Less Toxic, More Targeted Treatments for Breast Cancer
are Saving Lives

Every patient wants to hear a hopeful prognosis from their doctor once they’ve been diagnosed with breast cancer. The good news is that we’ve come a long way from the one-size-fits-all treatment plan of radical surgery and severe regimens of chemotherapy.

In the past decade breast cancer therapies have become much more tailored for the patient’s specific cancer. Treatments are less invasive and the prognosis for living a healthy, productive, cancer-free life is increasingly higher.

In general, cancer therapies have become more targeted to the individual tumor’s characteristics and behavior. Therapies are more localized, more effective and less harmful. Even chemotherapy is being prescribed in smaller, more frequent doses instead of large, periodic ones.

Unlike chemotherapy, which attacks most dividing cells with potentially debilitating side affects, the new generation of less invasive, more targeted agents are preventing cancers from spreading or returning after tumors have been removed. Other new treatments such as hormonal therapy, small molecules and monoclonal antibodies can selectively kill only cancer cells and protect non-cancerous ones.

In the past, despite radical treatments like double mastectomies and single-drug chemotherapy, a significant number of women could generally expect the cancer to return within three to five years. Scientists believed the cancer would spread to nearby tissue and lymph nodes before spreading to other parts of the body. However it has now been proven that cancer cells can break away from the primary tumor and metastasize even if the patient has no evidence of the cancer spreading to the lymph nodes first.

Today, through improved diagnostic studies we can identify the risk of cancer spreading or returning based on the size of the tumor and certain molecular characteristics. With this information, a surgeon may recommend additional adjuvant therapy after surgical removal of the tumor. The goal of adjuvant therapy would be to kill any undetectable cancer cells that may have spread.

This adjuvant therapy for breast cancer involves chemotherapy or hormonal therapy, either alone or in combination. Adjuvant chemotherapy is used during early stage breast cancer in the form of multiple anticancer drugs, rather than a single drug, to help prevent metastatic cancer.

Post-menopausal women who make up the majority of breast cancer patients are at risk for developing breast cancer cells that rely on estrogen to grow. For the past 20 years, Tamoxifen, an anti-estrogen drug, has been prescribed to prevent the cancer from returning or spreading. Tamoxifen works by interfering with the harmful effects of estrogen in breast cancer cell growth. A newer form of hormonal therapy called aromatize-inhibitors appears to be as good as or better than Tamoxifen in adjuvant settings, with fewer side effects.

In other areas of development scientists have identified certain subtypes of breast cancer characterized by an over expression of a protein called
HER2-Neu. This protein plays a major role in breast cancer growth in, as yet undetermined ways. HER2-Neu positive breast cancer is typically more aggressive than HER2-Neu negative breast cancer, resulting in a greater likelihood of recurrence with a decreased chance of survival.

Several years ago a monoclonal antibody called Herceptin was developed by scientists at Genentech to bind to the HER2-Neu protein. This antibody therapy was found to be very effective in treating women who had metastatic breast cancer. This therapy led to some women living longer with a much better quality of life.

New this year, Herceptin has now been approved for treating breast cancer in the adjuvant setting. This approval came after several large studies showed that when women who had HER2-Neu positive breast cancer were given Herceptin in combination with chemotherapy they showed a significant improvement in survival.

While Herceptin is being given to a small percentage of breast cancer patients it represents a big step forward in the treatment of breast cancer and has paved the way for various treatments to offer women a chance to be cured of this cancer.

In addition to new treatment options, oncologists through family history and genetic analysis can predict with greater accuracy which women may be predisposed to developing breast cancer. Women can now be tested for the BRCA1 and BRCA2 genes, which if positive may put them at higher risk for developing breast and/or ovarian cancer. For these women a variety of options are now available such as surgery, hormonal therapy and specialized diagnostic imaging studies, all of which may prevent breast or ovarian cancer from developing at all.

Improved surgery, radiation and medical therapy, as well as more refined analyses of breast cancer tumor characteristics have translated into meaningful treatment for breast cancer patients. Eventually doctors will be able to look at the entire scope of the tumor and develop matching treatments and therapies, which hopefully will maintain a better quality of life and ensure survival for breast cancer patients.

John T. Ganey, M.D., is an oncologist with privileges at Sutter Delta Medical Center in Antioch, CA.