An overview of the Fifth Annual Metastatic Breast Cancer Forum, held annually at Dana-Farber Cancer Institute.

1. Fifth Annual
Metastatic Breast Cancer Forum
Saturday, September 24, 2016

2. Forum Chair
Nancy Lin, MD
Forum Co-Chairs
Liz Frank
Lauren Knelson

3. Overview
• What is metastatic breast cancer?
• What is EMBRACE?
– Clinical program
– Research study
• How else are we learning about metastatic
breast cancer?

4. 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!

5. • 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

6. Breast Cancer Subtypes
Breast Cancer Subtypes
ER-positive
HER2-positive
Triple-negative
TALK to your doctor if you are not sure what type of breast cancer you have

7. Hormonal
therapy
Hormonal
therapy
Chemotherapy Chemotherapy
Chemotherapy Chemotherapy Chemotherapy
Herceptin +
perjeta +
chemotherapy
TDM1
Lapatinib +
Capecitabine
Herceptin +
chemotherapy
Herceptin +
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 with
Metastatic Breast Cancer?

8. Social
Emotional
SpiritualIntellectual
Physical

9. 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-out
August 2016

10. 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

11. EMBRACE Clinical Program: Coordinators
Maggie Merrill Rebecca Santiago Nicole Kuhnly Lindsey Crowley
Gunjan Gupta Kathryn Silva

12. 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

13. −1.0
−0.5
0.0
0.5
1.0
Frequency
1 2 3 4 5 6 7 8 9 10 11 12 13 15 17 19 22
n=19
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
X
FrequencyAltered
1.0
0.5
0
0.5
1.0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
22
X
FrequencyAltered
1.0
0.5
0
0.5
1.0−1.0
−0.5
0.0
0.5
1.0
Frequency
1 2 3 4 5 6 7 8 9 10 11 12 13 15 17 19 22
n=19
Primary TNBC
Tumor tissue
Metastatic TNBC (EMBRACE study, 87 patients)
Cell-free DNA
Example: Triple Negative Breast Cancer
Slide courtesy of Dan Stover, MD

14. Example: ER+ Breast Cancer
Blood
Blood
Matched tumor
Heather Parsons, Viktor Adalsteinsson, Gavin Ha, Sam Freeman, Nick Wagle, Dan Stover

15. 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
CLIA
Tumor
Bank
Single Cell
RNA-seq
Studies of
Resistance
and
Heterogeneity
Functional
Studies / Co-
Clinical Trials
Future
Studies
cell free DNA (cfDNA) for
WES and hotspot profiling
Serial Blood
Samples
Core 1
Pathology
ER, PR, HER2 Returned to
Physician
94 biopsies from 88 patients
July 2015 – May 2016
CLIA Targeted
Seq Panel
Core 3
Biopsy Study
Wagle et al, ASCO 2016

16. What Type of Breast Cancer?
Have you received:
Trastuzumab (Herceptin), pertuzumab (Perjeta),
Kadcyla (TDM1), or Lapatinib (Tykerb)
YES HER2-Positive
Yawkey 306/307
NO
Have you received:
Tamoxifen, letrozole (Femara), anastrazole
(Arimidex),Exemestane (Aromasin)
YES
ER-Positive
In this room
NO
Triple-negative
Smith 308/309

17. Funding Sources
• Grant from the National Comprehensive
Cancer Network-Pfizer
• Fashion Footwear Association of New York
• Pan-Mass Challenge
• Breast Cancer Research Foundation