Illeana Casiano-Vazquez delayed her first mammogram until after she discovered a lump, leading to a diagnosis of triple negative breast cancer. Following chemotherapy and surgery, she was declared free of disease but remained concerned about recurrence, which is a common fear among survivors. About 30 percent of breast cancer survivors will experience relapse, often in other parts of the body, with the highest risk within the first five years.
Angela DeMichele, MD, MSCE, medical oncologist at the Abramson Cancer Center at the University of Pennsylvania, described the uncertainty faced by patients post-treatment: “So often I’d sit with a patient at the end of treatment and they’d ask, ‘How do I know it’s gone?’ I had to tell them I don’t really have a way of knowing. That feels terrible, and it really weighs on patients.” She noted that millions of survivors are worried about recurrence.
Researchers at Penn Medicine are focusing on understanding cancer dormancy—the period when residual cancer cells remain inactive after initial treatment. Lewis Chodosh, MD, PhD, chair of the Department of Cancer Biology at Penn Medicine and associate director of basic science at the Abramson Cancer Center, explained: “There’s this time lag from the end of initial treatment to the point when recurrence happens. The cells have to be there somewhere, but the lag suggests they aren’t actively dividing and growing. We think of this as a sleeper phase, where the cells are sitting in suspended animation, like a bear hibernating in a cave through the winter.”
Chodosh developed mouse models that revealed dormant tumor cells could survive in multiple organs and behave differently from active cancer cells. His team identified pathways supporting these dormant cells and demonstrated that certain medications could eliminate them.
He recalled skepticism early in his research: “The guy said, ‘You’re living in a fantasy world.’ I spent a lot of years trying to convince people that this isn’t crazy.”
Collaboration between clinical and basic researchers has been key at Penn Medicine. In 2014, Chodosh and DeMichele became co-directors of 2-PREVENT (Secondary PREvention through surVEillance and iNTervention) Breast Cancer Translational Center of Excellence (TCE), aiming to change both scientific paradigms and clinical practice.
Ravi Amaravadi, MD, associate director of translational research at the Abramson Cancer Center said: “Our goals with the TCE program are first to change paradigms in science, and then to change practice. And 2-PREVENT is a great example of that. This research is changing the paradigm on dormancy. We’re not quite at practice-changing yet, but that takes time—and the early research is showing high rates of success.”
Proof-of-concept trials have shown dormant cell detection is possible; larger clinical trials are underway.
Funding for this work comes from public sources such as federal grants—including those from agencies like National Institutes of Health—as well as private philanthropy. Philanthropic support has come from individuals including Sara and Jim Gowing; Rhoda Polly Danziger and Michael Danziger; Andrea Orsher VMD and Robert Orsher VMD; Jerry S. Rosenbloom PhD; as well as organizations like Dietz & Watson Family.
DeMichele highlighted why academic centers play an important role: “This research would not be done by a pharmaceutical company because the drugs are off patent,” she said—meaning generics could be available if approved for new uses. “This distinguishes the work we do at Penn and academia as a whole from work done in [the pharmaceutical industry]. We can focus entirely on what is right for current and future patients… Many such studies at Penn and elsewhere are focusing on how to use existing drugs in better ways or how to use biomarkers to identify which patients will benefit from a drug.”
Personal connections also motivate donors like Rosenbloom—whose late wife was treated for breast cancer at Penn—and Andrea and Robert Orsher who lost their daughter Rebecca Kate Orsher Stemplewicz to breast cancer.
Philanthropy has enabled programs such as ACORN (Access Community Outreach & Research Navigation), increasing access to clinical research locally while advancing discovery efforts aimed at detecting microscopic residual tumor cells.
Penn Medicine researchers continue their efforts toward reducing breast cancer recurrence risks through collaborative science supported by public funding sources https://www.nih.gov/ as well as private donations.
