W hile treatments for metastatic breast cancer (MBC) have progressed significantly in recent decades, there remains an opportunity to provide patients with more flexibility and options in where and how they receive their treatments.
A recent survey1 revealed that women with ER+, HER2- MBC sometimes encounter barriers to receiving their treatment, like time spent and transportation, that may negatively impact other areas of patients’ lives. These experiences can lead to patients feeling anxious and overwhelmed, among other emotional impacts, adding to the disruption the disease has already caused.
In conversation with Stephanie Walker, a patient with MBC, and Dr. Lillian Smyth, a medical oncologist, and oncology development leader at Lilly, we delve into the evolving landscape of MBC care, from discussing the persistent issues patients face to exploring the innovations paving the way toward additional treatment options that may benefit the lives of patients with MBC.
1 The survey was conducted online by Ipsos in partnership with LBBC and funded by Eli Lilly and Company. The survey was conducted August 23 to October 18, 2023. Read the full survey results https://www.ipsos.com/en-us/understanding-patients-metastatic-breast-cancer-preference-oral-treatments
Can you share with us what life has been like since your diagnosis?
It’s been almost nine years, and my life has changed tremendously. Metastatic breast cancer is like a thread that has been woven through every aspect of my life: from my professional life to my personal life, to my emotional and financial life.
I currently reside in a rural community, and I have to get my treatment about 100 miles away2. I am on what we consider my first line of treatment, and that has not been easy. It’s two painful injections every 28 days. If you can compound that over almost nine years, it’s been very impactful on my life.
2 Women with ER+, HER2- MBC spend, on average, almost two and a half hours to attend oncology appointments, including travel and wait times. Patients also reported attending appointments every six weeks, on average.
Lillian, for patients like Stephanie, the work you do has a very real impact. Tell us about your role at Lilly as it relates to metastatic breast cancer.
At Lilly, I lead the development of our breast cancer medicines and work with our discovery scientist group to identify new medicines for patients. The key piece that attracted me to this work was really the ability to make a broader impact on patient outcomes. I, like many other oncologists, just want additional treatment options for patients, and I want them urgently.
Unfortunately, metastatic breast cancer remains an incurable disease and patients need us to rapidly develop more treatment options. We continue to work very hard toward that critical goal.
How have the challenges in your journey as a patient impacted your sense of control?
I absolutely can say that I had no control of my life at one point. I was always going to the doctor’s office. I wasn’t seeing the inside of my house because of how often I was in the hospital. I was getting scanned every three months in the beginning, so I lived my life in three-month blocks. I could not plan anything outside of three months because I was too scared - I didn’t know if the treatment was going to be effective.
But that’s in the past. It is by the grace of God and all of the developments that the doctors have been able to make that I am still here.
Could you provide insight into metastatic breast cancer treatments and how they have evolved over time?
Thankfully, MBC treatment options and outcomes have improved dramatically in the last several decades. At a high level, as we’ve learned more about how cancers grow and spread, one of the ways we’ve learned how to treat them is to target (with medicines) some of those key signals/drivers of cancer growth (e.g. the estrogen- or HER2- receptors in breast cancer). This “targeted treatment” strategy has dramatically improved patient outcomes. Overall, what we’ve seen more recently is that the pace of drug development is greatly accelerating. Ultimately, that’s a good thing for patients – bringing more options to those who need them.
This recent survey highlights an important point, however, about patient experience. Specifically, that the impact of this disease and the treatment needed for it is broader than just a physical impact. It can, in fact, be quite disruptive at times3, emphasizing the need for effective and tolerable treatment options that are also minimally disruptive to a patient’s life.
Certainly, there have been some optimizations in how we administer treatments that can improve that patient experience. For example, some medicines or classes of medicines previously given as an infusion or an injection are now optimized to be given either as an injection or as a pill, respectively, potentially providing more convenient ways to receive treatment.
3 35% of HR+, HER2- MBC patient respondents reported having to take time off from work to accommodate their oncology appointments. 33% said they needed to find a friend or family member to accompany them to the appointment.
What do you think should be prioritized in the development of new treatments for metastatic breast cancer?
Anything that keeps us out of the doctor’s office and gives us more time at home and with our families, making memories and living a “normal” life. I hate the injections. I wish that the medication I am taking could be administered a different way. For those of us living with this disease, quality of life with minimal disruptions is an important thing4. For example, the development of new oral drugs that we can take at home.
4 79% of survey respondents with HR+, HER2- MBC said the freedom to take a medication in a convenient location and not having to travel to their oncologist's office for treatment are perceived benefits of an oral medication.
Looking ahead, what are some of the areas of focus for Lilly for advancing treatment options and improving outcomes for patients with metastatic breast cancer?
Fundamentally, we want to continue to build on our understanding of what those drivers of breast cancer are so that we can develop new medicines that target them effectively. Our efforts will involve optimizing and improving how we target known drivers of breast cancer, but also include us looking for new druggable targets.
Ultimately, we’re striving to create more effective and tolerable options for patients living with breast cancer and to improve the patient experience with this disease.
What were some of the most unexpected parts of your journey as a patient with metastatic breast cancer?
When I was told I couldn’t work. That statement was harder to swallow than my cancer diagnosis. In my head, I’d had the perfect job, lived the best life, and had my needs met. I never envisioned a cancer diagnosis let alone what it would take from me. Patients like me just want their life to go back to as normal as possible, including work. Hopefully, we will get closer to that with the treatments being developed.
I was also shocked to realize my lack of knowledge was a barrier [in my treatment process]. Nobody taught me [how to handle all of this] prior to when I was first diagnosed. As a nurse, I thought I was armed with all the what-ifs, but you don’t know what you don’t know.
What’s the connection between innovation and health equity*?
Innovation can advance health equity in a variety of ways. For example, ensuring that all patient populations are represented in the development of a medicine. We know that patients can sometimes respond differently to medicines based on their age, sex, race, and ethnicity, so we need to ensure we’re evaluating our medicines across diverse populations. Unfortunately, in clinical trials of new medicines, we often see underrepresentation of diverse populations. This is something we’re working hard to remedy.
Another innovation in advancing health equity is developing treatment options that can reduce the burden of metastatic treatment, which is a hurdle for many patients. In fact, another key learning from this survey was that patients consider safety and quality of life to be the most important characteristics of metastatic breast cancer treatment. As you would expect, patients value therapies with minimal side effects that they can take conveniently with minimal disruption to their life. It’s intuitive, but it’s something that we who develop medicines need to be continually cognizant of.
At Lilly, we are committed to discovering and developing medicines with the potential to make a meaningful difference for people living with metastatic breast cancer, which includes providing more treatment options that can be taken at home. We continue to work closely with scientists, researchers, oncologists, regulators, and patient advocates on this endeavor.
*According to the World Health Organization, health equity is defined as the state in which all individuals can achieve their full potential for health and well-being.
Disclosure: Stephanie Walker was compensated by Eli Lilly and Company for her time participating in this interview.