in metastatic breast cancer.
“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.
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