Fifth Annual Metastatic Breast Cancer Forum
-
Upload
dana-farber-cancer-institute -
Category
Healthcare
-
view
143 -
download
0
Transcript of Fifth Annual Metastatic Breast Cancer Forum
Fifth AnnualMetastatic Breast Cancer Forum
Saturday, September 24, 2016
Forum ChairNancy Lin, MD
Forum Co-ChairsLiz Frank
Lauren Knelson
Overview
• What is metastatic breast cancer?• What is EMBRACE?
– Clinical program– Research study
• How else are we learning about metastatic breast cancer?
What is Metastatic Breast Cancer?• Cancer that has spread outside of the breast and local lymph
nodes
• Frequently can be controlled with current treatments, but length of disease control can be quite different between patients and from one treatment to the next– One size does not ‘fit all’– Not a set treatment course; unpredictability, ups and downs
• Usually not ‘curable’, but some patients can live for many years with good quality of life
• An area of very active research – we are making progress!
• There are three main subtypes of breast cancer
• Within these, there are other ways to further sub-divide breast cancers
• Oncologists use the breast cancer subtype to guide the kinds of treatments to recommend
• Clinical trials often will focus on specific subtypes
Breast Cancer Subtypes
Breast Cancer Subtypes
Breast Cancer Subtypes
ER-positiveHER2-positiveTriple-negative
TALK to your doctor if you are not sure what type of breast cancer you have
Hormonal therapy
Hormonal therapy Chemotherapy Chemotherapy
Chemotherapy Chemotherapy Chemotherapy
Herceptin + perjeta +
chemotherapyTDM1 Lapatinib +
CapecitabineHerceptin +
chemotherapyHerceptin +
chemotherapy
Hormone receptor (ER)positive
Triple-negative
HER2-Positive
*Note, these are just examples. Each patient is different and treatment is tailored accordingly.
How Do We Treat Patients withMetastatic Breast Cancer?
Social
Emotional
SpiritualIntellectual
Physical
Why EMBRACE?
•Support your doctor at DFCI to be aware of trial options, research testing results, and facilitate care
•Interface with referring/local oncologist to improve ease of communication and enhance collaborative care
•Support patients by facilitating access to supportive care services, providing educational forums and materials
•Support research efforts, including the EMBRACE research study
PILOT begun summer 2015, full roll-outAugust 2016
Clinical Trial “Prescreening”
• Some trials only enroll patients whose tumor tests positive for a specific marker
• EMBRACE program facilitates testing, think ahead– Oncopanel– Trial specific testing– Coordination with biopsy study
EMBRACE Clinical Program: Coordinators
Maggie Merrill Rebecca Santiago Nicole Kuhnly Lindsey Crowley
Gunjan Gupta Kathryn Silva
What is the EMBRACE research study?
Patient consent*
Blood samples for research
Records review into database
*also includes permission for research on existing tissue samples
12
34
56
78
910
1112
1314
1516
1718
1920
2122
X
Freq
uenc
y Al
tere
d 1.0
0.5
0
0.5
1.0
12
34
56
78
910
1112
1314
1516
1718
1920
2122
X
Freq
uenc
y Al
tere
d 1.0
0.5
0
0.5
1.0
Primary TNBC Tumor tissue
Metastatic TNBC (EMBRACE study, 87 patients)Cell-free DNA
Example: Triple Negative Breast Cancer
Slide courtesy of Dan Stover, MD
Example: ER+ Breast Cancer
Blood
Blood
Matched tumor
Heather Parsons, Viktor Adalsteinsson, Gavin Ha, Sam Freeman, Nick Wagle, Dan Stover
Metastatic tumor biopsy (3-8 cores) & blood samples
Patients with ER+ MBC
Core 2
Core 4 - 5
Core 6++
WES +RNASeq
Cell Lines / Mouse Models
CLIATumor Bank
Single CellRNA-seq
Studies of Resistance
and Heterogeneity
Functional Studies / Co-Clinical Trials
Future Studies
cell free DNA (cfDNA) for WES and hotspot profiling
Serial BloodSamples
Core 1
PathologyER, PR, HER2 Returned to
Physician
94 biopsies from 88 patientsJuly 2015 – May 2016
CLIA Targeted Seq Panel
Core 3
Biopsy Study
Wagle et al, ASCO 2016
What Type of Breast Cancer?Have you received: Trastuzumab (Herceptin), pertuzumab (Perjeta),Kadcyla (TDM1), or Lapatinib (Tykerb)
YES HER2-PositiveYawkey 306/307
NO
Have you received: Tamoxifen, letrozole (Femara), anastrazole (Arimidex),Exemestane (Aromasin)
YES ER-PositiveIn this room
NO
Triple-negativeSmith 308/309
Funding Sources
• Grant from the National Comprehensive Cancer Network-Pfizer
• Fashion Footwear Association of New York• Pan-Mass Challenge• Breast Cancer Research Foundation