Hear My Voice: How Far We’ve Come and Where We Need to Go

MBC Medical Expert Julie Gralow MDJulie Gralow, MD, blogs about the advances we’ve experienced in treating and managing one subtype of metastatic breast cancer, and calls for more support in research and care for people affected by the disease worldwide.


Substantial advances have occurred in the field of breast cancer during the 20 years I’ve been caring for people diagnosed with metastatic disease. I had a chance to reflect on this last month, when I saw a woman newly diagnosed with breast cancer whose sister had also been a patient of mine. The sister died of metastatic breast cancer in 1995 at the age of 35. There were few effective treatments at that time, and despite access to state-of-the art care and enrollment in a clinical trial, her survival following recurrence was short.

My current patient accompanied her sister to many of those last clinic visits. Memories of those visits were prominent in her mind when she was diagnosed with breast cancer in 2014, at the age of 47, and became a patient herself. Both sisters were diagnosed with HER2-positive breast cancer, but there were no approved HER2-targeted therapies in 1995. In 2014, there are four approved therapies and others in development. What used to be an aggressive type of breast cancer with a poor prognosis has now become much more treatable and survivable. This woman’s outlook is tremendously hopeful.

Thanks to the Human Genome Project, we no longer think of breast cancer as a single entity, or its treatment as “one-size-fits-all.” Our increasing understanding of cancer genomics has revealed multiple subsets of breast cancer with different behavior patterns and different responses to therapy. Dozens of new agents have been approved for the treatment of metastatic breast cancer in the past two decades, offering meaningful improvements in the likelihood of response and length of survival.

Many medicines in the development pipeline that are now in clinical trials fall into the category of “targeted therapies,” treatments that are generally less toxic and more specific to cancer cells compared to healthy, normal tissues. In the past few weeks we saw an updated presentation of the CLEOPATRA trial that showed one of the most impressive improvements in survival in metastatic breast cancer ever reported – an additional 15.7 months – by adding the HER2 antibody pertuzumab (Perjeta) to standard chemotherapy and trastuzumab (Herceptin). While this study focused on the 20-25 percent of breast cancers that overexpress the HER2 protein, there are exciting new agents being developed, and some close to FDA approval, that target additional receptors and pathways relevant to many other types of breast cancer.

We still have a long way to go, and we are still losing too many women (and some men) to metastatic breast cancer. But there is a lot more hope for many years of good, quality life for a patient diagnosed with a metastatic recurrence in 2014 than there was 2 decades ago. I’ll even go so far as to say that I’m pretty sure I have some metastatic patients in my practice who are cured of the disease. These gains are available at least to those living in the United States or in the developed world who have access to high-level medical care.

As a professor of global health as well as medical oncology, I spend part of my time working with breast cancer patients in low- and middle-income countries. It’s sobering to realize that most people in the world living with metastatic breast cancer have little or no access to the approved treatments and supportive or palliative care that we take for granted. None of the progress gained from our understanding of cancer genomics and the development of better, targeted therapies will make a dent in the global burden of suffering due to metastatic breast cancer unless we are able to rectify this inequity in access to care. On Metastatic Breast Cancer Awareness Day 2014, I’m calling for all of us to advocate for more resources for the basic research and clinical trials needed to conquer metastatic breast cancer, and to support efforts to improve access to diagnosis and treatment for those affected by breast cancer–no matter where they live in the world.


Julie R. Gralow, MD, is the Jill Bennett Professor of Breast Cancer at the University of Washington School of Medicine, director of breast medical oncology at the Seattle Cancer Care Alliance, and a member of the clinical research division of the Fred Hutchinson Cancer Research Center. She is also a professor in the department of global health in the University of Washington’s schools of medicine and public health. She is a member of LBBC’s Medical Advisory Board. Follow Dr. Gralow on Twitter at @jrgralow.

Read more blog posts in this series at lbbc.org/hearmyvoice.

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