As a medical oncologist, Dr. Mark Kozloff has been taking care of people with cancer for more than 35 years. He is medical director of oncology for Ingalls Health System and a clinical associate professor at University of Chicago Medicine focused on attacking the disease while helping patients live as normal and productive lives as possible.
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But another big part of his mission is research. Currently, Ingalls is one of a handful of Illinois hospitals participating in a large-scale clinical trial to determine whether a common and inexpensive diabetes drug, metformin, may be the next new weapon in the fight against breast cancer.
Findings from the five-year study, sponsored by the National Cancer Institute, could be available in 2016, according to Bloomberg News. We talked to Kozloff about his work.
Q: Metformin is taken daily by millions of Americans to help them control their blood sugar. How did it come to be connected to breast cancer?
A: In the past, researchers have found that diabetics taking metformin were less likely to develop cancer. There’s no study proving it … so this study would make a more definitive statement on the benefits of the drug … but more studies would be needed.
Q: Who is eligible for the study?
A: Nondiabetic women younger than 75 who have been diagnosed with early-stage breast cancer in the last 12 months. A woman would be randomly assigned metformin or a placebo … the doctor doesn’t choose. A patient can still be on standard treatment — like radiation — while participating in the trial.
Q: In layman’s terms, can you explain how it might work?
A: Another earlier study showed that diabetics with breast cancer responded more favorably to breast cancer therapies given before surgery. The researchers think (metformin) might act against breast cancer by working directly on the cancer cells — that by lowering insulin levels you decrease enzymes in the cell, which, in turn, decrease growth and proliferation of the breast cancer cells.
That’s where almost all the research is right now … finding something abnormal about the cancer cells, then target that abnormality, to increase benefits and decrease the toxicity. At Ingalls, we’re involved in more than 40 studies that specifically look at what’s different about the cancer cell vs. the normal cell — then target that abnormality with treatment. The researchers think it might act against breast cancer by working directly on the cancer cells — that by lowering insulin levels you decrease enzymes in the cell, which, in turn, decrease growth and proliferation of the breast cancer cells.
Q: Do you find it incredible that something so common and cheap could be the key to a big breakthrough?
A: I would not want to mislead by saying this is a “big breakthrough” or a “cure” for breast cancer. But it is a very exciting new idea that may be promising in the prevention of breast cancer recurrence.
Q: I’ve read that metformin research was hampered by a lack of money for clinical trials — that pharmaceutical companies have little financial incentive to fund or conduct studies on generics like metformin. Your thoughts?
A: There’s no question that funding has taken a hit … certainly, the contracting economy has played a part but we also need to spend our money more wisely. We all know that cancer treatment can be costly. Any time we can find an intervention or therapy to help prevent the cancer from recurring not only benefits the individual but also helps to decrease the cost of health care overall. That is why the cost of doing these research studies could potentially be well worth the investment
Q: If you’ve received a cancer diagnosis, who is a candidate for a clinical trial? Some people think it’s only for those at end stage.
A: Clinical trials are a treatment option and can vary from the earliest stages to later. Trials are very thoughtfully conceived and aimed at helping people do better, increase cure rates and help find new drugs. They’re always done with the knowledge that the potential benefits will outweigh the potential side effects.
Q: I am sure people think your work is sad. What would you want them to know?
A: To watch a drug help someone significantly and do well over time, there’s nothing finer. I’ve seen young people get engaged … raise families. It’s very uplifting.
Q: How about when things don’t go so well?
A: Even when the outcomes were horrible, I’ve had families write letters and say the nicest things … and that’s very positive reinforcement because it can become depressing. But if you can help someone live longer and better, you can walk away with your head held high.
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