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"  How does the availability of an anticancer &amp;quot;smart bomb&amp;quot; such as T-DM1 change treatment possibilities for patients?  Almost all the chemotherapy we give for the treatment of breast cancer involves hair loss, anemia, and low white blood cell count, which make people susceptible to infection. Killing cancer in the laboratorythat&amp;#039;s not a hard task. The hard task is getting chemotherapy where we want it and keeping the rest of the patient&amp;#039;s body out of the picture.   Because the molecule T-DM1 directs or targets where the chemotherapy is given, we see very little bone marrow suppression. We don&amp;#039;t see any decrease in red count. Everything my patients dread when they think about treatment for metastatic breast cancer has been eliminated by T-DM1. On average, patients&amp;#039; cancers were under control for five to six months longer if they got the T-DM1. More important, when patients take T-DM1 compared with the drug it was compared against, patients live on average six months longer.  Where is this treatment going in the future?  We got approved by the Food and Drug Administration in February 2013. It&amp;#039;s commercially available for the treatment of pretreated metastatic breast cancer, and we&amp;#039;re expecting in early 2014 a study in patients that have never received therapy, so this will be the make-or-break moment for T-DM1 versus the old way of treating [HER-2-positive breast cancer].   If we can show that it&amp;#039;s as good as old-fashioned chemotherapy . . . this could set a new standard in the way we treat breast cancer. I think what we&amp;#039;re going to see over the next two to three years is that everyone&amp;#039;s going to be pulling out their chemotherapies that they tried to use for the treatment of breast cancer and found too toxic, and they&amp;#039;re going to be pulling out their antibodies that didn&amp;#039;t make much of a difference, and they&amp;#039;re going to try to use those antibodies as a carrier pigeon to deliver those chemotherapies to tumors.  How is treating HER-2-positive breast cancer different from treating other kinds of breast cancer?  The breast cancer research community sort of lucked out in the development of trastuzumab. We knew that in one out of every five tumors, HER-2 was essential to the cancer&amp;#039;s growth. This HER-2 protein, if overexpressed, led to a tendency to grow faster and die less [quickly]. For 80 percent of patients facing breast cancer, we don&amp;#039;t have that key. Some people have actually argued that we&amp;#039;ve made the most progress in cancers that are rarer than run-of-the-mill cancers, and I would say HER-2-positive breast cancer falls into that domain as well. What&amp;#039;s really the fundamental driver behind 80 percent of all cancers, we still have yet to discover.  What role might technology play in that discovery?  I think projects such as the Human Genome Project will allow us to do what T-DM1 represents on a very individual patient level, which is to figure out what makes the tumor tick and then figure out how to fix it or block it in order to kill the cancer completely. That you would be able to sequence full genomic sequences of an individual&amp;#039;s cancer for $2000 in three weeksif you had told me that 10 years ago, I would have just laughed.  What is the process of developing a new anticancer drug like?  The drug itself represents about 20 years of trial and errorhow do you get the chemotherapy bound to the antibody? It&amp;#039;s like Goldilocks and the Three Bears. You can&amp;#039;t have it bound too tightly, you can&amp;#039;t have it bound too loosely, you have to have it bound just right so the chemotherapy is released just where you want it to be. It wasn&amp;#039;t until 2006 that the linker component was fully realized.   Mark Sliwkowski, a research scientist at the drug company, Genentech, [that] markets T-DM1, played an instrumental role not only in the development of T-DM1 but also . . . in the original development of trastuzumab and pertuzumab. Mark&amp;#039;s the common thread from a scientist standpoint, with major contributions to these three drugs over two decades. I tell my two children, &amp;quot;This man&amp;#039;s been working on this longer than you&amp;#039;ve been on the planet,&amp;quot; and they&amp;#039;re 8 and 10.   It does take a long time from the discovery in the lab. In 1989, we knew that in one out of five breast cancers, HER-2 was the driving force behind the cancer&amp;#039;s growth; two and a half decades later, we&amp;#039;re just realizing how to take advantage of that. If we continue at this pace, even with the technology breakthroughs we have, that means within my entire career there will maybe be one more breakthrough in the way we treat breast cancer. It seems like we should set the bar a little higher. The pace is too slow.  What can be done to increase that pace?  It&amp;#039;s a matter of companies, clinicians, and patients all working together to get the trials done. It&amp;#039;s about all the invested parties defining common goals, and sometimes that can be complex. We need to start thinking aboutif we have limited resources, how do we work together to maximize those resources? Teamwork sometimes can be really easy if the common goal of getting one drug from here to there meets everyone&amp;#039;s interest. It can be more complex when there are commercial interests, sometimes even political interests, and financial interests, when the common goal of the team is not so clear.  Do commercial interests play a positive or negative role in cancer research?  I think both industry and federal sponsors of research do have the same goal, which is to cure cancer. Understanding the basic science of cancer will have to come from the basic science lab, but commercial interests fuel development of drugs that we wouldn&amp;#039;t see at this stage if those resources weren&amp;#039;t there.   It gets a little bit more complex with intellectual property. If you have one target and three companies all working on the same drug, does that fuel the process [into] moving faster because you have three companies all developing a drug, or should there be some sort of process in which one company is developing one drug for one patient population? If three different companies all find that they have a drug that&amp;#039;s effective and safe, and all three drugs are priced about the same, which do you take into the next layer of studies?   Within the HER-2 domain, we now have four approved agents, all four very expensive, all four developed in a slightly different setting, so it&amp;#039;s not like we had an eight-armed study and there was a clear winner. What I would imagine within the next five to 10 years is we&amp;#039;re going to have another layer of complexity, which is we&amp;#039;re going to have so many options it&amp;#039;s not going to be clear which drugs to use first.  How does technology influence the research process?  Technology is what&amp;#039;s accelerating the process. We have nanomonitoring technology: By implanting a remote optical device in the center of a tumor, we can figure out how much of the anticancer drug is getting to the center of the tumor. You can bind many of these things to a traditional cancer treatment and get real-time monitoring of how much of your anticancer drug is actually getting to the cancer versus, say, a blood cell in the finger. There are implantable devices right now that, if you place them in the center of a breast cancer tumor and administer radiation, can tell you how much radiation is getting to the center of the tumor.  You were recently named one of Time Magazine&amp;#039;s 100 most influential people. What does that mean to you?  Part of me is feeling like, &amp;quot;What an amazing cancer research community I live in!&amp;quot; The award, even though it was given to me, represents our ability to work with patients and scientists and clinicianshow quickly the trial occurred and how passionate patients were that they were getting a treatment that they don&amp;#039;t have to get sick to get. That&amp;#039;s really what T-DM1 represents.  What led you to this field of research?  My love is taking care of patients facing breast cancer. Taking something from the lab to make a difference in the clinic is what it&amp;#039;s all about for me. I&amp;#039;m a geek. I just love taking something that I discovered in the lab and taking it to a clinic and saying, &amp;quot;Does this apply here?&amp;quot; It&amp;#039;s what makes my job the best. There are a lot of people who work in the lab and a lot of people who work in the clinic, and I get to see the best of both worlds. "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.popularmechanics.com/science/health/a9045/interview-fighting-cancer-with-smart-bombs-15553244/>