Team DCI's in a Race for the Cure
By: Julie Poucher Harbin, Senior Writer, DCI
UPDATE 2 (May 10, 2021): The 24-member DCI team raised $7,895.27, topping the Top Corporate Teams leaderboard and coming in third on the Top Teams list. Team co-captain Karen Johnson, MD, MS, took the number 6 spot on the Top Participants leaderboard, having raised $2,793.20.
UPDATE 1 (May 1, 2021): WRAL aired an interview with Sarah Sammons, MD, on the day of the Triangle Race for the Cure — Doctor, daughter, cheerleader sees all angles of breast cancer fight
DCI oncologists and researchers are supporting the Komen mission “for a cure” — fighting breast cancer on all fronts. Learn more & join them on May 1 !
The 2021 Susan G. Komen Triangle Race for the Cure, presented by Duke Cancer Institute, is tomorrow — May 1, but it’s not too late to join Team DCI (virtually) at the event !
This year's event will be streamed through the event Facebook page and YouTube. The Race-Day program includes:
:: a live warm-up at 10 a.m. to send you off and running (or walking) on your 5K self-designed routes
:: a survivor/thriver virtual meet-up
:: recognition of the top fundraising individuals and teams
:: videotaped messages of support from the community
It’s a #RaceWhereYouAre experience. Whether in your neighborhood, the park, the forest, the beach…the sky is literally the limit.
Registration, at a cost of $25, will close at midnight on May 1 (the very end of Saturday), with donations continuing to be accepted well after Race Day. Once you register, you’ll have access to the virtual Race-Day program, but you'll get your Race-Day packet with a t-shirt, bib and a DCI visor in the mail after the event.
Team DCI in currently in second place in the Corporate Challenge and climbing. Captained by an all-star lineup of DCI breast oncologists and researchers including Sarah Sammons, MD, Susan Dent, MD, FRCPC, Karen Johnson, MD, MS, Vijay Paryani, MD, and Laura Rosenberger, MD, MS, Team DCI is raising critically important funds for patient support and breast cancer research.
They’re champions for the cause. Committed to showing support for their patients on Race-Day. And committed to bringing new treatments and treatment strategies to their patients.
“Race-Day is an incredible atmosphere. It’s an atmosphere of achievement and celebration and those two emotions don’t always partner very readily with the words ‘breast cancer,’” said DCI breast radiologist and new-to-the team co-captain Karen Johnson, MD, MS. “So, for the women who have that diagnosis and all of the women who fear that diagnosis, Race-Day is very special. It shows us that there is a community of support and love and it brings us hope.”
Johnson’s research interests include detecting and diagnosing early-stage breast cancer so women have the best chance possible to conquer the disease early.
“The appropriate and best use of breast MRI is of specific interest to me as well as finding ways to help women cope with and reduce the anxiety experienced in conjunction with mammography,” she said.
Vijay Paryani, MD, is a breast medical oncologist who sees patients at Duke Women’s Cancer Care Raleigh and Duke Cancer Center Cary. He also does inpatient consults at WakeMed as part of the new Cancer Care + initiative.
Paryani is new to DCI, having joined Duke in August 2020 directly after completing his fellowship at Wake Forest Baptist Medical Center and in the midst of the Covid-19 pandemic. Like Johnson, this is his first year serving as a team co-captain. He’s all-in for the Triangle Race for the Cure and all-in for his patients.
“When my patients see me, they may be going through the scariest and most difficult time in their lives. My goal is always to do everything in my power to improve their physical and emotional well-being. My patients are family to me,” said Paryani who's committed to bringing new clinical trial opportunities to DCI’s Wake County locations. “I have witnessed firsthand the devastating effect this disease can have patients and their families.”
Breast cancer will affect one in eight women in the U.S. and is the second leading cause of cancer death in women (after lung cancer) in the U.S. According to the latest statistics from the American Cancer Society, an estimated 44,000 women will die from breast cancer this year.
“Our patients who’ve been facing both breast cancer and the isolation of a global pandemic need us now more than ever,” said Sarah Sammons, MD, who this year was named first ever medical chair for the Komen Triangle Race for the Cure. “As a breast oncologist and clinical researcher, I support Susan G. Komen in their endeavors to raise funds specifically related to grant funding of research to find novel therapies for early stage and late stage/metastatic breast cancer.”
Duke Cancer Institute scientists have, to date, benefited from more than $20 million in research grants from the Susan G. Komen foundation and there’s more to come.
Apart from Komen’s signature Race for the Cure fundraising events that funnel research dollars to projects throughout the country, the Susan G. Komen foundation announced this winter they’d raised close to $1 million for the Komen Metastatic Breast Cancer Collaborative Research Initiative — a program launched in 2019 that specifically supports collaborative Duke Cancer Institute/UNC Lineberger Comprehensive Cancer Center research projects in metastatic breast cancer. Blue Cross and Blue Shield of North Carolina have invested $500,000 of that total — earmarked for research into the tragic disparities in mortality between Black women living with stage IV, metastatic breast cancer, and their white counterparts.
Research funding, no matter where it comes from, has a ripple effect, on the field and ultimately on patients. One grant begets the next. Promising science translates to clinical trials, which can translate to new therapies and/or new strategies to defeat breast cancer or at least hold it at bay.
The challenges of the past year didn’t stop breast cancer studies from moving forward. DCI researchers, in many ways, are supporting the Komen mission “for a cure” — fighting breast cancer on all fronts.
From survivorship studies, to surgery and radiation oncology trials, to studies harnessing the immune system, from trials with new vaccines, targeted therapies and combination trials, to the molecular profiling of rare tumors, there’s a bumper crop of DCI-born studies in breast cancer, none of which could be achieved without grant funding.
Profiling a Rare Tumor
Breast surgical oncologist Laura Rosenberger, MD, MS, new to the roster of Team DCI co-captains this year, is eager to share her pioneering rare-breast-tumor research, primarily phyllodes tumors.
“Typically identified in younger women (average age of 40 years), all grades of phyllodes tumors are treated almost
exclusively with surgery alone,” she explained. “Surgery remains the only effective therapy, as there is no known effective chemotherapy, immunotherapy, or hormonal therapy. When tumors are metastatic, however, few treatment options exist making prognosis dismal.”
Rosenberger is the founder and principal investigator of an 11-site multi-center
collaborative network of Comprehensive Cancer Centers that research phyllodes tumors.
She currently leads an open genetic testing study for women with phyllodes and a phyllodes tumor registry study, which collects biospecimens and stores
live tumor/tissue for future research. Rosenberger says the Duke Department of Surgery in collaboration with the Duke Cancer Institute is uniquely poised to lead critical investigations into genomic profiling of these rare tumors, development of early detection strategies, prevention, and even the potential development of a therapeutic target.
LEARN MORE
Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines Journal of Clinical Oncology Laura H. Rosenberger, MD, MS, et al...
“Clinical trials bring hope. They move the needle forward every year with the goal of extending life, improving life’s quality and ultimately finding a cure for our patients living with advanced breast cancer.”
Vaccines: A New Weapon in the Arsenal
Supported in part by Susan G. Komen foundation funding, DCI researchers Kim Lyerly, MD, Zachary Hartman, PhD, and Erika Crosby, PhD, developed a vaccine that targets the HER2 protein, which is the driver of HER2-positive breast cancer and the cause of about 20 percent of all breast cancer cases.
In a Phase 1 clinical trial (2012-2015) of the investigational vaccine — initially alone and then in combination with standard HER2 targeted therapies — the vaccine sparked the immune system to mount a reaction against cancer cells.
Lyerly, a professor of surgery, immunology and pathology at DCI, reported in Clinical Cancer Research (May 2019) that the investigational vaccine demonstrated an ability to halt tumor growth and improve survival for a subset of patients, showing early promise that “vaccine approaches could lead to an additional weapon in the arsenal” to fight breast cancer. (LEARN MORE)
In March 2019, DCI breast oncologist Jeremy Force, DO, joined Lyerly and another member of the cancer vaccine development team — DCI professor and GI oncologist Michael Morse, MD — in launching an innovative Phase 2 clinical trial (NCT0363294).They'd deploy their investigational vaccine in combination with the immunotherapy drug pembrolizumab in addition to standard HER2 therapies. (The trial’s due to be completed in Oct. 2022).
The following year, in July 2020, Hartman revealed, in Clinical Cancer Research, some initial findings from the Phase 2 trial. He noted that adding pembrolizumab, which alone has shown little benefit in treating HER2+ breast cancer, boosted the impact of the investigational vaccine — providing “a one-two punch against HER2+ breast cancer.”
The group is currently leading two other trials involving two different anti-cancer vaccines — both of which target genes associated with resistance to therapy after surgery, but before the cancer cells have a chance to develop a resistance. Resistance to standard HER2+ therapies is common.
“There are several open studies in our group looking at the ability to vaccinate against certain types of breast cancer as is done against known viruses,” said Hartman. “Our research efforts have shown the importance of developing vaccines against the ‘right’ targets in cancer, which we’ve found to be genes that are important for tumor growth and resistance.”
UPBEAT
Susan Dent, MD, FRCPC, associate director of Breast Cancer Clinical Research and co-director of the Duke Cardio-Oncology Program, returns as a Team DCI co-captain this year.
She’s leading the charge at DCI in research into the effects of cancer and cancer treatment on the heart. Last summer she spoke on this topic at a virtual patient forum on breast cancer and survivorship co-hosted by DCI and Susan G Komen North Carolina Triangle to the Coast. The powerful live discussion with patients, survivors, thrivers and beyond was part of a month-long Virtual Survivorship Day event hosted by DCI.
Known throughout the world as an expert in cardio-oncology, Dent is currently excited about a clinical trial she’s running called UPBEAT (Understanding and Predicting Breast Cancer Events After Treatment). Dent is leading the Duke arm of this national multi-site study that's examining the long-term impacts of chemotherapy and radiation on the cardiovascular health of women treated for breast cancer.
UPBEAT participants undergo heart MRIs, cognitive testing and exercise evaluations at varying intervals to measure heart function and exercise capacity. They receive follow-up phone calls and questionnaires to assess fatigue, behavioral and psychosocial risk factors.
“This study is very important because it will help define which women are at increased risk of developing cardiac problems related to their breast cancer treatment,” Dent explained. “And if we know, we can think of preventive strategies to attenuate or diminish the risk of long-term cardiovascular effects.” (LEARN MORE: THE PATIENT'S PERSPECTIVE)
A Driving Force Meets A Force of Nature
Susan G. Komen Scholar Donald McDonnell, PhD, associate director for Translational Research at DCI and director of the McDonnell Lab, has been the recipient of $1.2. million in funding from Susan G. Komen, to date, for various projects.
Last fall, he was named the winner of the Susan B. Komen 2020 Brinker Award for Scientific Distinction in Basic Science Research for "his significant contributions to breast cancer research, which have been instrumental in advancing our understanding of estrogen receptor signaling in breast cancer."
The McDonnell Lab has had a role in the development of the majority of anti-estrogen drugs on the market, estrogen therapies that revolutionized how breast cancer was treated by slowing the growth of breast cancer but that haven’t solved the problem of eventual treatment resistance and potential harm to the immune system. Not resting on his laurels, he’s been the driving force to find even better treatments.
A research team that McDonnell is leading is currently in the third year of a four-year $7 million grant from the Department of Defense to assess the impact of estrogen therapies on breast cancer patients’ immune systems and to identify ways to improve the effectiveness of existing and emerging endocrine therapies taken to prevent breast cancer recurrence.
The work includes a clinical study led by Sammons, who McDonnell calls a “force of nature.”
For two years Sammons has followed 200 women with ER+ (estrogen-receptor-positive) breast cancer, the most common type, starting when they began endocrine therapy (following surgery, radiation, and chemotherapy). There are currently 25 enrolled. While not published in the scientific literature yet, researchers in the lab have already found that the effects of anti-estrogen drugs on the immune system depend on the type of breast cancer and its immune profile. The team is now moving toward developing breast cancer drugs that retain their ability to stop the spread but that don’t have negative effects on the immune system. (LEARN MORE)
Sammons is also clinical PI for another ER+ breast cancer study to have emerged from the McDonnell lab. McDonnell was part of a pharmaceutical industry team in 1992 that first developed the drug lasofoxifene, a selective estrogen receptor modulator (SERM) or type of endocrine therapy, to treat osteoporosis.
A discovery made decades later in McDonnell’s lab at Duke (2016) — that the drug might also work for metastatic ER+ breast cancer — ultimately led to the launch a year and a half ago of an international clinical trial of lasofoxifene for advanced breast cancer in women with ER+/HER2- breast cancer that harbor an ESR1 mutation. These ESR1 mutations are believed to be one cause of acquired resistance to endocrine therapy and a likely driver of breast cancer spread. Lasofoxifene had successfully targeted ESR1 mutations in the lab. Now it was time to find out if it worked in people and how it measured up against fulvestrant, an anti-estrogen drug considered to be the backbone of treatment for this patient population. Sammons launched the Duke arm of the trial late last year. (LEARN MORE)