Treatment for Metastatic Breast Cancer

Kristie L. Kahl: Can you discuss the factors that are taken into consideration when you are trying to determine a treatment plan for metastatic breast cancer?

Jamil Rivers: The most important factors are definitely the subtype of the metastatic breast cancer, where has the cancer spread, what tumor involvement there. It's really important to understand what proteins or mutations are targets that could be applicable with the tumors.

Kristie L. Kahl: Similarly, how does quality of life play a role when you're trying to determine your treatment options?

Jamil Rivers: It is definitely a factor. I would say that there's definitely different goals. As far as quality of life and dealing with cancer, side effects and things like that can run the gamut. Side effects could be hot flashes, nausea, gastrointestinal issues. You could be in and out of the hospital. So those types of things can be considered, based off of what the patient's goals are. Someone on the younger side might want to go through more aggressive treatment. With metastatic breast cancer, you're are always going to be in treatment. There isn't a cure, per se, or a stop of your treatment. So, you're going to stay on treatment until that one fails, and then you're on to the next treatment in order to keep the cancer at bay and controlled.

In each instance, a patient will have to make that decision based off of what treatment options are available, and if they can tolerate those side effects. I also think it’s really important to not necessarily write off certain treatments because usually, if you're having that conversation with your doctor, and you have a good support team around you, there's ways to mitigate those side effects where it necessarily doesn't have to completely rule out a particular treatment.

Kristie L. Kahl: In the metastatic breast cancer setting, do you think it's important for patients to comnsider getting a second opinion as well?

Jamil Rivers: Oh, definitely. I mean, we do have standards of care, which are accessible and are updating all the time. But you have different cancer centers that have access to more treatments and innovations, and might be on the pulse of more available treatments than others.

Also, there are actually doctors that don't understand metastatic breast cancer. I've come across doctors that are not really into or not abreast of the latest treatments and innovations. And so they're thinking that once you hear metastatic that you should be in a palliative state and, you know, on your way out. That is definitely changing. Metastatic breast cancer does not mean that it's necessarily a death sentence right away. So, if you are presented with treatment options, definitely go get a second opinion from someone else just to make sure that that is the most effective treatment. There are so many new proteins, so many new targets, so many new options, and that particular cancer center might not have access to that innovative treatment that actually would be the most targeted and effective to treat your breast cancer.

Kristie L. Kahl: Can you discuss how treatment for metastatic breast cancer works?

Jamil Rivers: There's now consideration for levels of metastasis. So, you can have bone-only metastasis. There are metastasis that is not just necessarily focused on a subtype of breast cancer in order to dictate that particular treatment.

For the most part, they're going to think about what is the most effective target that they could specifically hone in on that will control that cancer before they get to the more aggressive chemotherapy, which is really just targeting all cells – cancer and healthy cells. So if they could really have treatment that is precise and targeted, where the treatment can really focus and target on what is actually making that cancer go and thrive and move all around the body, they can suppress that. Then it buys you time and it can be controlled. And that's really what this is all about.

We want metastatic breast cancer to be a chronic illness where that cancer is controlled. It really can't get a leg up and spread throughout the body and wreak havoc. And if you didn't understand what fuel that cancer is operating off of you can hone in on it. Target and suppress it. And it really doesn't have a way to get all around the body and cause so much damage.

Kristie L. Kahl: Can you discuss some of the exciting innovations that are coming?

Jamil Rivers: So it's really great that we have the targeted therapies that have been developed in the past eight months, including Piqray (alpalisib). Most of those patients, we've now validated that if they fail on a CDK4/6 inhibitor, that they switch to that particular drug and have a durable response and their metastasis will be controlled.

There are also new targeted therapies for triple-negative breast cancer, which is a space that has been lacking for a long time. Now we have a number of drugs that are available that are targeted therapies for triple-negative breast cancer.

We've really found ways to live for a longer period of time with drug combinations, and our cancer is functioning as a chronic illness at this point. So that's really exciting. And now they've identified hundreds of new proteins, mutations and targets that they're developing to manipulate in that tumor microenvironment or create stress on those cancer cells based off of that environment in order for them to trigger to themselves to commit suicide, in a sense, which is really exciting. There's so many new developments with immunotherapies and targeted therapies where there's a whole new realm of proteins and targets outside of just the standard hormone receptors and mutations that we can go into and target now. So it's really exciting.

Kristie L. Kahl: What do patients with metastatic breast cancer have to look forward to most?

Jamil Rivers: I've had so many conversations with researchers who say, “You know, there's people attached to these tumors that we have to think about, with cardiac effects and quality of life.”

In the future, you're going to see more targeted therapies, and definitely more emphasis on oral therapy, so you're not actually bogged down going to the hospital every week, hooked up to an IV. You actually do have that portability, where you have an oral treatment, and it has your cancer controlled. That’s really something that folks can look forward to,

Doctors and researchers are really taking this into account to think about effective combinations that are going to address this particular cancer based off of characteristics: their age, the subtype. All of these factors rolled up together help us to think about what is the most targeted, personalized treatment that we can provide, that will create that long-term, durable response, increase survival, and also factor in quality of life.

Kristie L. Kahl: what would you say is your biggest piece Advice for a patient with metastatic breast cancer who's trying to decide their best treatment option?

Jamil Rivers: Definitely get the genomic testing. That is so important. Get the genomic testing in order to get that molecular profile to understand what proteins and mutations are really predominantly expressed by that cancer. And it's going to change when you have a recurrence, or if that cancer has now developed a drug resistance, it's going to change. So, in each instance, let's focus on: What's the new coding here? What's going on? What is this cancer fueling off of? And then that way, you can target that. And there's evidence to show which ones are actually the most effective for particular proteins and mutations. Once you hit those targets, that's going to really tell your team and you what it is that they can hone in on and what they can do in order to keep that cancer under control.