With Mark Burkard, MD, PHD, of the University of Wisconsin Carbone Cancer Center
By Sarah DiGiulio
Two individuals given the same cancer diagnosis and who end up following identical treatment plans may have identical outcomes. Or they may have very different ones. Across all cancer types, some patients survive years beyond their prognosis and some survive for far less time.
New research seeks to look more closely at why that is. Instead of starting with a specific drug or treatment, researchers at the University of Wisconsin will begin their investigation by looking at the best outcomes—by identifying exceptional survivors who have lived for a longer-than-expected time—and then looking at treatment decisions, genetics, lifestyle choices, or other factors that may have led to those outcomes.
"How do these exceptional patients survive so long with incurable cancer? We're hoping the answers can help more people live better and longer with cancer," the study's principal researcher Mark Burkard, MD, PhD, a breast cancer oncologist at Wisconsin's Carbone Cancer Center in Madison, said in a statement.
This study will focus on women with metastatic breast cancer. Though in the future, Burkard hopes the work will guide similar projects in pancreatic cancer, colon cancer, and other types of cancer, he told Oncology Times. Here's what else he said about the new project.
1. Can you walk through the steps of the study and how individuals can participate?
"In the first step, women or men with metastatic breast cancer can go to our website (bit.ly/2CiUdya); and if they are interested select 'Participate Now,' read the information, and then provide their contact information.
"Once we verify they meet eligibility requirements—an adult with metastatic breast cancer—we will email them a unique link to fill out a full web survey about their cancer history, treatment, habits, and diet. For this portion of the study, they need not be a 'long-term survivor.' We hope to have 2,000 individuals participate, of which 1,000 are long-term survivors.
"We plan to invite 50 individuals who are the longest-term survivors who have available archived tumor specimens to participate in step two. Individuals who choose to participate [in this second step] will send a saliva sample and give us permission to obtain medical records and archived tumor specimens from a surgery or biopsy in the past. We will use these to study the genes in the cancer and the genes in person.
"We hope to use this [information] to identify unique genes that control long-term survival, such as those that make slow-growing cancer or allow the immune system to restrain the growth of cancer."
2. What led you to look at these extreme survivors and how is the project different from other research?
"I met a 40-year survivor in clinic and was amazed to learn her story. I started asking my colleagues and discovered there are many more [long-term survivors] out there. I slowly came to the realization that we could learn a lot from these amazing people and use the information to help others.
"I opened a study of exceptional survivors at our hospital and found it would be helpful to identify more. At the same time, other exceptional survivors heard about some of the local news stories and asked to participate—I had emails from across the U.S. and one from the U.K. So it was clearly important to find a way for them to participate as well.
"There are ongoing projects that are working on genetic analyses of tumors in people with metastatic breast cancer. Also, there are studies on 'exceptional responders,' or people who have a surprising benefit from a particular drug. Though most exceptional survivors I have identified so far have not had such an exceptional response.
"Our study is the first comprehensive study, to my knowledge, that seeks to identify behavior, diet, treatment patterns, immune system, and genes that allow some individuals to be exceptional survivors."
3. What's the takeaway for practicing oncologists and cancer care providers about how this research will benefit their patients with breast cancer in the future?
"I'm hoping to identify the fundamental reasons why some people live so long with metastatic breast cancer. There are a number of alternative reasons that have been proposed—treatments, diets, habits, medical practices, immune system, or the genes driving the growth of the tumor. We are going to survey all these possibilities.
"Some of these [findings] could be directly used to advise other people on how to become long-term survivors. Others will not be easy for us to control (e.g., genes inside the tumor).
"However, even if the tumor genes are controlling long-term survival, we could at least identify which individuals are likely to be [long-term survivors] at the outset and develop a different treatment plan. It is possible, for example, that many of these people don't need to have harsh chemotherapies if they will outlive their cancer anyway."