For me, the highlight of this year's American Association for Cancer Research (AACR) Annual Meeting had to be seeing work funded by the Inflammatory Breast Cancer Research Foundation presented during a poster session!  This has been a long time in coming but then bench research is often slow and painstaking.

Diane Palmieri, PhD, received a grant in 2009 to develop a mouse model of IBC brain metastasis.  Dr. Palmieri was also working with the Breast Cancer Brain Metastasis Center of Excellence grant, along with a host of others, under the direction of Dr. Patricia Steeg.  This IBC work dovetailed nicely with the other work going on in the lab and was a perfect
opportunity to determine if indeed there are differences in the brain metastasis of IBC when compared with non-IBC brain
metastasis.

Taking a cell line, getting it to grow in a mouse, getting it to spread to the brain, and then studying it is a huge challenge.  So much can go wrong in every step.  Dr. Palmieri and colleagues put in countless hours on this project in the hope that something useful would come from their work.  I had the opportunity to spend a day in the lab with Dr. Palmieri.  She guided me thought some hands-on experiences to give me a
better sense of what happens in the lab day to day.  It was an exciting day and helped me appreciate even more the importance of laboratory research in laying the groundwork for translational research.

Last year Dr. Palmieri changed jobs at the NIH but left the project in the capable hands of Dr. Steeg and L. Tiffany Reed,
DVM, MS, (Diplomate ACVP and NIH Molecular Pathology Fellow) who recently joined the lab.  Dr. Reed presented the poster at AACR describing the mouse model work done in the lab.  She is continuing to work with the project, taking things on to the next steps under the direction of Dr. Steeg.

Rather than try to explain the poster, I asked Dr. Reed a few questions in an interview style.  

What led you to pursue breast cancer research?
"Breast cancer and more specifically brain metastasis from breast cancer, which is my area of research, is a devastating disease process with an increasing incidence.  In this area of research, I have been given the opportunity and resources to solve important problems in a disease that impacts the lives of many.  My research focus in this field is driven by my desire to answer the tough and difficult questions that may have a therapeutic impact."
 
What can you share about the mouse model of IBC brain metastasis?
"Because very little is known about IBC brain metastasis, the mouse model provides a useful tool to decipher changes in the brain microenvironment and potential alterations in the blood brain barrier.  Thus far, we have learned that there is a large influx of inflammatory cells and reactive glial cells in the brain microenvironment of an IBC.  This information is useful because changes in the brain microenvironment may alter the efficacy of some chemotherapeutics."
 
Can you share a bit about your future research plans?
"I will continue characterizing the brain microenvironment in the mouse model of IBC brain metastasis.  Complete characterization of the microenvironment will assist in development of sound functional experiments, which will hopefully provide a better understanding of this disease." 

Read more about grants awarded by the Inflammatory Breast Cancer Research Foundation. 

The Inflammatory Breast Cancer Research Foundation has joined forces with the Cancer Support Community (CSC) in the launch of the Cancer Policy Institute (CPI).  As a "Friend of the Cancer Policy Institute", we'll work with CSC to ensure that no one faces cancer alone.  One of the goals of the CPI is to advance the recommendations in the 2008 Institute of Medicine report, "Cancer Care for the Whole Patient",  to ensure that today's 13.7 million cancer survivors have access to the highest quality care, which must include social and emotional support.  CSC was formed by the 2009 union of The Wellness Community and Gilda's Club.  It brings a combined 50 years of experience serving people with cancer and their loved ones.

Earlier this year CSC's Research and Training Institute launched a nationwide registry that will help researchers better understand the impact of cancer on people who have or have had this disease.  The following paragraph from CSC explains the project and includes an invitation to join the Cancer Experience Registry.

"Cancer is more than just treating the tumor -- there are often emotional and social challenges to overcome as well.  The Cancer Support Community (CSC), an organization providing high-quality emotional and social support through a network of more than 50 local affiliates, more than 100 satellite locations and online, has launched a nationwide registry that will help the cancer community better understand the social and emotional needs of people living with a diagnosis of cancer. Called the Cancer Experience Registry (CER), this first-in-its-kind initiative will collect the experiences of people who have volunteered to share their cancer journey by answering a series of questions online and will connect them to a network of support and resources. Anyone who has ever faced a cancer diagnosis -- whether just diagnosed, in treatment or years beyond treatment -- is invited and encouraged to join the registry by visiting http://www.CancerExperienceRegistry.org. The CER consists of questions that measure the social, emotional, spiritual and financial impact of cancer. After completing the questionnaire, individuals will be able to compare their responses with others in the community. Information shared through the Cancer Experience Registry will remain anonymous and will be used to identify gaps in care, help develop innovative programming, and inform next steps in research and policy.  The findings will be published in an Annual Index and will be available to the cancer community at large and to all people who take part in the Cancer Experience Registry."  

The words, "you have cancer", are probably pretty close to the top of the list of things you never want to hear.  No doubt most of us are aware that an estimated 232,340 new cases of breast cancer in women, and 2,240 new cases in men will be diagnosed this year. Recently a physician on a breast cancer panel stated that one case of breast cancer is diagnosed every two minutes, and one woman will die of breast cancer very 13 minutes in the U.S.  These are sobering numbers and a reminder that more quality research is needed to understand metastatic disease and prevent it.  Few people die of primary breast cancer, the real danger is when it takes up residence in other places in the body.

This topic has been weighing heavily on my mind these days for a number of reasons.  The primary one has to do with a dear friend whose estrogen receptor positive breast cancer was under control for quite a while but has been dealing with recurrences for quite some time now.  This dreadful disease is taking away my friend and I'm angry and frustrated that we in the research community have failed to "fix this" in time to help my friend and countless others.

Once diagnosed with inflammatory, or other types of breast cancer, people often search the internet to learn as much as possible.  What does it mean to be ER+ (estrogen receptor positive) or ER- (estrogen receptor negative)?  What about HER2?  The pathology report contains a whole new language that is as foreign as hieroglyphics to most of us.  One article states that having ER+ breast cancer is a "good thing" because there are endocrine therapies for treatment and outcomes are good.  Another labels triple negative breast cancer (estrogen receptor, progesterone receptor and HER2 all negative) as "the worst type" because of limited treatment options.  No doubt women compare notes when they gather on line or in a face to face support group.  Whose cancer has the best or worse prognosis.  If only things were that simple.  Dr. Perou's seminal work has shown that breast cancer is not a single disease, but instead, represents a series of diseases that include the more favorable prognosis luminal A subtype and multiple worse prognosis subtypes including the luminal B, HER2 positive (HER2+), basal-like and claudin-low groups. His work is focused on identifying the causative genetic alterations that give rise to these poor prognosis subtypes through their continued use of multiple genomic and genetic technologies including DNA microarrays, RNA-sequencing and genome sequencing. Breast cancer is a complex and individual disease.  This and other research shows that breast cancer is not just one, five or seven diseases but could be described as many, many different diseases.

Hormone receptor positive (HR+, meaning estrogen is the primary driver) breast cancer, typically the most common but not necessarily so in IBC, has been thought to be less aggressive and more amenable to treatment.  The estrogen receptor is one of the first biomarkers to be used to personalize treatment.  Unlike in other breast cancer subtypes, more than half of all disease recurrences in HR+ breast cancer occur 6 years or more after diagnosis, particularly after 5 years of adjuvant anti-estrogen therapy (tamoxifen or aromatase inhibitors).  This finding has lead to the recent recommendation that patients consider an additional 5 years of anti-estrogen therapy at the close of the initial 5 years.

Last year researchers at the Washington University School of Medicine published a commentary in Oncology titled, "The Natural History of Hormone Receptor-Positive Breast Cancer: Attempting to Decipher an Intriguing Concept".  (The full text article is available at: http://www.cancernetwork.com/breast-cancer/content/article/10165/2093839).  The authors were responding to an earlier article titled "The natural history of hormone receptor-positive breast cancer", in which authors from Dana Farber Cancer Institute discussed in detail this problem of late relapse in HR+ breast cancer.  This article looked at how current technologies might help reveal the relationship between tumor relapse and anti-estrogen therapy resistance as well as the concept of tumor dormancy.

Clearly more research is needed in this area.  Being able to identify which HR+ patients are at greatest risk for relapse (recurrence) following initial treatment and subsequent anti-estrogen therapy could help reduce the number of late recurrences currently being seen in the HR+ patients.  Better treatment options for those currently dealing with metastatic disease are sorely needed but we must also work at understanding metastasis in hopes of discovering methods of prevention.  New models and new clinical trial methods will be needed to find these answers.

Editor's Note: Maria Wetzel, Ginny's friend, died on Memorial Day.