Komen Scholar Joe Gray Brings Patient Perspective Into His Work

Jul 01, 2020 | Cancer Updates, Care, Research, Stories

Komen Scholar Joe Gray, Ph.D., has been a biomedical researcher for 48 years. His wife’s metastatic breast cancer diagnosis in 2017 provided him with a unique and personal perspective on the way breast cancer patients are treated. Gray recently spoke with Susan G. Komen about the importance of focusing on a patient’s quality of life in their breast cancer treatment.

Gray is the Associate Director for Biophysical Oncology at the Knight Cancer Institute at the Oregon Health & Science University.

Komen: We’re sorry to hear about your wife’s diagnosis. How is she motivating the work you do?

Gray: My wife is my life partner, and obviously I am deeply interested not only in maintaining the control of the cancer that she has, but to do this in a way that really allows her to enjoy life and to experience the things we’ve come to love over the years. I pay attention to every symptom she develops. There are many. This has caused me to appreciate the importance of things you read about in the literature: a rash, a problem with your foot – those don’t sound very important when you read about them in the literature but that are highly important in the context of quality of life.

When you actually have to live with these symptoms, these are really important things, and they can affect your quality of life in ways that I would never have guessed just as a researcher. Seeing the disease firsthand has really caused me to appreciate how important it is we work on the quality of life aspects of cancer treatment. I have to say, I think we don’t put enough research emphasis on quality of life compared to quantity of life right now. We are still overly focused on the cancer and not as focused on the patient as we should be.

Komen: As a researcher, how can the patient remain at the center of everything we’re doing to better treat and cure breast cancer?

Gray: One of the things that’s changed over the years is that I have become increasingly aware of the importance of the patient, as well as the disease. Early in my career, I was interested in understanding disease mechanisms, and publications, but not so much about the patient. Most basic researchers are separated from patients and really don’t interact with them much. As consequence we don’t have a full understanding of all of the problems that must be addressed to achieve durable and tolerable control of breast cancer.

I think the introduction of the Komen Advocates in Science research advocacy program is an important step in helping the research community understand we’re treating real people, and it’s important they live high quality lives.

Because of my education about my wife’s cancer experiences, I think I understand now, at a depth I never had before, the importance of quality of life and how difficult it is to live with the kinds of medicines we are now giving.

Komen: How do you balance trying to prolong a person’s life with improving their quality of life, as it relates to clinical trials (Clinical trials test the safety and benefits of new treatments as well as new combinations (or new doses) of standard treatments.)?

Gray: Well, one of the things that’s interesting about our ability to control cancer for long periods of time is we’ve come to appreciate that the quality of life becomes increasingly important.

One of the things we’re doing in the SMMART program (Serial Measurements of Molecular and Architectural Responses to Treatment) is to monitor closely our control of the disease and do it in a way that allows us to consider reducing a patient’s drug dose, whether chemotherapy or a targeted drug, to one that still maintains control but increases quality of life for the patient.

Komen: Will this process also allow us to quickly adapt and switch directions on our treatment so that when a patient stops responding to one treatment, a new treatment can then begin without too much delay?

Gray: That is exactly the goal. What we try to do is to monitor patients frequently for the possibility of disease progression. The moment we see an indication that we’ve lost or are beginning to lose control of the disease, we can reassess the therapeutic vulnerabilities and consider switching to treatments. The idea is that if we treat early in the resistance process, we’ll have a higher probability of success. This approach becomes increasingly attractive as the number of treatment options increases.

Komen: What else have you learned through the SMMART program?

Gray: The goal of the SMMART program is to apply the lessons we’ve learned from a large number of precision medicine studies to the individual patient. We’re applying a very broad spectrum of analytical tools to try to teach us about vulnerabilities within a particular cancer, and then to start a personalized treatment program based on that information.

We then follow the individual patient over time and ask the question, is the tumor still under control? If so, we’ll continue. If not, then we reanalyze the now-resistant tumor and ask what’s changed, what are the new vulnerabilities and what can we do about that to continue to maintain control of the tumor?

Komen: Are we starting to see some evidence of success?

Gray: We’re still in very early days of the program, but I can say that early indications are that many patients have survived substantially longer than expected, and the tolerability of the treatments has been good.

Komen: What are the long-term benefits of these studies for treating cancer and improving patients’ quality of life?

Gray: The goal of the SMMART program is to learn how to achieve durable and tolerable control for the individual patient. Our goal is to identify molecular and architectural features of a tumor that will allow us to predict the combinations of specific drugs that a tumor will respond to, and then administer the drugs to effectively to manage the care of that individual patient. By participating in these trials, I think patients both stand to benefit personally, and they help us to gain knowledge that will help worldwide in the management of these complex diseases.

Komen: What are you most excited about in the future of breast cancer research?

Gray: We now have an amazing suite of analytical tools that can be deployed pretty much in real time for individual patients. I think we are in a position in the world today to know what the vulnerabilities of cancers are. Further, we have an ever-increasing armamentarium of therapies that we can combine to target the cancer and the microenvironments to improve outcomes for the individual patient. The outcomes for patients with hormone receptor positive and HER2-positive tumors have improved rapidly based on these new therapies. SMMART is designed to bring these benefits to all types of breast cancers and to breast cancers where our first line therapies have failed.

At the same time, thanks to worldwide work in academia and the pharmaceutical industry, we have a wealth of chemical and analytical tools we can use to attack the different points of vulnerability these tools identify. I think the combination of analysis, computational tools and drugs put us in a position where we can tolerably control these cancers. I believe we are really at the beginning of a revolution, especially in the treatment of metastatic cancer.