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

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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