[00:00:00] Adam Walker: Komen has funded research for more than 40 years to find the cures for metastatic breast cancer, also known as stage four, but the five year relative survival rate for those living with MBC remains only 29%. That means seven out of every 10 people with MBC are expected to live less than five years.
This year alone in the us, nearly 44,000 lives will be lost to MBC. This week is MBC week, and we are publishing a new episode every day to shed light on the people who are impacted the most. When a life is lost to MBC, the husbands, daughters, sisters, and friends who are left behind each of our guests this week is driven by the purpose to help find the cures for. And to be a positive force for hope.
From Susan G. Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
Susan G. Komen knows that even one more day without a cure for metastatic breast cancer is one day too many when lives are at stake. MBC is the most advanced stage of the disease. Though there are treatments to extend life, there is no cure. That’s why this year, Komen is going one step further to raise an extra $1 million to fund the first ever MBC Excellence in Research Award. Here today to tell us about this $1 Million Challenge and some of the promising new research the grant could fund is Dr. Kim Sabelko, Komen VP of Scientific Strategy and Programs. Kim, welcome to the show!
[00:01:49] Kim Sabelko: Thank you so much and I’m happy to be here.
[00:01:53] Adam Walker: I’m excited about this. I mean, we talked, we’ve talked a lot about MBC. It’s so important, and now Komen’s doing even more for this community. So let’s start off by talking about what the $1 Million Challenge is. Can you share with our listeners more about it?
[00:02:08] Kim Sabelko: Sure. So as, as some of our listeners may know, October 13th is Metastatic Breast Cancer Awareness and Action Day, and While Commons Fighting Metastatic Breast Cancer year round through public policy advocacy, community health programs and research. This week we really put the spotlight on, on MBC, sharing the stories and information and ways people can join us to take action.
And so the goal of this challenge is to raise $1 million to fund cutting edge research that holds a promise to impact the lives of people living with metastatic disease. And the hope is that that this boost in funding will spark new discoveries that will transform how we’re treating this disease and in as a result, save lives.
[00:02:50] Adam Walker: That is always the goal and so important. Is Komen already funding any MBC research today? And, and why is this so important? Talk about that a little bit.
[00:02:59] Kim Sabelko: Yeah, so we, we are actually more than a little bit, I guess before we go any further Adam, I, I don’t want to assume that everyone knows what metastatic breast cancer is, is fair?
[00:03:10] Adam Walker: Yeah, please. Okay. Yeah, please walk us through that.
[00:03:11] Kim Sabelko: Okay. So let me, I just, just real quick. So metastatic breast cancer, we also refer to it as MBC is the most advanced stage of the disease when breast cancer spreads to other parts of the body. So I don’t know if anyone who’s died of a tumor that stay can find in the breast.
It’s, it’s when it spreads or metastasizes to places like the bones and the liver and the lungs and the brain, that’s when it becomes deadly. So in other words, and not to be too blunt about it, but I’m going to keep it real, it’s metastatic breast cancer that kills, Right. And like you said, there’s treatments, but there are no cures.
And the fact of the matter is more than 44,000 people are expected to die of it in the US this year alone. And that’s just not okay. Wow. So we’re funding research. Yeah. Right. We’re funding research. Our mission is to save lives. And so, you know, it makes sense that one of our priorities. Is to really conquer aggressive and deadly breast cancers.
And to do this, we need research because we need to better understand the biology of the disease. And, and with that understanding, we’ll be able to develop new drugs that will slow or stop or prevent breast cancer from spreading. So get this since 1982, I said we funded research and we do, We’ve invested more than 230 million.
In over 550 research grants. That includes 60 clinical trials that are focused on metastatic breast cancer. And right now, today as we are talking, there’s over a hundred common funded research teams that are studying metastatic breast cancer. It’s just about 75% of the active research grants we have going on that are focused on this because that’s just how important we, we know this.
[00:04:49] Adam Walker: Wow. That is, that’s astounding numbers. I, I really appreciate you sharing that. And so, so kind of thinking back about that progress. I mean, there’s just been an amazing amount of progress over the last 40 years since Comen was founded. So can you just kind of walk us through where we started and how far we’ve come?
[00:05:06] Kim Sabelko: Yeah. So I, I love this question. It’s a good one. You know, history’s a great teacher and a good yard stick, and we have made so much progress. Against breast cancer in the past four decades. And it’s in large part thanks to research and, and, and the other things that Komen does are public policy and our community work as well.
So I was actually over the weekend trying to think of a good analogy to help explain some of this. And for better or worse, , when I was thinking of it, I was watching football. Go Packers. And it dawned on me that we could have a sports analogy that could work for this. So, The way I was thinking about it is, you know, way before game day coaches are watching tapes and they’re studying their opponent, really trying to figure out how this other team works, right?
Do they favor the past or the run, and who their key players are and what plays do they do under under certain circumstances, You know, the list goes on and the more tapes those coaches watch, the more they learn about the other team in their playbook. And then they use that intel basically to plan their own game day strategy.
Right? Right. So they’re mapping out how to keep their opponent from scoring and really that’s what we’re trying to do with breast cancer research. So we, the researchers we’re like, The coaches we’re conducting studies to learn more about metastatic breast cancer, our opponent. We’re trying to figure out what molecules are the key players.
We’re trying to figure out what mechanisms or plays breast cancer has in its playbook that it uses to grow and spread. And then we use this information about cancer’s playbook to develop those new ways to treat, detect, prevent breast cancers from growing and metastasizing. The problem is breast cancer’s really good, right?
They’re tough, they’re clever and they’re not going to go down easy. And so we don’t have an easy. But our job is basically to our outsmart breast cancer. And I’ll tell you what, I know we can do this because we have truly brilliant people as researchers, healthcare providers, patients, advocates, our listeners, and so many others on our team, team common.
And I’d say, Team, let’s be breast cancer. So, you know, when we talk about progress, because it’s important, you know, everything that we are using for standard of care for breast cancer today. Had to be studied and there were clinical trials, which was, which is a type of research that led to that.
And so we have research and we have the thousands of people who participated in that research to thank for what we know about how to treat breast cancer today. So if you go back to the seventies, early eighties, Certainly within my lifetime, our understanding of the biology of breast cancer was rudimentary.
I mean, we didn’t know much at all about breast cancer’s playbook, and as a result, we didn’t have a lot of tools, including drugs to manage it. So you fast forward today, things are super different because we have advances in technology. We have explosion of research. This really increased our understanding of, of how breast cancer works and literally transformed every, I can’t think of a single aspect of breast cancer care that hasn’t changed because of research.
So, when we talk about detection, back in the day breast cancers were being detected by people finding lumps in their breasts. Today, most breast cancers are detected by re routine screening mammograms. They’re, they’re found much earlier. Usually before there’s lump and we know that when that breast cancer’s detected earlier, there are better outcomes.
Back in the eighties when we talk about What happens after diagnosis? Most people would have a mastectomy and a lot of them are still getting these radical mastectomy, which is, you know, it’s not just removing the breast tissue, but it’s the chest muscles and all the lymph nodes under the arms are removed too.
And today we know from clinical trials that there are breast conserving surgeries like lumpectomy and sentinel, no biopsies that are just as effective. And so we use those whenever we can. When it comes to treatments 40 years ago, we didn’t have a lot of options. It was really one size fits all, and we know how good that works, , especially when it comes to genes.
But it’s also true for breast cancer. And so, you know, there weren’t a lot of chemotherapy drugs. Endocrine therapy. So that’s the type of therapy we use to treat certain breast cancers that use estrogen to grow. Mm-hmm. . So that usually involves removing the hormone producing organ. So you’re, you’re surgically removing the ovaries.
Now think about that. That’s how we’re treating breast cancer. And it was effective sure. But really invasive and had lifetime consequences for the patients. So, I mean, with research we’ve been just able to do so much more to think about the whole patient and not just the cancer that we’re trying to Get rid of and, and you know, we’ve had a lot of advances in like molecular biology and genomics and other areas and all of this stuff is just helping us to learn more and more and more about the key players and the key place that breast cancer has in its playbook with human genome was sequenced in 2000 and you.
And that taught us that there’s more than one type of breast cancer. It’s not just one size fits all. It can’t be because there’s not just one type of breast cancer. And so we know we have these ER positive breast cancers and we have HER-2 positive and we have triple negative breast cancers. And that helped us then to develop a whole lot of different treatments.
So now, instead of one size fits all, the chemotherapies are kind of the one size fits all treatment. We have a whole portfolio of drugs that. Estrogen receptor positive breast cancers. First one was at 1983 Tamoxifen, but there’s a whole host of others now, thanks to research when it comes to HER-2 positive disease.
Again, a whole portfolio of drugs that we have to treat it now. In, I think it was 1998, the first targeted therapy for breast cancer was a HER-2 targeted therapy called Herceptin or Trastuzumab. And now there’s a whole host of other drugs to target that disease as well. And then there’s all kinds of other key players that we’re targeting, right?
It’s an alphabet suit like. Three ca cdk, four six mTOR. And it doesn’t really matter what the, What the letters, what the acronyms are. The key takeaway is, is that through decades of research, we’ve learned so much more about breast cancer and that’s helped us to develop more and more treatment options.
And this has all opened up the door to personalize therapy based on not just the type A breast cancer person has, but it’s molecular makeup.
[00:11:38] Adam Walker: Wow. That’s fantastic. I mean, I, I like that analogy, like the, it’s gone from one size fits all to a very customized, very nuanced approach to dealing with these things because we, we just know so much more about them because of research, which is just so critically important. So what are some of the new emerging areas of research and treatment that this $1 million challenge could fund?
[00:12:01] Kim Sabelko: Yeah, so, you know, it’s, I, I think I shared before that there’s probably going to be 44,000 people who die of metastatic breast cancer in the US this year. And so clearly we have not figured out yet how to defend against everything in metastatic breast cancer’s playbook.
So there are a lot of different areas and you know, I could sit here and talk to you about probably all day or a whole series of podcasts. Right. But I wanted to just share a couple that I think are really exciting and, and particularly addressing To me, my background is, is in some of the areas that I’ll talk about.
So one is we need to learn more about the process of metastas. How do breast cancer cells move to different parts of the body? What makes that new environment, the bones, liver, lungs, brain, a good place for them to those tumor cells to kind of settle in and stay? What triggers them to start growing? You know, sometimes they start growing, you know, 10, 20, 30 years after that initial treatment, when.
You know, people aren’t thinking about that in breast cancer anymore. They’ve moved on with their lives and then there’s a recurrence. And we know some about these things you know, all of those things. But we have to learn more through research so that we can really design the right place the right drugs to stop metastatic breast cancer.
There’s another one, you know, like immunology, So that’s what my background is, is in. I don’t know. Do you know what immunology is?
[00:13:31] Adam Walker: I, I do not. No. Please, please tell me.
[00:13:33] Kim Sabelko: Yeah. Immune system is really, or immunology is really the study of the immune system. And how, for us for cancer researchers, we want to know how it can be used to fight breast cancer, you know, the immune system.
We especially hear about it a lot lately with the pandemic. It’s incredibly powerful and it’s what helps us all to stay healthy. So the immune system will recognize things that are foreign to our body, could be a virus or a bacteria, and then it develops a response to. And then it destroys that foreign invader, basically the the virus or the bacteria.
There are two features of the immune system that are really intriguing to cancer researchers. So one is what we call a specificity. So there are certain parts of the immune system that have this amazing ability to specifically hone in on very specific targets. And the other feature that that is super interesting is the immune responses longevity.
So it has what we call memory so that when we are exposed to that same virus or bacteria or other foreign protein, again, we have this long lasting immunity and the immune system because it remembers, he’s like, Hey, I saw that before. It fires up really fast and it protects you from that infection.
[00:14:54] Adam Walker: Wow.
[00:14:54] Kim Sabelko: Okay. So that’s just basic, like, that’s my immunology 1 0 1 and you can apply it to, you know, covid vaccines or whatever else you want to Yeah. But it also works. And we’re, we’re thinking about how to harness the power of the immune system to fight breast cancer. And that’s really what immunotherapy is all about.
And there’s a lot of different ways that we’re doing that. Right. So I think there’s three that I’ll share with you. One, okay. Is to develop antibodies that recognize very specific proteins on the cancer cell surface. So I talked about her septin and that’s an example of an antibody that hones in on HER-2 molecules that are overexpressed by some cancers.
And this, these HER-2 proteins, they send signals to the breast cancer cells to grow. That’s how HER-2 positive cells grow. It’s their key play. Okay. And so Herceptin works by blocking those gross signals and by encouraging the immune system to attack and kill those cancer cells.
That’s just one example. And now, you know, the research is happening now is really looking at, well, what other tumor antigens could we target? There’s more than just HER-2, for example, and there’s some really cool stuff going on. It’s like nanoengineering stuff to develop new drugs. So some of them are called antibody drug conjugates.
And so what this does is take. Antibody, which can hone in on really specific targets. And it links it to a drug like a chemotherapy, a cancer drug. Right. And it then uses the antibody, basically like a guided missile to deliver that cancer drug right to the cancer cell.
[00:16:35] Adam Walker: That’s fantastic. I love that.
[00:16:38] Kim Sabelko: It’s like science fiction stuff only is real, you know?
[00:16:41] Adam Walker: Yeah. I love that. That’s, that’s that, that’s what we’re going for. Yeah. Okay. Yeah.
[00:16:46] Kim Sabelko: Okay. Yeah. So another type, our flavor immunotherapy is drugs that block immune checkpoints. So We talk about immune checkpoint inhibitors, so checkpoints in immunology and one of the molecules was called PD one.
Not that you need to know that, but if it’s flown out there, you know, in, in some random conversation now you’ve, you’ve heard it before. So these checkpoints. Our normal part of the immune system and they act like breaks on your body’s T cells to help prevent an auto control immune response.
Because when you have an infection, once the, once the virus or bacteria is gone, you don’t want your immune system to keep going because you be, you know, a tired, fevery, swollen mess, you know, not a good look. . Yeah. So there’s all these checks and balances in, in the immune system. To make sure that it’s turning on when it should and, and turning off when it’s not really needed.
The problem is, Oh, it’s fantastic. Yeah, right. I mean, this is like, you can tell I’m getting all excited and geeking out, but this is like, it’s so cool and breast cancer isn’t cool, but the science behind some of this is really amazing and just the potential that it has to help patients is incredible. So breast cancer is, you know, it’s, I said it was a smart and tricky opponent, so what it does is it can turn the brakes on our immune system.
You know, we would like for the immune system to be really strong and get rid of the breast cancer, but the breast cancer can turn on it. This molecule called PDL one and it basically puts the breaks on our immune system so that it’s kind of hiding from our immune system. And what these immune checkpoint inhibitor drugs do is they block the PDL one on the tumor.
So basically they’re turning off the brakes that cancer has its foot on. Right. So the immune response can come back against the breast cancer. It’s able to go full speed ahead.
[00:18:42] Adam Walker: Wow. Wow. That’s, that’s. I mean, it is kinda like science fiction. You’re not wrong about that. Okay. So it is then what I mean, knowing the amazing advances that we have made, knowing the amazing advances that are are to be made hopefully in the very near future. What does the future look like for MBC?
[00:19:02] Kim Sabelko: Yeah. So, you know, to me, I mean, if you want the short answer, I think that the short answer is that I see a future where nobody is dying from metastatic breast cancer no matter who they are. Or where they live. And, and so what that means is we need to have a lot more better treatments to slow stop and prevent metastatic disease.
We, we’ll be using genomics and other information about the tumor and the patient to tailor treatments. So it’s not that one size fits all and it’s really more getting more and more personalized care. And we need to have strategies that I think that are not just safe and effective. So, In getting rid of the cancer cells, but they have to be less toxic because as people are living longer with metastatic disease, we need options that are going to offer them quality of life too.
You know, if everyone, you know, if, if a patient there’s a drug that a patient is taking, but they can’t leave the house because you know, they’re vomiting all the time. What is that? You know? And we really want to make sure that, that there’s that quality of life there along with the, the extension of life.
You can’t have one or the other at this point. It’s just the future needs to be both. So to me, you know, the other thing is when I think about the future, There’s a lot of stuff that’s happened being in the lab, right. And talked about the, the immune stuff didn’t even talk about vaccines. So we’re trying to harness the power of the immune system to to build vaccines basically that could help us to prevent recurrence so that long lasting part, the memory part of the immune system can be harnessed to hopefully one day.
Help us to prevent breast cancer recurrence. So if someone’s diagnosed with breast cancer, they get their immunotherapy, they get their vaccine, they. and maybe they don’t have to worry about breast cancer ever coming back again. And, you
[00:21:01] Adam Walker: know, so just to be clear, this is the, they’re working on a breast cancer vaccine.
I just want to make sure that our audience hears that. Yeah.
[00:21:07] Kim Sabelko: Right now. Okay. It’s a little bit different. Yeah. Little bit different than vaccines. Like for, Right, for Covid of course, because Yeah. It’s, it’s actually They’re called treatment vaccines because obviously the patient already has the disease, so it’s not like you’re preventing breast cancer.
But actually, you know, there are people that are looking at vaccines to prevent us from getting breast cancer. Ever talk about game changer, right? And so that’s the kind of future that I envision. You know, we want to make sure. That we have the tools in our toolbox to care for people who do get breast cancer especially those who get metastatic disease because that’s important.
But at the same time, you know, I have a daughter. You have a daughter. I don’t want them to have to worry about breast cancer ever. I would love to see the day where we can prevent it entirely.
[00:21:55] Adam Walker: Well, and it’s research like this that paves that way. Right? I mean, that’s, that’s where we’re headed. I mean, we’ve, we’ve come so far and there’s ways to go.
And and that’s what this fund is about, right? Is, is is that research.
[00:22:06] Kim Sabelko: That’s right. That’s right. And I think it gives a you know, people hope, you know, I talk to a lot of people living with Mets and just who’ve been diagnosed with breast cancer and you know, they share their hopes with me, and they’re not different from what I hope, you know Part of it is of course they want their cancer to not progress and they want to make sure there’s treatments available if it does.
But the part that resonates with all of us is that, you know, they want to have more time, They want to have quality of life. They want to keep doing the things they love with the people that they love. And so, you know, that makes me always think about, you know, this isn’t just. Their problem or someone else’s problem.
It’s my problem. It’s Komen’s problem. It’s all of our problems to solve and work together until we really do have that future where no one’s dying from metastatic breast cancer.
[00:22:57] Adam Walker: That’s right. It’s a problem that we all share and it it’s something that we can all help solve. Which leads perfectly to my last question for you, which is how can our listeners donate and support the $1 million Challenge to help fund research for one day?
[00:23:15] Kim Sabelko: Curing MBC. Yeah. So I mean, that’s the ultimate future, right? Is when we have the cures for, for these different types and stages of breast cancer. So for our listeners who are inspired and able to donate they can go to Komen.org/supportMBC. Komen.org/supportmbc, so that’s correct. I’d love, love to have you go and, and be a part of this challenge.
[00:23:43] Adam Walker: Well this has been amazing. I mean, I, I learned, I, I’ve been doing this show a long time and I feel like I, there’s some episodes where I learned quite a bit and realize how little I know, and this was one of those episodes I had no idea some of the amazing research that has been done, and I’m, I’m very, enthusiastic about the research that is to come because it’s going to make a huge difference in people’s lives.
Thank you so much for joining me today. Thank you for the, the work that you’re doing.
[00:24:09] Kim Sabelko: Oh, thank you so much. And I just want our listeners to know that, you know, however, wherever and whenever they choose to act, that we are so very grateful and there really is a lot of, of promise and, and hope to be had. That we can realize that future where there’s, we put an end to breast cancer.
[00:24:29] Adam Walker: All funds donated to Komen this week will be dedicated to funding the cutting-edge research to one day end MBC. People living with MBC are desperately waiting for new treatments to extend and improve their quality of life. Visit Komen.org/supportMBC to donate.
Thanks for listening to Real Pink, a weekly podcast by Susan G Komen. For more episodes, visit RealPink.com. For more on breast cancer, visit Komen.org. Make sure to check out at Susan G Komen on social media. I’m your host, Adam, you can find me on Twitter @AJWalker or on my blog, AdamJWalker.com.