Modeling the patterns of breast cancer early metastases
Walter O’Dell, PhD (University of Florida Health Cancer Center)
Christine Takita, MD (University of Miami Sylvester Cancer Center)
This year over 230,000 women in the US will be diagnosed with breast cancer. Florida alone will add over 9,000 breast cancer survivors to this pool. Approximately 26,000 of these women will develop distant spread of their cancer after initially being diagnosed without any spread. These patients with late-onset metastases will account for nearly 2/3 of the 40,000 breast cancer deaths annually. Currently, survival for those who developing metastases is poor at 1 out of 5 (20%) living for 5 or more years, However, numerous recent studies have shown that there is a subset of women for whom conventional therapy coupled with surgery and/or radiation treatment of each metastasis achieves a large improvement in survival. For example, from 2010 to 2014, Dr. Cristiane Takita and her team at the Sylvester Comprehensive Cancer Center at the University of Miami, treated 62 patients with oligometastases (5 or fewer metastases) using targeted radiation therapy. They achieved a 79.6% 5-year survival rate for patients with oligometastases, versus 45.7% for patients with greater than 5 metastases. Because radiation is given only to the site of each tumor, side-effects such as nausea are almost non-existent. The problem for these patients is that current national guidelines for follow-up care of breast cancer patients do not include the use of modern imaging methods that could detect metastases at an early stage even for those patients that we know are at high risk. Instead, metastases are usually discovered only after they have become so large and numerous that they cause symptoms.
Our belief is that by adding proactive imaging to standard follow-up care for high-risk breast cancer survivors a large portion of patients will be found with early stage, highly-treatable metastases that can be treated effectively to give them much improved survival and quality of life. This is a collaborative effort of the cancer centers of the University of Florida and the University of Miami; applying the imaging research technologies in Dr. Walter O’Dell’s lab with the clinical base and experience at the UF Health Cancer Center and the University of Miami Sylvester Comprehensive Cancer Center. Under this award we will perform the first proactive imaging study of high-risk breast cancer patients to document the first incidence of metastatic spread; we will measure patterns of the initial clinical (symptomatic) presentation of metastases; and we will apply this new information to extend and strengthen mathematical models of when and where metastases spread. Through this work we will create a direct path to a national clinical trial to evaluate the benefit of combining proactive imaging with targeted therapy of breast cancer metastases. We will also create a path for integrating evolving discoveries from tumor biology into imaging-based risk assessment and optimal follow-up care of breast cancer patients who are at high risk of developing metastases.
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