Dr. Stephanie Graff: Understanding Progression
Episode Notes
In the inverted language of MBC, “unremarkable” is something we all aspire to, and “progression” is something we dread. Progression means that our current medication regimen is no longer working and cancer is spreading and/or growing. It means that treatment is likely to change—bringing new drugs with new side effects. It also means that we’ve exhausted one of the available treatment options for our disease, leaving fewer remaining lines of treatment. In this episode, breast oncologist Dr. Stephanie Lynn Graff helps us unravel the mysteries of progression and resistance, tissue and liquid biopsies, tumor markers and scans.
Additional resources
Landscape of HER2-low metastatic breast cancer (MBC): results from the Austrian AGMT_MBC-Registry,Breast Cancer Research volume 23, Article number: 112 (2021)
Androgen Receptor in Breast Cancer—Clinical and Preclinical Research Insights Molecules 2020 Jan; 25(2)
ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer☆ - Annals of Oncology (from the European Society of Medical Oncologists -not an easy read but contains info on treatment options when progression occurs)
Treatment of Stage IV (Metastatic) Breast Cancer (from American Cancer Society –overview of various lines of treatment for different cancer types)
NCCN Guidelines for Patients Metastatic Breast Cancer (from the National Comprehensive Cancer Network – a truly comprehensive overview that includes info on scans and tests as well as treatment options that may be helpful to inform decisions at various points in disease progression)
Resources to seek emotional support after progression
Dealing With Cancer Recurrence
More Information
American Cancer Society: Understanding Recurrence
National Cancer Institute: Managing Cancer as a Chronic Condition
Abigail Johnston’s Blog Articles used in this episode
Blog No Half Measures LIVING OUT LOUD
Dr. Graff’s Video Appearances, Interviews, and Articles
Stephanie Graff, MD: Information Is Power for Patients With Breast Cancer, OncLive on Air, January 1, 2020
Dr. Graff on Future Research With Immunotherapy in Breast Cancer , OncLive
Dr Graff discusses future research with immunotherapy in Estrogen receptor–positive breast cancer.
Dr. Graff on the FDA Approval of Sacituzumab Govitecan in TNBC By Stephanie Graff | OncLive
Dr. Graff discusses the FDA approval of sacituzumab govitecan-hziy (Trodelvy) in metastatic triple-negative breast cancer (TNBC).
Dr. Graff on Current Treatments in ESR1-Mutant Breast Cancer By Stephanie Graff | OncLive
Dr. Graff discusses current treatments in ESR1-mutant breast cancer.
Dr. Graff Underscores Unmet Needs in By Stephanie Graff | OncLive
Dr Graff discusses some unmet needs of patients with ESR1-mutated metastatic breast cancer.
Critical Aspects of a Sustainable Clinical Research Program in the Community-Based Oncology Practice By Jennifer L. Ersek, Stephanie Graff, Neelima Denduluri, Francis P. Arena | ascopubs.org
Exemplary clinical trial sites should seek to enroll at least 10% of their patients on clinical trials. Achieving this goal requires commitment across physician and administrative leadership to create a culture of clinical research. Leaders of community-based clinical research programs must understand the patient population they serve and advocate for their patients to be involved in research.
The most valuable lessons in life can be learned in oncology By Stephanie Graff | KevinMD.com
I am a medical oncologist specializing in breast cancer. I often try to conceal what I do for a living when I meet people for the first time as it always leads down a particular road. “Is that so depressing? I don’t know how to deal with that all day, every day.” But in truth, it is not depressing. My work is very rewarding. I feel that the most valuable lessons I have learned in life, I have learned in the practice of oncology. 1. Labels hurt.
Scared of clinical trials? 7 reasons to not be.By Stephanie Graff | KevinMD.com
I see more and more patients decline to participate in clinical trials. Simultaneously, I hear patient advocates on the national stage clamoring for better trial access. Why the disconnect? Let’s explore 7 reasons why clinical trial participation is right for you:1. The smartest minds in medicine designed this for you. Clinical trials are not designed by one doctor on the fly. Most oncology drugs have been studied for at least six years prior to entering clinical trial.
Where physician and mother meet By Stephanie Graff | KevinMD.com
In 2017, results of a study were published in JAMA suggesting women are better doctors than men. While I celebrated the acknowledgment for myself and my female physician peers, it prompted me to reflect on how my gender impacts how I practice medicine. Reflection kept bringing me back to a simple truth: my job as a mother and my job as a physician are strikingly similar. They are yin and yang, balancing and strengthening me. I am constantly swinging from high to low.
The only perfect cancer statistic is an imperfect one By Stephanie Graff | KevinMD.com
As an oncologist, I spend my days with women and men diagnosed with cancer. My patients, particularly my advanced-stage or Stage 4 (metastatic) patients, often ask what they did wrong. How did they end up with metastatic cancer? They share with me the subtle accusations made by friends, family and acquaintances that somehow they brought this on themselves. “If only Susan had done her screening mammograms faithfully, she never would be in this position.” “Did you hear Bob has metastatic melanoma?
Honor National Women Physicians Day With Self-Care , Women in Oncolog, Feb 01, 201
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Check out our past episodes that deal with some of these topics.
Meet the Guest of this Episode
Growing up in a small farming community in rural Missouri, Stephanie Lynn Graff, MD, FACP was the first in her family to attend college. Because she was drawn to science from a young age, she enrolled in a 6-year medical program right out of high school. As she progressed from medical school to residency to a fellowship, she was fascinated by every aspect of the science of oncology—including cell biology and pharmacology.
Dr. Stephanie Graff is the Director of Breast Oncology at Lifespan Cancer Institute at the Legorreta Cancer Center at Brown University in Providence, Rhode Island. Dr. Graff serves as co-lead of the Breast Cancer Translational Research Disease Working Group at Brown University and is an Assistant Professor of Medicine at the Warren-Alpert School of Medicine. Prior to joining the team at Lifespan/Brown, she was Director of both the Breast Program and Clinical Research at the Sarah Cannon Cancer Institute at HCA Midwest, as well as Associate Director of the Breast Cancer Research Program at Sarah Cannon Research Institute and National Breast Lead for the Sarah Cannon Cancer Network’s clinical programs. In addition, Dr. Graff serves as a medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research.
Dr. Graff is board certified in Medical Oncology, Hematology, and Internal Medicine; and completed a breast oncology sub-fellowship at the University of Kansas. Dr. Graff has broad experience as a Principal Investigator on numerous clinical trials across all phases of drug development, in addition to work in translational research, genomics, and gender bias. In addition to scientific publications, she is an award-winning writer, social media influencer, and sought-after public speaker. Dr. Graff has received the Frist Humanitarian Award for her work in the community and the Benjamin L. Sapers Memorial Award for her “passion for pedagogy, academic rigor, empathy and humanism, with profound feeling for the person as patient.” Dr. Graff currently serves on the American Cancer Society Rhode Island Leadership Council and actively volunteers in the American Society of Clinical Oncology, where she is a 2020 graduate of the prestigious ASCO Leadership Development Program, and now serves on the Joint Certifications Committee and Women In Oncology Work Group. Ultimately, Dr. Graff is passionate about connecting with her patients to provide personalized, comprehensive oncology care, advancing breast cancer research, and breast cancer prevention.