Groundbreaking treatment tool being developed for male breast cancer diagnosis

Doctors diagnosed Christopher Gregg, Ph.D., member of the Nuclear Control of Cell Growth and Differentiation Program at Huntsman Cancer Institute at the University of Utah (the U) and neuroscientist and professor of neurobiology and human genetics at the U, with stage 4 metastatic breast cancer in 2018. At that point, he started thinking of ways to improve his treatment.

"The core problem of metastatic cancer is it evolves," says Gregg. "There may be a treatment that works today but eventually the disease will become resistant over time." He sought to solve this with a groundbreaking approach called extinction therapy.

Though breast cancer rates for men are much lower than women, the American Cancer Society (ACS) estimates that in 2023, about 2,800 men in the United States will be diagnosed with breast cancer and 530 men will die from the disease. Many are diagnosed when the disease has progressed to later stages because it is so rare. Most patients who have metastatic cancer receive palliative care, which does not attempt to cure the disease, but instead focuses on providing relief from the symptoms.

Gregg wanted to save lives so he pursued a career in cancer research. He co-lead the winning team at this year's 11^th annual Moffitt Cancer Center Integrated Mathematical Oncology (IMO) workshop. At this annual event, where leading thinkers from around the world develop new innovations in cancer care, Gregg and his team created a tool to help oncologists decide the right treatment path for patients with metastatic cancer.

On the first day we decided to make a tool that would help oncologists determine the right medication dose and treatment for each individual patient, giving them both the best chance at eliminating the cancer and the best quality of life. One of the biggest challenges for cancer treatment is that the drugs are toxic, so not only do we need to factor in the disease response but also how much of the medication their body can handle for a specific amount of time."

Christopher Gregg, Ph.D., member of the Nuclear Control of Cell Growth and Differentiation Program at Huntsman Cancer Institute at the University of Utah

Working around the clock, Gregg's team used data from his own breast cancer treatment to create a prototype. They created an algorithm that uses artificial intelligence to accurately measure patient symptoms detected from vocal and behavioral information captured via smartphone. This allowed them to precisely measure how a patient is doing during their treatments. Based on their symptoms, the algorithm predicts changes to future symptoms. Oncologists will then be able to adjust treatments to help avoid drug toxicity and dangerous side effects, ultimately designing the best plan for each patient.

With a $50,000 grant from the IMO workshop, Gregg and his team will continue to develop the tool, using it in a clinical trial at the Moffitt Cancer Center starting January 2024.

"When I was diagnosed, I asked my oncologist at Huntsman Cancer Institute, if there were any exciting new treatments that could be curative," says Gregg. "She said after a long career in oncology, she's seen many ideas and new medicines that didn't turn out to be curative. She thought the solution would come from learning how to use the medications we already have in a better way. I started to shift my attention that way."

Gregg identified ways to help with metastatic cancer. After finding a promising study, he asked the researchers to come to a symposium at Huntsman Cancer Institute. There, they all worked together to come up with Gregg's first treatment plan, extinction therapy.

Gregg explains that typical care for metastatic patients calls for treatment with medication and if there's a good response, clinicians give it regularly. However, over time the cancer inevitably evolves and develops resistance to the treatment. Once that happens, doctors introduce a new medication. Extinction therapy introduces new medication before the cancer develops resistance, striking the disease before it progresses. Gregg refers to this as a treatment resistance management plan and believes that these will become standard practice and improve metastatic cancer care.

"My team at the Moffitt Cancer Center competition included 20 diverse experts from around the world. Expert mathematicians, researchers, software developers, and clinicians worked together to create a solution for metastatic cancer care. The amazing thing about this workshop is that it creates an environment that fosters collaboration between those who may not usually work together," Gregg says.

Since Gregg's diagnosis in 2018, he and his oncologist have been able to effectively manage treatment resistance in his care. Gregg and his care team continue to work on preventing the development of resistance.

"I'm doing really well right now. I've continued to innovate and come up with ideas to control the disease," Gregg says. "I've been off treatment for many months at a time and successfully been able to keep the disease stable. My goal is turning metastatic cancer, which is currently a lethal disease, into a manageable chronic disease that offers patients a high quality of life for a long time."

This research was supported by the National Institutes of Health and National Cancer Institute including P30 CA042014, U54 CA274507, the Moffitt Center of Excellence for Evolutionary Therapy, Storyline Health Inc., and Huntsman Cancer Foundation.