Clinical trials took top billing at the fourth annual Northwest Metastatic Breast Cancer Conference held September 7th at the Amazon Meeting Center in Seattle. Scientists from Fred Hutchinson Cancer Research Center shared new treatments; National Cancer Institute experts and patient advocates provided searchable trial registries and resources; and a Clinical Trials Fair let patients and caregivers learn about the latest cancer trials at treatment centers in Seattle and across the country.
Hutch clinical researcher and SCCA breast cancer oncologist Dr. Julie Gralow kicked things off with a fast-paced overview of genetics, genomics and targeted therapies. Cancer’s mutational shapeshifting means targeted therapies for people with metastatic disease need to constantly be informed by the genomic profiling of tumor tissue, Gralow said. And oncologists need to constantly keep an eye out for the actionable genomic alterations, i.e., cancer mutations that can be targeted with treatment.
“We’ve got to know what’s in the genome and we’ve got to know how it changes over time,” Gralow said. “I want to stress the importance of getting the tumor tissue — serially, over time — to know what we’re treating.” Testing tumor tissue means biopsies, which Gralow and others acknowledged are neither painless nor without complications. Liquid biopsies, using a patient’s blood to find all the various mutations that could lead to treatment, are getting close but aren’t quite ready for prime time.
Fred Hutch and SCCA physician-scientist Dr. V.K. Gadi emphasized the role of precision medicine in oncology, likening “old school” cancer genomics to a paper roadmap and precision medicine to a GPS-enabled phone app. Oncologists, he said, are now working with biotech partners to create cancer avatars and tumor organoids — biological models of disease grown on the backs of mice or in dishes — to determine the best therapy for each patient’s cancer. And this practice will only increase as time goes on. “We can now grab cancer cells out of a patient, grow them in a petri dish and literally have them behave as if they were still in a human being,” Gadi said. “We can massively test drugs and combinations of drugs and generate a report from that. This is the next generation of what’s going on with how we interrogate cancer cells for their sensitivity for precision medicines.”
Gadi talked about all the strategies he and other scientists are exploring to squelch cancer before it can spread, giving updates on drugs that target DNA repair pathways, PARP inhibitors, antibody-drug conjugates and CDK4/6 inhibitors. He also encouraged patients to “absolutely” bring new findings and potential trials to the attention of their oncologist.
Hutch/SCCA physician-scientist Dr. Jennifer Specht gave an in-depth presentation on immunotherapy, which, in addition to surgery, chemotherapy and radiation, has become what she termed “the fourth pillar” of cancer treatment. Hutch translational researcher and SCCA breast oncologist Dr. Kevin Cheung talked about tumor cell clusters and how these clumps of cells break off from a tumor and cooperate to actively promote metastasis, a process he’s trying to stymie with his new TARGET-CLUSTER trial. Dr. Hannah Linden, also of the Hutch and SCCA, led a Lobular Lunch and Learn with a deep dive into this sneaky ER+ subtype and how its growth pattern and metastatic spread differs from the more-common ductal breast cancer. “Unlike ductal, lobular tumors may line the organs,” said Linden. “It may line the outside of the lungs or you’ll see caking on the surface inside of your belly. It’s sometimes difficult to see by imaging but not always. We’re doing work with estrogen-receptor imaging now that seems to be useful.”
Dr. Larisa Korde, current head of the breast cancer trials at the NCI-sponsored National Clinical Trials Network, explained the phases and basic framework of all trials and agreed with advocates in the audience that the master list of all clinical trials in the country, NCI’s ClinicalTrials.gov, could be “amazingly difficult to navigate.” “I don’t know of any efforts to bring it into the 21st century but I agree that it’s incredibly important,” Korde said.
The new oral drug Neratinib (Synonyms: HKI-272) was granted orphan drug designation (a drug category for rare diseases) by the Food and Drug Administration for breast cancer brain metastasis in HER2-positive patients. “If you’re a patient with brain mets that’s HER2 positive, bug your doctor now,” Gadi said. “You could potentially get on this drug. And if the insurance companies argue back with you, tell them V.K. Gadi sent you.”
Call to Action: Interested in more information on clinical trials on Metastatic Breast Cancer? Check into the trial registries site as well as the Fred Hutch and SCCA trails appointment registry and subscribe to the TrialSiteNewsletter.