Two years ago, Debbie Cabrera and her pink-clad supporters walked in the Susan G. Komen Race for the Cure in downtown Miami. She carried a sign: “My last day of chemo is Thursday.”
Six months earlier, Cabrera, then a 47-year-old single mom who had just started a new job as a marketing program manager, got a call from her radiologist. She was about to start a strategy meeting with her director. She stepped out of the conference room to answer the phone.
“You have cancer.”
As she went outside to gather her thoughts, she had already made the decision to fight.
“I looked up to the sky and said, ‘Hey, You save me and I’ll make sure everyone knows it was you.’ ”
Her oncologist, Dr. Stefan Gluck at the University of Miami, gave her a few treatment options, ranging from gentle and risky to harsh and thorough. Cabrera said she wanted the strongest science had to offer. Her doctor warned that it would be rough.
“It’s going to get you,” he said.
“It’s not going to get me. It’s going to heal me,” she responded.
Treatment for breast cancer has advanced enormously in the past two decades, propelled by the urgency of survivors and family members to find a cure. One in eight women in the United States will be diagnosed with breast cancer in her lifetime. Every 13 minutes, one of these patients dies.
A study published last month from The Cancer Genome Atlas, part of the National Institutes of Health, has identified four distinct genetic types of breast cancer, which could mean new targeted treatments for the next generation of breast cancer patients. The search for a cure is what inspires the walkers and runners in Saturday’s Komen Race for the Cure. Komen is the largest non-profit, non-governmental source of breast cancer research funding in the country.
Charles Perou, the lead author of last month’s study, has long been supported by Komen grants for his breast cancer research at the University of North Carolina at Chapel Hill. For this project, researchers examined the genetic profiles of 825 tissue samples from breast cancer patients. The tissue bank at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine contributed.
By discovering the genetic signatures of the four types of breast tumors, Perou’s study will help researchers explore possible cures more strategically. Scientists were already aware of the four kinds of breast cancer, but now they have identified the precise DNA mutations that cause protein production in cells to spiral out of control and become deadly.
Dr. Carmen Gomez, the director of the UM tissue bank and one of the study authors, said the findings will be especially important for women with one type of cancer: the Basal-like tumors that disproportionately affect women of African descent. Also known as “triple negative,” the Basal-like cancer is the only kind for which there are no targeted therapies, only chemo.
“Chemo is like a dynamite blast that kills normal proteins along with the bad. Targeted therapies are like a sniper that goes after the specific proteins that cause the tumors to grow,” Gomez said. “With what this study tells us about the genes that code for these proteins, we want to develop more effective targeted drugs.”
The study also found a “stunning similarity” between Basal-like breast cancers and ovarian cancers, prompting doctors to consider using ovarian cancer treatments for breast cancer patients.
Basal-like tumors are the least common of the four types of breast cancer. Two of the tumor types, Luminal A and Luminal B, begin in the milk ducts and can be treated with hormonal therapy in addition to chemo.
The fourth type is a tumor that produces too much of a naturally occurring protein called HER2. A new drug, Herceptin, is able to block this protein in some women, giving them a much better prognosis.
Patricia San Pedro, a Miami public relations executive, was diagnosed with HER2 breast cancer 16 years after she watched her mother die of breast cancer. She didn’t inherit the tumor-causing gene – less than 10 percent of breast cancer is inherited. She knew with recent scientific advances she had a better chance than her mother to survive.
San Pedro embraced her treatment and called her chemo cocktail “sacred juice,” for its healing powers. She did 17 rounds of chemo in a year, receiving three different drugs: two of chemotherapy, along with Herceptin to specifically target the tumors of HER2 proteins. The treatment worked its magic, and now she asks, “Cancer? What cancer?”
To develop and test new drugs, scientists need patients. People who have these cancers growing in their breasts, bones, kidneys and other parts of the body have, in their DNA, the answers to researchers’ questions about how genes mutate and tumors grow.
The Cancer Genome Atlas is a comprehensive project that counts on international cooperation to catalogue the genes that cause cancer. More than 5,000 cases of 22 different kinds of tumors have been analyzed to date, and the data is publicly available for any researcher to use. Dr. Kenna Shaw, director of TCGA, said tissue samples donated by cancer patients are the most fundamental part of their research; her goal is for 20 percent of new samples to come from minorities.
“It’s crucial that we get a racially diverse sample set,” Shaw said. “Our samples right now are very much skewed toward the Caucasian population, so we’re trying to prioritize getting samples from minorities. In order to understand the genetics of tumors, we have to look at people of different genetic backgrounds.”
This is where patients treated at UM come in. The diversity of South Florida’s patient population gives doctors an almost global sampling of genetic information.
Gomez, the director of the Sylvester tissue bank, said developing life-saving drugs depends on enrolling patients in clinical trials to test existing drugs and the new drugs that target out-of-control proteins. It could take as long as 10 years to develop new therapies.
“This is going to require the altruism of patients who participate. It may or may not help them personally, but it will further our knowledge to help future patients,” Gomez said. “To cure breast cancer in 10 years, we need women to donate tissue sample now.”
New breakthroughs, like this study, help invigorate the search for the cure, said Chandini Portteus, Komen’s vice president of research. She helps translate medical research into improved care for patients and said Komen has concrete goals to reduce the frequency and mortality of breast cancer “within the decade.”
Cabrera had a double mastectomy, six months of chemo, 45 days of radiation therapy and a hysterectomy. Now, two years later, she is healed, healthy and reaching out to other cancer patients. She said faith and science saved her, and tells other women to take comfort in both.
“The patients of today are leading the way for future generations, and the way to do it is through community and faith, but also through research and trials and trying new medicines,” Cabrera said. “I don’t want anyone to go through this. I want breast cancer to be eradicated.”