Why metastasis research is important for stage IV

http://www.nashuatelegraph.com/opinionperspectives/960655-263/bill-would-identify-scientific-advances-for-breast.html

I am not a fan of screening/prevention methods (mammograms, awareness, elimination  of  environmental causes that definitely leads to 2% of breast cancers, etc), as they have inherent limitations that will fail a big percentage of early stage patients and do no good at all for late stage patients.

However, research into metastasis and preventing metastasis is still a great direction because even late stage patients would benefit if further metastasis after NED could be prevented.

The cure has to come from a multi-pronged attack, understanding metastasis and preventing metastasis is an integral part.   Look at the cure for AIDS, ultimately it comes from a cocktail of drugs that does different things.   

If lawmakers really want to speed up the process for the cure, here are my suggestions:

1.  mandate or encourage clinical trials for patients of all stages.  and mandate better quality clinical trials that track patients long term, do genetic analysis of tumor samples, better target drugs and share raw data (while protect patient privacy).

2.  fund basic science and technological innovations, whether in high throughput DNA sequencing, wet lab or tissue regeneration

3.  make new targetted drugs cheap/fast to develop/try out.   Cooperate internationally.


Still I don't like "prevention of metastasis" as the "primary" focus.  It might be journalist speak for "let's get all the other patients on the bus and throw the current stage IV patients under the bus"...

Cancer stem cells

Note:  Cancer stem cells are not your normal stem cells.
Quote: " It is essential to appreciate that the field of solid tumor CSC research remains at a nascent stage compared with the leukemia stem cell (LSC) field, and, therefore, our understanding of solid tumor CSCs and their significance is a work in progress. "


Relatively old review from 2 years ago:

http://clincancerres.aacrjournals.org/content/16/12/3113.long

Understanding fundamental biology is fundamental to the cure for solid cancers.

Breast Cancer Vaccines

This article mentions some breast cancer vaccine and other cancer vaccine breakthroughs:
http://www.firstpost.com/living/breakthrough-in-immunotherapy-could-cure-cancer-300846.html

The newer vaccine testings tend to target earlier stages, unfortunately.  The later stages of breast cancer might also benefit from a multi-pronged attack like the AIDS cocktails.   A lot more work is needed.

I found its coverage of business aspect of vaccine development particularly interesting.   Especially in light of some recent postings on whether Neuvax will be a hit or dud:
http://www.thestreet.com/story/11507036/1/galenas-breast-cancer-vaccine-doomed-to-fail.html?cm_ven=GOOGLEN

http://seekingalpha.com/article/525841-mark-ahn-interview-neuvax-demonstrated-preclinical-and-clinical-benefit-in-all-levels-of-her2-expression?source=feed

Well, only clinical trials would tell.

Thin red line around breast cancer

How immune system fails to stop breast cancer.   Great images and insight.   These are the studies that need funding:

http://www.ucsf.edu/news/2012/05/11966/thin-red-line-around-breast-cancer

Pushing Stem Cells More

I have been accused of "pushing stem cells".   Here's why I think stem cell therapy can improve metastatic breast cancer patients' chances. 

1.  Heart stem cells help low LVEF-heart to regain muscle.   Implication to cancer patients?   If this research pans out, then patients who had already had lifetime doxocirubin or reaction to Herceptin can have more doxuribin/Herceptin if it's needed. 

http://www.mdanderson.org/newsroom/news-releases/2010/adult-stem-cells-help-injured-hearts.html

2,   Liver stem cell to reduce mortality after hepatic resection

http://www.ncbi.nlm.nih.gov/pubmed/22156926

3.   Liver stem cells to grow whole organ

http://www.wakehealth.edu/News-Releases/2010/Researchers_Engineer_Miniature_Human_Livers_in_the_Lab.htm

Prevention and screening is a deadend that yields decreasing marginal returns.  Innovation has always saved our butts, and will save our butts in future. I am happy to push for it and run commercials for it.    There are lots of things patients can do to accelerate the process, like participating in clinical trials, go to major NCI cancer centers, donating tissue and blood samples, ask questions to make sure the research data will be shared, push for better quality clinical trials to be designed.    My blog makes more elaborate cases for these patients participation.  Please don't be put off by the lousy English.   I am not an english major or a marketer, never will be.

Stem cell for liver regeneration

Liver regenerates naturally.   People can surgically remove 1/2 of liver and still be ok.  However, Breast cancer has the nasty habit of dispersing itself like dandalions across liver.   Some people who has big liver or total liver involvement will face high mortality risks if you cut more than 2/3 of liver.   And cancer patients are not eligible for liver transplant anyway.
Enter stem cell technology to allow entire organs to regenerate.  It's preclinical.   But it will be coming:
http://www.wakehealth.edu/News-Releases/2010/Researchers_Engineer_Miniature_Human_Livers_in_the_Lab.htm
Even if that is not an option, one can potentially inject stem cells into liver to speed up the regeneration process and reduce mortality risk and hence expand the usage of hepatic resection for metastatic breast cancer patients.
These technologies are improving from all over the world.  China/Germany/Japan are places to watch.    But be careful to sign up with any clinic who claims they already know how to do it.   Whatever they know and can do, should be reproducable by other labs/hospitals across the world.
Nobody knows for sure, that's why we need clinical trials, we need international effort for data sharing and trustworthy data.   Patients need to demand newer techniques and fund basic/translational research.

What can a Patient do?

I think patients can do a lot more than donating money.
1.  We can advocate for ourselves, demand genomic sequencing on our tumor samples (not oncotype DX which gives me 4 pieces of information), but something that will return gigabytes of your tumor DNA sequence so it can be analyzed in future in light of new research
2.  We can donate our patient record and our blood samples and our spare tumor samples to researchers who are interested (and who will share, that's important).   The 10 subcategory of BC was done based 2000 such patients.
3.  We can fund more old clinical trials to be retrospectively analyzed for DNA.   A lot of drugs failed on phase III at 5-20% clinical response.   These drugs may work 100% for some people with specific subtype of breast cancer.
4.  We can join clinical trials whenever we can.     Pediatric cancer made a lot more progress in the last 20 years because all kids with cancer join clinical trials.    Medicine advances fastest through clinical trials.   Just say no to the snake-oil salesman who wants to sell you the secret to survival; if it is a secret, if it's not reproducable, if it's not sharable, then it's likely worthless.
5.  We can fund fundamental biological research, in immunology, in brain, in stem cells.   One day, vaccine and stem cells will revolutionalize treatment of metastatic breast cancer.