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healthcare system [26] . Another commonly cited barrier is the challenge of presenting
information about clinical trials and eligibility requirements to patients in an easily searchable
and understandable fashion. The Alliance member BreastCancerTrials.org is one resource for
identifying trials patients may be eligible to join. Although this site is considerably user-friendly,
it could provide a more customized user experience. For example, searching would be simpler
if dashboards and search results were provided by tumor type (see Table 3 for an example
for TNBC). In addition, the ability to export search data to other websites frequently visited by
MBC patients would simplify the search process for patients and increase participation in these
clinical trials.

The academic and pharmaceutical industries were also identified by KOLs as barriers to progress
in MBC clinical trials. Specifically, in both academia and the pharmaceutical industry, there is
too much focus on “me-too” drugs—drugs designed to target the same molecules (e.g., PI3K
inhibitors) —rather than focusing on new drugs or drug targets. In addition, academia places too
much emphasis on single investigator/single institution trials. To successfully accelerate MBC
clinical research, these barriers must be broken down and multi-institution, multi-investigator
trials that focus on new drugs or new drug combinations must become the norm. The MBC
Alliance is poised to act on the recommendations of KOLs in this area through its experience
with the TBCRC, which has been collaboratively funded by 3 Alliance members (Breast Cancer
Research Foundation, Komen, and Avon), as well as by leveraging existing relationships with
many of the leading pharmaceutical and biotechnology companies that are active Alliance
partners and members.

Although our study of previously funded research shows that only 7.1% of breast cancer
research investments has been directed towards understanding metastasis, several new
initiatives could quickly begin to fill gaps, including the Ludwig Institute for Cancer Research’s
$540-million investment in 6 centers to fast-track research to bring new treatments for
metastatic cancers [27] , the Breast Cancer Research Foundation’s $27-million Founder’s Fund
with a focus on MBC [28] , and the National Breast Cancer Coalition’s MBC Artemis project [29] .
Breast Cancer Research Foundation raised millions in memory of Evelyn Lauder after her death
in 2011 and is directing the funds to projects focused on understanding the biology of MBC.
Breast Cancer Research Foundation’s Founder’s Fund is coordinating the efforts of leading
clinical and laboratory sites across North America and Europe over a 3-to-5-year period that
started in early 2014 and will include the prospective collection, banking and analysis of primary
and metastatic tumors from 1300 patients.

In conclusion, using publicly available research databases, we have abstracted information
from approximately 2281 funded research grants and 224 clinical trials related to MBC. We have
assembled comprehensive lists of the molecular targets, cellular pathways, and therapeutics
under study for MBC that will enable us to better coordinate, manage, and advocate on behalf
of MBC research.

Our next steps as an Alliance are to understand why these gaps in MBC research exist
and launch new programs to fill these gaps. For example, why are intravasation, arrest and
extravasation, and immune escape understudied? Are there adequate model systems to
study these steps of metastasis? Are there adequate numbers of scientists working on
understanding the multiple steps in the metastatic process? What are the bottlenecks to
further understanding these metastatic processes? Identifying and understanding these gaps
will enable the MBC Alliance to work to effectively advocate for funding to fill them. 55