Memorial Sloan Kettering Cancer Center

A growing problem facing cancer patients today is metastatic disease, especially metastases to the central nervous system (CNS). As things stand today, we have large knowledge gaps in understanding why some breast cancer becomes metastatic to the CNS and how we can effectively identify CNS disease earlier. CNS disease is a serious complication of cancer and a major cause of death and well as disability. Breast cancer is the second most common cancer to spread to the CNS. Over time, this problem has been growing and we see more patients now with CNS disease than ever before. Today, this disease is typically found once patients become symptomatic and we are left to react.

Part of this devasting problem, is that our understanding of why this disease occurs is lacking. In turn, this limits our ability to develop more effective treatments. Through this study, we aim to change this. We propose to create a novel approach to screening for disease in the brain and allow for the understanding of why CNS disease forms. If we can detect cancer earlier, then we have earlier opportunities for treatment. By starting treatment earlier, we may be able to more positively impact how long patients survive and their quality of life.

Novel techniques have been developed to investigate the CNS through methods that avoid a surgical procedure such as a biopsy. These novel techniques including evaluating cerebrospinal fluid (CSF) for circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). CTCs are cells which have been shed from the primary tumor and ctDNA is shedding of DNA from the primary tumor. We propose the use of these novel techniques as a form of liquid biopsy in search of a biomarker to diagnose BM earlier in patients with breast cancer and also to understand how CNS metastases form.

Dr. Malani received her medical degree from University of Sheffield Medical School and completed her neurology residency at SUNY Downstate. She then did her fellowship at Memorial Sloan Kettering Cancer Center in Neuro-Oncology where she was able to undertake research in CNS metastases, including studying CSF-CTCs in patients with CNS metastases. Upon completing her fellowship in 2016, she transitioned to faculty at Memorial Sloan Kettering Cancer Center as an Assistant Attending. She focuses on taking care of patients with CNS metastases in her clinic and also undertakes clinical research in this disease area as well aimed at the understanding of disease formation in the hopes of developing better treatments.