INTERVIEW BY MEGGIE O’DELL | PHOTOGRAPHY BY AGAPITO SANCHEZ
Countless Miss America contestants have professed their deep-seated desire to cure cancer in front of television audiences of millions, but deep in the heart of Texas, Dr. Mothaffar Rimawi may have beaten them to the punch. With his team at Baylor College of Medicine’s Smith Breast Center, this Jordanian-born scientist has challenged cancer to the fight of a lifetime — and he’s winning. Given that the American Cancer Society estimates that more than 230,000 women are diagnosed with invasive breast cancer each year, Dr. Rimawi’s research has implications for millions of Americans, and Daily BR!NK is proud to feature his amazing discovery.
Let’s get right down to business. Could you please describe, as simply as possible, the breakthrough you and your lab made in breast cancer treatment and its possible implications?
Okay, so there is a group of breast cancer patients, about 25%, who overexpress a protein called HER-2. And this protein, when it’s overexpressed, leads to a breast cancer that’s more aggressive. Typically, this cancer is usually treated with an antibody that targets the protein combined with chemotherapy.
What we did initially was to use a combination of targeted therapies that I worked on in the lab and essentially gave this medicine, Lapatinib, along with trastuzumab, and this combination, which has no chemotherapy whatsoever, led to remarkable results in the initial animal models. Both these drugs are active against breast cancer, but they’re both only modestly active on their own. Combining the drugs this way, we saw that in 28% of the patients who received the treatment, the tumors at the time of surgery had completely disappeared. Not only that, but in about another 25% of the patients, the tumors shrank so much so that there was very little cancer left when the surgery was performed.
The implication here is that now you have a very aggressive form of breast cancer, which usually requires a lot of treatment with chemotherapy, being treated with a combination of targeted treatments that have really very tolerable side effects, like diarrhea and rash. Compare that with the side effects of chemotherapy, and the cost of chemo, and the complications from chemo… that is really a big deal.
Wow, that’s really exciting. You talked about the cost of chemotherapy. How available are the Lapatinib and the trastuzumab? Will this lower the cost of breast cancer treatment?
They are both available and approved in the U.S. for treatment of breast cancer. My disclaimer is that we are not making a claim that the results of our study eliminate the need for chemotherapy for all women; what we’re trying to do is study their tissue and identify who does not need chemo and do a larger validation study. But essentially, these are FDA approved—they’re ready, and this is why they’re a big deal. We know how they work, we know their toxicity. It’s just that combining them in the right way in the right patient population—this is very important.
Both medicines are expensive—but the cost is not always only the cost of the treatment. It’s the cost of the medicines you give the patient because they feel bad after the chemo, the supportive care, the potential work loss, the time in the hospital, the long-term complications from chemotherapy. I think that this treatment would be a more tolerable and more desirable treatment than chemotherapy.
That’s amazing. The cost in human capital is something that gets undervalued sometimes in medical treatment. I know you’ve been in cancer research for many years. Do you have a personal connection to cancer? What got you interested in cancer research?
I was fascinated by medicine and its mechanism—the science of life—for a long time. And what I found most intriguing about cancer is how a human cell utilizing the mechanisms of life—the mechanisms that we use for us to grow and to prosper and to live—how those could be turned into a deadly disease once they get dysregulated.
Since cancer is such a leading cause of death, do you think there will be similar breakthroughs in cancer research — will we be able to make it chronic, or to cure other subsets of cancer?
The answer to this is yes. I am optimistic, but I think the single most important element to approaching cancer research is basically that one size does not fit all. Not all breast cancer is the same, or prostate cancer, or colon cancer. What we should be doing, and what a lot of scientists are starting to do, is to start to identify the different subgroups in every cancer, and what drives a particular cancer.
As far as the new government guidelines for mammograms, etc., do you have an opinion on that and how it might affect early detection? How important is early detection in cancer treatment?
Early detection in cancer is quite important. You know, I know that some cancers are more aggressive and some are not, but all in all, it’s much easier to treat a tumor the earlier you find it. My conclusion is to respectfully disagree with those recommendations for two reasons: essentially, the recommending panel reconsidered the results from old studies, and they seemed not to take the latest imaging technologies into account, like digital mammography. Those studies were done in Europe, in Sweden, and our population is a lot more diverse — people hail from all parts of the world, and I think that that generalization is ill-advised.
Based on your interactions with patients, what is the biggest misconception about breast cancer?
Cancer is a very, very scary word. And I think that if you take a woman and look at three diagnoses—breast cancer, congestive heart failure and end-stage kidney disease, for example — I think that the majority of women would probably think that breast cancer is the most serious or the most deadly of these, and that’s not necessarily the case. Some breast cancer is very deadly, but the majority of breast cancer is curable.
The other misconception is that when people think about cancer treatment, they think mostly about a short-term thing, like surgery or radiation. A lot of times, we are curing cancer by doing several things—it could be a combination of surgery, radiation, hormonal treatment, targeted treatment. I think that sometimes the expectation is, “I’m going to have some surgery, some treatment and I’ll be done in a few months,” but the battle against cancer takes years. Living and surviving cancer is not an easy task, but that is what needs to be done.
What do you hope to do next with the Smith Breast Center?
What we’re doing in a follow-up study in the next month is to ask, “What if we treated these patients for a longer period of time?” Could we maybe have converted those patients who have very little cancer left—could we make that disappear with a longer treatment? So we’re going to do a study that would use the same combination but compare giving it for 12 weeks versus giving it for 24 weeks and seeing if we can improve the outcome further.
It’s sort of like the old saying that the difference between a doctor and a scientist is the patients.
You spoke earlier about what a diverse society we live in, and how that might impact cancer research. Our readers are always interested to hear about the personal backgrounds of the people we profile. What can you share with us about your experience growing up in Jordan and then moving to the U.S.? Was it a big adjustment?
I was born and raised in Jordan and I moved to the United States for training right after medical school and then essentially stayed here. I have to say that growing up, I was somewhat familiar with Western, particularly American, culture—we had American shows, and I went to a school that had all American books in the English syllabus, and I’m familiar with American writers and novelists and poets. I loved Mark Twain and T.S. Eliot as a kid. But reading about a culture is different than experiencing it, and one of the challenges when you move is just adjusting to this new place. What was astonishing to me was the amount of diversity—people from all parts of the world, especially at the Texas Medical Center in Houston. Yet there is a unifying theme—it was more about me absorbing the diversity and the culture than adjusting my behavior. Of course, being in clinical training and being away from family is hard, but I made friends quickly, and it’s been a very exciting journey. My anxiety was a lot more than what I faced. I was quite pleasantly surprised with how wonderful the culture is.
How can our Daily BR!NK readers contribute to your continued success?
I think that there are two ways. One is that if any of them have family or friends who they think can benefit from going onto one of our trials or any of the trials at academic institutions, I would ask them to help them with that. A lot of times a friend or family member who has received this diagnosis gets so upset or paralyzed by the news that they need help looking for the best treatment. If they are cancer patients themselves, they should go on clinical trials—the only reason we know how to treat patients today is because years ago, other patients decided to go on clinical trials.
The other thing is to just continue to reach out, continue to educate people about the importance of going for cancer screenings and going to the doctor. And, of course, it is vital to meet with elected officials about the importance of continuing funding for cancer research—that is a critical part of continuing to make these breakthroughs.