A Champion in Breast Cancer Research

Edith Perez, M.D., is one of Mayo Clinic's most celebrated physician scientists. She is a highly acclaimed expert in breast cancer research well recognized for her contributions to the field, but perhaps even more important, she is revered by her patients who come from throughout the world for a consult with the doctor they've heard so much about.

Breast cancer is a complex disease consisting of both genetic and environmental influences. More than one million new cases of breast cancer are diagnosed each year worldwide. While a cure remains elusive, discovering new treatments that could have a big impact on the disease is on the horizon and possibly even in hand.

In 2005, Dr. Perez led a clinical trial of the drug Trastuzumab (Herceptin) for use in treating patients with HER2 positive breast cancer, an aggressive form of the disease that affects one in five patients.

Herceptin was originally developed and approved for women with metastatic, or advanced, HER2-positive breast cancer to prevent progress or the spread of the disease. But the clinical trial in 2005 tested Herceptin in women with early-stage HER2-positive breast cancer. The study showed that Herceptin cut in half the risk of recurrence after surgery and improved survival by more than one third.

The study's results were so strong that Dr. Perez and colleagues said that Herceptin would have an immediate impact on the practice. They were right - it did. The drug has since been approved by the Food and Drug Administration for use in treating women with early-stage HER2-positive breast cancer. She described this study as the"most important study I've been involved in, in terms of the impact it has on thousands of women worldwide."

The Herceptin trial is career a milestone for Dr. Perez, a physician described by colleagues as"driven" and"tireless" in her efforts to make significant contributions in breast cancer research. She currently oversees more than 30 clinical trials, including an even larger trial of Hercepin used in combination with a drug called Tykerb, which is the generic name for Lapatinib.

Dr. Perez, a native of Puerto Rico, received her medical degree from the University of Puerto Rico and completed her residency at Loma Linda University Medical Center in California. She served as a fellow in hematology/oncology at Martinez Veterans' Administration Medical Center at the University of California, Davis School of Medicine. Dr. Perez, who has been with Mayo Clinic since 1995, is director of the Multidisciplinary Breast Cancer Program in Jacksonville and is chair of the Breast Disease Oriented Group for the Mayo Clinic Cancer Center. She is the first Mayo physician to serve on the prestigious National Cancer Institute's Board of Scientific Advisors.

Dr. Perez participates on the editorial board of several journals, and has authored more than 150 research articles in journals and books. She is a lecturer at numerous national and international meetings each year.

In 2007, Dr. Perez was named a Mayo Clinic Distinguished Investigator, Mayo's top honor for its investigators. It is an honor she does not take likely.

Q. Having reached Distinguished Investigator status at Mayo is a prestigious honor. What does it mean to you?

A. Humbling. There are many people at Mayo who are well-regarded and whom I hold in high esteem, so to be given this special recognition means a lot to me because I recognize the quality of my colleagues. I'm incredibly honored by this distinction and will continue to try to live up to the honor.

Q. You joined Mayo Clinic in 1995. What was it about Mayo Clinic that convinced you this was the right place to build your research program?

A. I knew before I arrived here that I connected with the Mayo principles. Here I found an environment that is collegial across the entire system, where there is mutual respect for all team members, and where I am able to engage in patient care, education and research. I'm a true believer of the Mayo shields and they're part of my life.

I never had a set goal to be one of the perhaps five best known breast cancer researchers in the world. I just wanted to do something to help patients. It's caught me a little by surprise that the research we do has had such global impact. I just wanted to make a difference. It's gratifying to know that we can help many more patients than just those I see on a day-to-day basis.

Hopefully, I'm not only helping patients, but I'm also advancing science. The methodology of how to do clinical trials and how to do what we call ‘translational studies,' furthers basic science research. My work extends way beyond taking care of patients.

Q. To make the best care available to patients means integrating the collective experience and wisdom gained from Mayo's multi-disciplinary, team approach to patient care, research and education activities. How is this important to your patients?

A. We can assure patients that they will receive the best care because our medical and scientific contacts with researchers and physicians within the Mayo system and elsewhere strengthen our strategies against diseases such as cancer. The world continues to move around us and I want to constantly bring change that will benefit patient care.

Q. You are currently involved in a wide range of clinical trials that explore the use of new therapeutic agents to treat and prevent breast cancer, including one referred to as ALTTO. What is ALTTO?

A. ALTTO stands for "Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization." It is a clinical trial we launched earlier this year that will include 8,000 participants from 50 countries. We will test the use of trastuzumab (Herceptin) and lapatinib (Tykerb) to treat women with the early form of HER2-positive breast cancer. Our goals are to optimize patient outcome and identify potential predictors of benefit. This study will allow us to get closer to the idea of individualized medicine: determine which patients can benefit most from different therapies based on biological markers. Our studies will also help understand biological markers that may predict for likelihood of side effects.

Q. In addition to the huge ALTTO clinical trial, did the 2005 Herceptin trial lead to other interesting follow-up studies?

A. Certainly. I'm currently involved in studies that are trying to understand the molecular basis of response to therapy. Understanding of genetic and protein abnormalities of tumors may help us predict what patient may benefit from what individual therapy. I just got a very favorable review on an NIH grant that will help me get the funds to do these very important analyses.

Q. I suppose that researchers are driven by the endless possibilities of discovery. You, yourself have been described as the epitome of driven. On any given day, you are scheduled with back-to-back meetings with patients, research colleagues, in consult with physicians and much more. And this effort, or rather this drive, has led to important advances in breast cancer research. While you have much ahead of you, how would you sum up your greatest achievement?

A. One of my most memorable moments was in 2005, when we first reported the results of the Herceptin trial as part of a special education session during the American Society of Clinical Oncology Meeting. This was a very meaningful time because it was the time to bring everything home. It was the culmination of years of work -- from developing clinical trials to the data analysis that would ultimately help so many patients.

There were 10,000 people in the audience from all over the world: research collaborators in medical oncology, nursing, technicians, advocates, and even some of my patients. To be able to tell 10,000 people at one time that this treatment works and is now available worldwide – well, I'll tell you, to see the faces of the patients directly affected by the results of this research, it was an amazing day in the lives of many people, including mine.