Racing Against Breast Cancer: A Conversation With Edith A. Perez, MD

OncologyLive, August 2011, Volume 12, Issue 8

It's hard to tell which moves more quickly: Edith Perez's feet, or her mind.

Edith A. Perez, MD

It’s hard to tell which moves more quickly: Edith Perez’s feet, or her mind.

A devoted runner, Edith A. Perez, MD, strides along the beaches of northern Florida whenever she gets the chance. A translational researcher who spends her time designing clinical trials of potential breast cancer treatments and studying the biology of the disease, Perez maintains the same swift pace as she travels the globe, interspersing projects at her home base, the Mayo Clinic in Jacksonville, with frequent trips to speak and consult.

Luckily, Perez is able to apply her mind just as nimbly to solving problems in breast cancer treatment. Rotating her sharp focus through the broad range of tasks that make up her typical day is a joy for the 55-year-old scientist who loves to read about any subject, is a whiz at math, and completed high school in 2 years and college in 3 years.

“My brain works fast,” said Perez. “It’s nice to be able to work for an hour, come up with something, then do something else, and something else. I enjoy that.”

The doctor’s intellectual appetite has made a marked difference for patients with breast cancer everywhere. Every day, she puts her mind to finding better treatments for the disease and conducting research that will help others in the oncology community move forward with science aimed at improving people’s lives.

Much of her work has concentrated on the study of compounds designed to fight HER2-positive breast cancer, leading to a 2005 discovery that changed the way the disease is treated. A study that Perez led and helped design showed that the use of Herceptin (trastuzumab), a monoclonal antibody that helps counteract a genetic mutation of the HER2 gene, in concert with chemotherapy—rather than chemotherapy alone—resulted in a 52% decrease in the recurrence of HER2- positive breast cancer in patients who had undergone surgery for the condition, and improved their survival by 33%.

“We presented those data at the largest meeting ever of the American Society of Clinical Oncology, with about 16,000 people in attendance— people who had been involved in funding and some of my patients who were in the trial,” Perez recalled. “I realized that not too many physicians have the opportunity to affect that many lives to this degree, no matter how dedicated they are or how incredibly good their ideas. It was humbling, actually.”

Using tumor and blood samples collected during the study, Perez and her colleagues have continued to consider the potential applications of Herceptin. In May, the doctor presented results demonstrating that the therapy works for P10-postive or P10-negative patients whose tumors do not express the HER2 protein.

Perez also is proud of a study she concluded 7 months earlier. The study of trastuzumab-DM1, or T-DM1, a drug antibody conjugate that combines chemotherapy agent docetaxel with Herceptin, demonstrated that the conjugate is half as toxic as the same drugs given separately to patients with HER2- positive metastatic breast cancer who had not received prior chemotherapy for metastatic disease.

“I routinely explore things that I hope will be more efficacious and lower toxicity,” Perez said, “because that’s huge for people’s lives.”

Many Roles at Mayo Clinic

The doctor accomplishes that through a variety of roles at the Mayo Clinic. For more than a year, she has served as deputy director of the Mayo Clinic Cancer Center, and also is director of the institution’s Breast Program and chair of its Breast Disease Oriented Group, which brings together researchers from all Mayo Clinic sites to review research opportunities related to breast cancer prevention, treatment, and survivorship.

She is a Serene M. and Frances C. Durling Professor of Medicine at the Mayo Medical School; the first Mayo physician to serve on the Board of Scientific Advisors of the National Cancer Institute (NCI); and, in 2007, was given her institution’s top honor for investigators when she was named a Mayo Clinic Distinguished Investigator. She chairs the Breast Committee for the North Central Cancer Treatment Group, sponsored by the NCI.

Finally, an annual marathon Perez helped to launch has led to the creation in January 2009—and continued funding—of Mayo’s Breast Cancer Translational Genomics Program, which aims to unravel, categorize, and catalog all the mutations present in breast cancer. The goals of the work include gaining a better understanding of what drives the disease’s growth, learning what may predict sensitivity or resistance to different treatments, and identifying targets that can be used to develop new treatments, Perez said.

Edith A. Perez, MD, At a Glance

  • Claims The Little Prince as a favorite book because it involves “someone looking at the world, experiencing new places, talking to people, getting insight, and having a positive outlook.”
  • Enjoys the movie Up Close and Personal because it’s also “a beautiful story about being positive. The main character was positive about herself and her potential through work.”
  • Has a favorite saying: “Being lucky means being ready when the opportunity arises.”
  • Spent 2 months exploring England between her first and second years of medical school, paying for the trip by working as a maid at a 5-star hotel.
  • During medical school, played on her university’s tennis team.
  • Since 1998, has been receiving grant funding from the Breast Cancer Research Foundation originated by Evelyn Lauder, who has served as senior corporate vice president of the Estée Lauder Companies. She describes Evelyn Lauder as a “renaissance woman.”
  • Is “very respectful of the contribution of other people” to her work and her field. “You need teams to be able to implement ideas,” she said.
  • Is proud to have earned an honorary doctorate of letters from the University of North Florida, among other awards.
  • In donating to cancer research, thinks it’s often more constructive to give to an existing nonprofit than to start a new charity in a loved one’s memory.
  • Has published 550 research articles in journals and books, and abstracts.

Research Part of Hectic Pace

Her myriad roles make for a whirlwind schedule of 10-hour days.

In addition to her clinical trial work, Perez’s schedule includes organizing, attending, and speaking at meetings all over the globe; participating in conference calls; conducting grant reviews on behalf of the National Institutes of Health (NIH); advising scientists and companies throughout the world on studies, research, and patient care; writing manuscripts; mentoring younger scientists; and making videos for YouTube to explain her current research.

Perez also heads Mayo teams in conducting basic research projects funded by the NIH, including one focused around tissue biomarkers for responsiveness to adjuvant trastuzumab and another aimed at understanding the role of the immune system in response to anti-HER2 therapy—trastuzumab and lapatinib (Tykerb)—in adjuvant and metastatic settings. In large part, the projects involve analyzing the proteins and genes in tissue and blood specimens and correlating them with patient outcomes.

“My work doesn’t feel like a lot of sacrifice. It’s what I can do best,” Perez said. “Although I would like more hours to play tennis, run on the beach, read, be with good friends, and volunteer my time, it’s not a sacrifice at all.”

Perez also manages to find time to see breast cancer patients, including 3 who periodically return for follow-up care, and new patients who are seeking second opinions about diagnoses.

Seeing patients on a regular basis would be difficult, Perez said, due to her travel schedule. Those she has treated, though, remain fixed in the doctor’s memory.

“Some of their stories are really amazing,” Perez said. “I just respect what they have to go through, because most of them thought they were healthy until, one day, this happened to them.”

The doctor was moved recently when she received an email from the husband of a deceased patient. “She died before Herceptin was available, and I thought, ‘If she had lived a few more months, we would have had this,’” Perez recalled. “This kind of thing has served as my inspiration all these years. Whenever I see a patient, I wonder, ‘Is this the patient I’m going to help next?’”

From Beach to Bench to Bedside

Florida Marathon Supports Genomics Program

For Edith Perez, MD, running is an opportunity to exercise, clear her mind, and think about her work.

For the oncology community, the hobby is a lucky break.

Without it, the translational researcher might never have helped found 26.2 with Donna, the National Marathon to Finish Breast Cancer, which in turn led to the creation—and continued funding—of Mayo’s Breast Cancer Translational Genomics Program. Under Perez’s direction, the Genomics Program aims to unravel, categorize, and catalog all the mutations present in breast cancer.

Seventy percent of the marathon’s proceeds go to the Genomics Program, with the remaining 30% helping to pay the living expenses of local patients who are unable to work because they are undergoing treatment for breast cancer. So far, the run has raised $2.5 million and helped pay the expenses of 4500 patients.

“The marathon is an event for everybody to get healthier and to get others healthier while doing some fundraising for two tremendously important causes: research and helping underserved women while they go through breast cancer treatment,” Perez said. “We’re looking for advances for the future, so everybody should be part of this run/walk event.”

Perez came up with the idea for the annual marathon in collaboration with her patient, friend, and running buddy Donna Deegan, a Florida television news anchor who serves as coordinator of the run that launched in 2008.

Perez runs in the marathon every year, and is involved in its planning and organization. She is proud of what it has accomplished on the research front, describing the Genomics project—which is now also supported by additional grants—as “a model for how to develop and perform translational research here at Mayo Clinic.”

“The Genomics project involves 20 people at different levels: a fantastic team of basic researchers, bioinformatics specialists, biostatisticians, and lab technicians,” Perez said. “Specifically, we intend to identify every genomic abnormality in tumors and develop therapeutic strategies based on the full range of genomic abnormalities, beyond just estrogen receptor, progesterone receptor, and HER2.

“The goals of our program also include utilization of these genomic technologies to serve as infrastructure for investigators here at Mayo Clinic to conduct translational research related to breast cancer as well as pancreatic, lung, thyroid, renal, and colon cancer, amongst others,” she said.

As of the close of 2010, Perez wrote in a progress report, the Genomics Program had already seen success.

Hundreds of people run through beachfront communities near the Mayo Clinic in Florida during the 26-mile marathon to raise funds for cancer research.

The program had “completed total messenger RNA sequencing of 24 primary breast tumors, 8 nontransformed human breast epithelial cells, 8 pairs of tumor-normal pancreatic tumors, and 15 lung cancers,” Perez wrote at the time, and had “a manuscript published, one submitted, and two in preparation.”

Looking ahead, Perez expects the Genomics Program to use its findings to identify new biomarkers and therapeutic targets in triple-negative, HER2- positive, and estrogen-receptor-positive breast cancer; identify risk factors and predictors of breast cancer; shed light on the reasons drugs do not work for some patients; and begin translational clinical trials.

“The financial support from the 26.2 with Donna foundation has made this program possible,” Perez wrote. “We look forward to continued, careful stewardship of the money in the context of our visionary strategy.”

Inspired by Loved One’s Death

It was a similar thought that inspired Perez to study medicine. She was a freshman in college when her grandmother died suddenly.

“I thought, ‘If I had been a doctor, I could have helped her,’” Perez recalled.

Growing up on the east coast of Puerto Rico, close to the beach and the rainforest, Perez exhibited all the skills she would later need to pursue a medical degree.

“I really enjoyed science very early in my life, although I was going to be a mathematician, not a physician,” she said. “I was really good at math, which I got from my father. Even when I was in college, I took a calculus class, and in the whole semester, I missed one question in one test. I could see the solutions easily.”

By the time Perez was an intern, she was considering a specialty in breast cancer.

“I thought it was interesting because it was evolving and complex, it had to do with people, and I realized that someone who liked to read could do well,” she said. “I thought I could be doing this for a while, and I was right.”

The child of a father who owned a grocery store and a mother who was a teacher-turned-librarian, Perez started school early, advanced an extra year during high school and graduated in 2 years, and, at 16, enrolled as a premed student at the University of Puerto Rico, Rio Piedras, where she earned a bachelor of science degree in biology 3 years later.

Perez stayed at the university to earn her medical degree, and then completed her residency in internal medicine at Loma Linda University Medical Center in California. Having decided to pursue oncology, Perez began a fellowship in hematology and oncology at the Martinez Veterans Administration Medical Center, School of Medicine, University of California, Davis. There, she did work related to lung cancer, and began to explore breast cancer.

Then, one evening in 1995, a phone call altered her path to the top of that field.

“I got a call asking if I’d be interested in transferring to the Mayo Clinic,” she said. “I was extremely happy, and I accepted the opportunity. I was very fortunate because it’s a great institution.”

New Compounds in Focus

Before moving to Mayo’s facility in Jacksonville, Perez spent 6 months working at the institution’s Rochester, Minnesota, location, where she devoted mornings to lab research and afternoons to patients.

In Mayo’s lab, her focus was “combinatorial chemistry,” Perez recalled, “treating cancer cells with different medicines or new compounds and seeing how you can best kill tumor cells—is it best to combine medicines or use one? These are ideas I carry today when I do lab bench work that can be translated into clinical trials.”

Since moving to Jacksonville, Perez has bolstered Mayo’s breast cancer program by attracting continuous grant funding from Evelyn Lauder’s Breast Cancer Research Foundation, becoming a founder of the genomics center, and helping to make numerous discoveries about the mechanisms of the disease.

For instance, “many people thought that the more copies a patient had of the HER2 gene, the better their response would be to Herceptin,” Perez said. “But we found that, up to a threshold, more copies of the gene didn’t make for a better outcome.”

In addition to the work Perez has done to help test anti-HER2 agents and other cancer drugs, she is contributing to studies of newer investigational compounds that may help patients who have breast cancer.

“The compounds have no names yet, just numbers,” Perez said. “I’m really excited about being involved in their development.”

Perez is proud of the progress she has made during her time at Mayo, and she is eager to build on it.

“I love what I do, and I want to do more,” the doctor said. “These days, I’m much more productive than I ever was, and I’m having more fun than ever. It’s all very interesting to try to put together.”

One thing Perez hopes she’s accomplished is to use her positivity to inspire others to help fight breast cancer.

“Most important is to get other people to understand that things are getting better, and that it’s worthwhile for them to join the effort,” she said. “I want people who are scientists and mathematicians to be involved with us, and for the lay public to understand that if we continue working together, things will get better quicker. That can include donations of funding, or the willingness of patients to participate in clinical trials or allow us to use their tumor specimens to test for proteins and genes so we can optimize our understanding of cancer.”

“I want people to know,” she said, “that we are committed to having a better future related to the understand ing of cancer.”

Beth Fand Incollingo is a New Jersey-based writer and editor, and owner of the communications firm Texterity, LLC.