Welcome to our summer newsletter "Talking about Trials" or, more specifically, talking about metastatic breast cancer trials.
No one knows precisely how many people are living with metastatic breast cancer. The Metastatic Breast Cancer Network reports the number is estimated to be more than 155,000. What we do know is that up to 10 percent of women diagnosed with breast cancer have metastatic disease, and that up to 30 percent of all breast cancer cases will become metastatic. We also know that metastatic breast cancer kills about 40,000 women each year.
Clinical trials are important options all breast cancer patients should consider. They are especially critical for those with metastatic disease, because it can give these women access to the new targeted therapies and immunotherapies that are being developed. As this interactive chart developed by Metastatic Breast Cancer Alliance (MBCA) shows, as of July 2015, there were 204 metastatic breast cancer trials underway--and more have been added since then.
To get results, these trials need to enroll close to 27,900 patients. We are proud to be a member of the MBCA research task force, and be contributing to the Alliance's aim to ensure all women with metastatic breast cancer know their participation in research trials is needed.
As part of this effort, and with support from the Avon-Pfizer Metastatic Grant Program, we worked over the past year with five other breast cancer advocacy groups to launch Metastatic Trial Search, the first and only clinical trial search engine specifically for people with metastatic breast cancer.
In this issue, we speak with two breast cancer researchers who want to see new areas explored in metastatic clinical trials--Dr. Patricia Steeg and Dr. Gabriel Hortobagyi. We hope you enjoy learning about their ideas and insights. We also hope that this issue leaves you inspired to explore trials for yourself as well as share this information with others you know, especially those living with metastatic disease.
--Elly Cohen, Ph.D., Program Director, BreastCancerTrials.org
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 Q & A with Dr. Patricia Steeg, Ph.D.
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Dr. Patricia S. Steeg, Deputy Chief, Women's Malignancies Branch, National Cancer Institute's Center for Cancer Research
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To reduce deaths from metastatic breast cancer, Dr. Steeg believes researchers need to conduct a new type of trial--one that would test drugs that laboratory studies have shown can prevent new metastases from developing. BCT spoke with Dr. Steeg about this new approach to clinical trials.
Q: Why do you think changing the way clinical trials are designed can reduce breast cancer deaths?
A: If we change the way trials are designed, we can enroll patients at different points, treat them with different types of targeted therapies, and use different end points that will still be relevant to patients' quality and quantity of life.
I am advocating for metastasis prevention studies.The bulk of the preclinical data (studies done in cells and mice) says we can prevent metastases much better than we can shrink ones that have formed. So the question is: Is that true or is that just something we see in mice?
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 Q & A with Dr. Gabriel Hortobagyi, MD
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Dr. Gabriel Hortobagyi, Professor of Medicine, Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
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In 2001, Dr. Gabriel Hortobagyi published an editorial in the Journal of Clinical Oncology that reviewed what was known at that time about treating breast cancer patients with very few metastatic sites. This limited metastases is called oligometastases. BCT spoke with Dr. Hortobagyi about what types of clinical trials are needed to move forward in this research area.
Q: How has research into oligometastases advanced over the past 15 years?
A: This is an uncommon situation, and the problem with uncommon situations is it takes a long time to do research. There's been very little additional data since I wrote that piece. The reality remains that there is a small percentage of patients with metastases--somewhere around 5 percent--who have oligometastases and, of these, one in three or one in four could potentially be cured with systemic treatment plus surgery or radiation or both.
The data we have show that these patients tend to be younger, in good physical condition and have metastatic disease that can be removed surgically with clean margins in the lungs, liver, brain and maybe some soft tissue. It also seems that patients with hormone-negative tumors are more likely to be cured, which is probably because their tumors are more responsive to chemotherapy.
Q: Does this mean women should have more screening so that more women would be found with fewer metastases? Read more
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New Resource: Frankly Speaking About Cancer Clinical Trials
This new educational program from the Cancer Support Community includes a guide for patients and caregivers (in English and Spanish), videos on cancer clinical trials, as well as We Have to Talk: A Story of Hope, a publication containing photographs, stories and dialogues of people impacted by cancer discussing issues they face when deciding to participate in a clinical trial. Learn more here.
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