I
sat in a row beside metastatic breast cancer patients and advocates, and
watched cutting edge results being presented at the San Antonio Breast Cancer Symposium last week.
They were taking it all in, trying to
understand everything from the details of the science to the details of the
clinical trials. This particular session wasn’t hard to interpret. You
certainly didn’t need an advanced degree to see that there was no difference
between the survival curves of the investigational drugs that were being
described versus the standard of care. Not only was there no change in these
curves, there’s been no change in the mortality rate for people with metastatic
breast cancer for decades.
DECADES
of awareness, and research, of publications and seminars, of symposiums and
conferences. Decades of career advancement and pats on the back. Decades of
Champaign bottles uncorked at thesis defenses, and dinners out to celebrate
successful grant applications. Decades of reviews, and study groups. Decades
that have resulted in no change in mortality? How is that even possible?
In
non-cancer lives, this is more than a generation of effort that has yielded no
change in the needle. In metastatic breast cancer lives, where the average life
span is ~ 3 years, this is over 10 generations of lives lost.
I
know what it’s like to track your own mortality along a Kaplan-Meier curve. I
watched as my friends saw in dual screen, that they are still looking down that
steep curve with nothing to intervene as they are forced down that slope. My
heart was broken into tiny little pieces, for them, and for all of us. If we
haven’t been able to figure out how to properly treat a population of people
who comprise a large fraction of the cancer gestalt by now, then when? That is
one of many outstanding questions that I hear from my many friends in the MBC
community. When.
People
with MBC have been told for decades that they just need to wait a little
longer, that research is slow, but that things are changing. As someone who
walks the line between research and advocacy, I can see crystal clear, many of
the factors that are impeding progress. We have an infrastructure that promotes
career development over collaborative
scientific endeavors. My experiences are in the space of academic
medicine, so I can’t speak to anything related to industry, but from my side of
the bench, I have been deeply disturbed by the way we publish, to the way we
promote junior investigators, all the way through tenure. I was a link in this
chain for 15 years before I decided to jump ship.
I
have seen postdocs in the same lab not aware of each others research because
they are so protective over their impending publications, that they don’t want
their colleagues to scoop them. I have seen data sculpted into the best
possible papers, but not the best possible science. I have seen people, myself
included, chose topics to write grants for because they are sexy and have a
better shot of getting funded rather then write for what is truly in their
hearts. I have pat my friends on the back for their papers, for their grants,
for their great successes, all the while, the people who are they greatest sake
holders are dying by the droves.
Until
every researcher, every study group, every granting agency understands the
sense of urgency that patients feel about their research, the status quo will
reign. I would love if we could sober up, take a look at the reality of our
collective ineffectiveness and chart a swift course toward some impactful
research. I know that the work I’m involved with is tacking in the right
direction, and I hope very much to help generate data ASAP. But I will hold off
on any hyperbole, on any pats on any backs and on easing up on my sense of
urgency until there is something to actually celebrate.
