Gretchen Kimmick

Overview:

Breast cancer; treatment of breast cancer; management of menopausal symptoms in breast cancer survivors; survivorship issues after breast cancer; supportive care in managment of cancer patients; breast cancer and treatment of cancer in older persons; diagnosis and management of cancer in underserved populations.

Positions:

Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1989

Wake Forest University

M.S. 2000

Wake Forest University

Medical Resident, Medicine

University of Florida

Fellow in Oncology, Medicine

North Carolina Baptist Hospital

Grants:

A Phase II Study of Neratinib in Metastatic HER2 Non-amplified by HER2 Mutant Breast Cancer

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Publications:

The Evolving Complexity of Treating Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2 (HER2)-Negative Breast Cancer: Special Considerations in Older Breast Cancer Patients-Part I: Early-Stage Disease.

The median age for breast cancer diagnosis is 62 years, but a disproportionate number of patients are over the age of 75 years and the majority of those have hormone receptor-positive, human epidermal growth factor receptor-2 (HER2)-negative cancers. This review provides a logical algorithm to guide providers through the many complicated issues involved in adjuvant systemic therapy decisions in older patients with hormone receptor-positive, HER2-negative breast cancer. For this subtype of breast cancer, the mainstay of treatment is surgery and adjuvant endocrine therapy with tamoxifen or an aromatase inhibitor (AI). Adjuvant chemotherapy is added to the treatment regimen when the benefits of treatment are deemed to outweigh the risks, making the risk-benefit discussion particularly important in older women. Traditional tools for cancer risk assessment and genomic expression profiles (GEPs) are under-utilized in older patients, but yield equally useful information about cancer prognosis as they do in younger patients. Additionally, there are tools that estimate life-limiting toxicity risk from chemotherapy and life expectancy, which are both important issues in the risk-benefit discussion. For very low-risk cancers, such as non-invasive and small lymph node (LN)-negative cancers, the benefits of any adjuvant therapy is likely outweighed by the risks, but endocrine therapy might be considered to prevent future new breast cancers. For invasive tumors that are > 5 mm (T1b or larger) or involve LNs, adjuvant endocrine therapy is recommended. Generally, AIs should be included, though tamoxifen is effective and should be offered when AIs are not tolerated. Bone-preserving agents and high-dose vitamin D are options to preserve bone density or treat osteoporosis, especially in older women who are taking AIs. Where the risk-reducing benefit from adjuvant chemotherapy outweighs the toxicity risk, adjuvant chemotherapy should be considered. Adjuvant chemotherapy has similar benefits in older and younger patients and standard regimens are preferred. Several exciting clinic trials are underway and have included older patients, including those adding molecularly targeted agents, cyclin-dependent kinase (CDK) 4/6 inhibitors and everolimus, to endocrine therapy in the adjuvant setting. The high incidence of breast cancer in older women should drive us to design clinical trials for this population and emphasize their inclusion in ongoing trials as much as possible.
Authors
Sammons, S; Sedrak, MS; Kimmick, GG
URI
https://scholars.duke.edu/individual/pub1433298
PMID
32100240
Source
pubmed
Published In
Drugs Aging
Volume
37
Published Date
Start Page
331
End Page
348
DOI
10.1007/s40266-020-00748-z

Abstract P6-08-05: Changes in Cognitive Function in Older Women With Breast Cancer Treated with Standard Chemotherapy and Capecitabine within CALGB 49907

Authors
Freedman, RA; Pitcher, B; Keating, NL; Barry, WT; Ballman, KV; Kornblith, A; Mandelblatt, J; Kimmick, GG; Hurria, A; Winer, EP; Hudis, CA; Cohen, HJ; Muss, HB
MLA Citation
Freedman, R. A., et al. “Abstract P6-08-05: Changes in Cognitive Function in Older Women With Breast Cancer Treated with Standard Chemotherapy and Capecitabine within CALGB 49907.” Poster Session Abstracts, American Association for Cancer Research, 2012. Crossref, doi:10.1158/0008-5472.sabcs12-p6-08-05.
URI
https://scholars.duke.edu/individual/pub1149581
Source
crossref
Published In
Poster Session Abstracts
Published Date
DOI
10.1158/0008-5472.sabcs12-p6-08-05

Different risk factors for mortality in younger and older women after breast-conserving surgery.

Authors
Kimmick, GG; Camacho, F; Hwang, W; Mackley, HB; Stewart, JH; Anderson, RT
MLA Citation
Kimmick, G. G., et al. “Different risk factors for mortality in younger and older women after breast-conserving surgery.Journal of Clinical Oncology, vol. 29, no. 15_suppl, American Society of Clinical Oncology (ASCO), 2011, pp. 6017–6017. Crossref, doi:10.1200/jco.2011.29.15_suppl.6017.
URI
https://scholars.duke.edu/individual/pub1031152
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
29
Published Date
Start Page
6017
End Page
6017
DOI
10.1200/jco.2011.29.15_suppl.6017

The Evolving Complexity of Treating Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2 (HER2)-Negative Breast Cancer: Special Considerations in Older Breast Cancer Patients-Part II: Metastatic Disease.

Breast cancer is a disease of aging, and the incidence of breast cancer is projected to increase dramatically as the global population ages. The majority of breast cancers that occur in older adults are hormone-receptor positive, human epidermal growth factor receptor-2 (HER2)-negative phenotypes, with favorable tumor biology; yet, because of underrepresentation in clinical trials, less evidence is available to guide the complex care for this population. Providing care for older patients with metastatic breast cancer, with coexisting medical conditions, increased risk of treatment toxicity, and frailty, remains a clinical challenge in oncology. In this review, we provide an overview of the current evidence from clinical trials and subanalyses of older adults with hormone receptor-positive, HER2-negative metastatic breast cancer, highlighting data on the safety and efficacy of oral therapies, including endocrine therapy alone or in combination with cyclin-dependent kinase (CDK) 4/6 inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, and mammalian target of rapamycin (mTOR) inhibitors. In addition, we note the significant underrepresentation of older and frail adults in these studies. Current and future directions in research for this special population, in order to address significant knowledge gaps, include the need to improve long-term adherence to hormonal and targeted therapy, prospective clinical trials that capture clinical and biological aging endpoints, and the need for a multidisciplinary approach with integration of geriatric and oncology principles.
Authors
Hill, A; Gutierrez, E; Liu, J; Sammons, S; Kimmick, G; Sedrak, MS
URI
https://scholars.duke.edu/individual/pub1437063
PMID
32227289
Source
pubmed
Published In
Drugs Aging
Volume
37
Published Date
Start Page
349
End Page
358
DOI
10.1007/s40266-020-00758-x

Improving health engagement and lifestyle management for breast cancer survivors with diabetes.

Breast cancer survivors with type 2 diabetes are at high risk for cancer recurrence, serious health complications, more severe symptoms, psychological distress, and premature death relative to breast cancer survivors without diabetes. Maintaining glycemic control is critical for decreasing symptoms and preventing serious health problems. Many breast cancer survivors with type 2 diabetes have difficulty maintaining diabetes self-management behaviors and achieving glycemic control. Both cancer and diabetes-related symptoms (e.g., physical symptoms and psychological distress) are often barriers to engaging in diabetes self-management strategies. This study evaluates a novel diabetes coping skills training (DCST) intervention for improving breast cancer survivors' abilities to manage symptoms and adhere to recommended diabetes self-management behaviors. The telephone-based DCST protocol integrates three key theory-based strategies: coping skills training for managing symptoms, adherence skills training, and healthy lifestyle skills training. A randomized clinical trial will test the DCST intervention plus diabetes education by comparing it to diabetes education alone. Symptoms, distress, diabetes self-management behaviors, and self-efficacy will be assessed at baseline and 3, 6, and 12 months. Glycosylated hemoglobin (HbA1c) will be assessed at baseline, 6, and 12 months. This study addresses a critical gap in the care of breast cancer survivors by evaluating a novel behavioral intervention to improve the management of symptoms, adherence, and glycemic control in breast cancer survivors with type 2 diabetes. Special considerations for this medically underserved population are also provided. The findings of this study could lead to significant improvements in clinical care and beneficial outcomes for breast cancer survivors. Trials registration: ClinicalTrials.gov, NCT02970344, registered 11/22/2016.
Authors
Shelby, RA; Dorfman, CS; Arthur, SS; Bosworth, HB; Corsino, L; Sutton, L; Owen, L; Erkanli, A; Keefe, F; Corbett, C; Kimmick, G
MLA Citation
Shelby, Rebecca A., et al. “Improving health engagement and lifestyle management for breast cancer survivors with diabetes.Contemp Clin Trials, vol. 92, May 2020, p. 105998. Pubmed, doi:10.1016/j.cct.2020.105998.
URI
https://scholars.duke.edu/individual/pub1437949
PMID
32289471
Source
pubmed
Published In
Contemp Clin Trials
Volume
92
Published Date
Start Page
105998
DOI
10.1016/j.cct.2020.105998