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| health > cancer > story page |         |
New developments in fight against breast cancerMay 27, 1999
By Nancy I. Bateman
(WebMD) -- The past year has produced a number of new weapons in the war against breast cancer. This is good news for the more than 175,000 women diagnosed with the disease each year in the United States. New biological discoveries, new therapies and chemotherapy drugs, new knowledge from recently released studies, and surgical improvements are all giving patients new hope in this battle, says Dr. W. David Henner, associate professor in the departments of medicine, biochemistry, and physiology and pharmacology at Oregon Health Sciences University. Calling it a "new biologic approach for the treatment of metastatic breast cancer," the Food and Drug Administration approved Herceptin for patients who have had little success with chemotherapy and for those with newly diagnosed metastatic disease. Herceptin was bioengineered from a mouse antibody and altered to resemble a human antibody. Though Herceptin was only recently approved for use, the research to develop this treatment began 20 years ago. "It's a kind of vaccine," Henner says, "that targets a protein on the surface of breast cancer cells." This protein, known as HER2, sends signals to cells to turn on genetic material that makes the cells grow and divide. "If you have cancer cells with lots of HER2 and add an antibody (Herceptin), the antibody bonds to cancer cells and prevents the signal from being sent, and (that) makes the cells die," Henner explains. Henner calls this technique "moderately" effective. Because some patients can develop congestive heart failure with this therapy, it is used only in advanced breast-cancer cases. The benefits, Henner says, far outweigh the risks for patients with advanced disease. Many cancers spread from their original site through the lymphatic system. Surgeons have typically removed the underarm lymph nodes from breast-cancer patients, frequently causing uncomfortable side effects. About 15 percent to 20 percent of women will develop lymphedema (swelling of the arm), which causes considerable disability, Henner says. In lymph-node mapping, a surgeon injects dye or a radioactive tracer into the breast and, after the breast drains the fluid into the nodes, the first node in the chain (the sentinel node) is examined. If this node is cancer-free, the surgeon will leave the nodes intact. This procedure is an important development that makes breast-cancer surgery safer, Henner explains. Adjuvant (post-surgical) treatment The benefits of using both tamoxifen and chemotherapy have been confirmed in large, long-term studies. "We can cure an additional 20 percent to 30 percent of women by adding one or both of these types of treatment to surgery and radiation," Henner says. The addition of new chemotherapy drugs, either paclitaxel (Taxol) or docetaxel (Taxotere), to older chemotherapy drugs further increased cure rates, he added. The exact benefits still need longer-term and larger studies, but the results are positive so far. Several studies released in the past year have shown tamoxifen to be beneficial in preventing breast cancer in women at high risk for the disease. A trial of 13,000 women who used 20 mg of tamoxifen daily for five years showed a 45 percent reduction in breast-cancer incidence among the high-risk participants. On the negative side, there was an increase in the chance of developing three rare but life-threatening health problems: endometrial cancer (cancer of the lining of the uterus), pulmonary embolism (blood clot of the lung), and deep-vein thrombosis (blood clot in major veins). Raloxifene is a drug similar to tamoxifen. Currently approved for prevention of osteoporosis, it also decreases incidence of breast cancer, but without the increased risk of uterine cancer. A study of the benefits and risks of raloxifene vs. tamoxifen will begin this summer. The study will look at 22,000 postmenopausal women with a predicted high risk for the development of breast cancer. It will compare health histories of women taking 20 mg of tamoxifen daily with women taking 60 mg of raloxifene daily, both for a period of five years.
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