Advancements
New Breakthroughs on the Horizon for Women With Breast Cancer
Women with advanced metastatic breast cancer can expect to live longer than ever before, and cancer survivors may not require as many follow-up imaging tests. This is just some of the good news presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in June 2007.
The meeting’s theme, “Translating Research Into Practice,” underscored the important connection between clinical research and how it ultimately can be used to treat patients in new and effective ways.
Stefan Glück, M.D., Ph.D., a professor of medicine at the Miller School of Medicine at the University of Miami, attended the meeting and shares the following highlights from the world of breast cancer research.
Improve survival time. Researchers at the University of San Francisco (USF) have found that a new drug called axinitib may enhance the therapeutic effects of chemotherapy for women with advanced breast cancer. Axinitib is an anti-angiogenesis drug and works by preventing the creation of new blood vessels that feed the tumor. When given with chemotherapy, axinitib has shown encouraging results and promising data.
Research into practice. In phase 2 clinical trials, axinitib increased the effectiveness of chemotherapy anywhere from 23 percent to 40 percent. If this combination (once approved by the Food and Drug Administration) becomes a part of palliative care treatment, women with metastatic breast cancer may survive longer and enjoy a better quality of life.
Cut down on scans. Currently, women who have had treatment for breast cancer will undergo numerous scans in an effort to detect any return of the disease — and researchers want to know if there may be a better way. Searching for tumor markers may be one potential method. Doctors already monitor certain types of cancers by sampling blood from a tumor and looking for cancer cells. (Prostate specific antigen, or PSA, for example, is a well-known tumor marker for prostate cancer.) But because there are multiple tumor markers for breast cancer that are not very reliable, researchers are at work on studies that test the cell search system. Using a blood sample, doctors can search for cells that are not usually found in the bloodstream. These cells are then stained and evaluated to see if they are cancer cells.
Research into practice. Much like the way a PSA test looks for prostate cancer, tests for breast cancer may replace some of the many scans that women now receive as part of their post-cancer care. Women wouldn’t need to spend as much time undergoing lengthy scans. In addition, fewer costly scans may mean fewer potential problems between patients and health insurers, and patients’ co-payments would likely be lower.
Measure the effectiveness of Herceptin. When a doctor wanted to gauge the effectiveness of Herceptin (trastuzumab), conventional wisdom suggested that he or she look at the patient’s genes for clues. Gene changes that showed the presence of cancer cells were thought to be the most accurate measure. But Soonmyung Paik, M.D., of the National Surgical Adjuvant Breast and Bowel Project (NSABP) in Pennsylvania, was more interested in the protein on the cells and what that might reveal. Paik’s work showed that the protein measurement is far more important when evaluating Herceptin’s benefits.
Research into practice. By studying protein on the cells rather than the changes of the genes in cells themselves, doctors may be able to fine-tune their evaluation of Herceptin’s benefits. This may lead to better outcomes for women who have finished successful treatment for breast cancer and are taking Herceptin to help prevent the cancer from returning.
Look for changes when breast cancer recurs. A recurrence of breast cancer may bring with it unanticipated changes: Several studies have determined that when the disease returns, between 5 percent and 15 percent of tumors are different than at the time they were first diagnosed. For example, estrogen-receptor-positive cancers may have developed into negative ones, or human epidermal growth factor receptor 2-negative (HER2-negative) cancers may have evolved into the positive type. These changes can translate into critical differences in the way the cancer should be treated.
Research into practice. In the future, biopsies of the new tumor may demonstrate whether or not the cancer has changed and help doctors determine the best way to move forward. This may increase a woman’s chances of having successful treatment and improve her likelihood of survival.
Lower the risk of heart problems. Although the combination of post-treatment chemotherapy and the drug Herceptin lowers a woman’s chances of breast cancer recurrence by 50 percent more than chemotherapy alone, the treatment is not without risks. Herceptin can cause heart problems, and although some women do not experience side effects, up to one in five are unable to finish the treatment due to complications. In addition, a commonly used class of chemotherapy drugs called anthracyclines can cause the same side effects — meaning a chemotherapy regimen containing this drug cannot be combined with Herceptin. Researchers, however, have made strides in testing chemotherapy combinations that don’t contain anthracyclines and hope to continue to develop these new therapies.
Research into practice. Women who take Herceptin and receive chemotherapy that doesn’t contain anthracyclines will benefit from the treatment but won’t be doubly at risk for heart problems.
Reviewed by: Val Jones, M.D.
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