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Chemotherapy Options for Metastatic Breast Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: Patients diagnosed with metastatic breast cancer must deal with a serious disease, but they have many therapeutic options available to them.

HAROLD BURSTEIN, MD: Treatments for metastatic breast cancer are not designed to eradicate the tumor once and for all. We don't have that ability right now. On the other hand, the good news is that there are many drugs and many treatments that can actually help keep the tumor under control for a very long time. And increasingly, women with advanced breast cancer have both multiple treatment options, are benefitting from newer therapies, and are living longer and better with their disease.

We are increasingly treating the tumor based on the biology of the disease. So we always test all breast cancers to determine whether or not they are sensitive to certain kinds of drugs.

KIMBERLY BLACKWELL, MD: In tumors that are estrogen receptor positive or in very simple terms need the female hormone estrogen to grow, we will almost a 100 perecent of the time recommend some sort of tablet form of antihormonal therapy.

ANNOUNCER: Chemotherapy also has an important role in helping to control advanced cancer.

HAROLD BURSTEIN, MD: What almost all chemotherapy drugs share in common is that they target the DNA machinery of the cell, or they target the so-called microtubules, the small structural elements within the cancer cell that help maintain the normal shape and function of the cell.

ANNOUNCER: There are many different classes of chemotherapy drugs.

HAROLD BURSTEIN, MD: These include anthracyclines, drugs like doxorubicin and epirubicin; taxanes, that's paclitaxel and docetaxel and derivatives of paclitaxel; vinca alkaloids, drugs like vinorelbine; alkylator-type chemotherapy drugs, cyclophosphamide and carboplatin; drugs that are so-called antimetabolites, drugs like capecitabine or 5-FU or gemcitabine.

ANNOUNCER: Combinations of the drugs are sometimes given to patients. Hair loss, nausea, vomiting, allergic reactions, low blood counts, mouth sores and neuropathy, a tingling in the hands and feet are common chemotherapy side effects. Anti-nausea medicines and medicines to help regulate blood counts have improved the patient experience.

ERIC WINER, MD: Most of our large studies have demonstrated that giving single agents one after the other gives you ultimately as good a result as giving combinations and giving single-agent chemotherapy tends to be associated with fewer side effects.

ANNOUNCER: Doctors are finding newer and safer ways to give old chemotherapy drugs.

HAROLD BURSTEIN, MD: Consider a drug like paclitaxel, which had been a mainstay of breast cancer therapy in the 1990s. It turned out that by using the exact same drug, but using a lower dose on a more frequent schedule—that is to say, giving it weekly instead of every three weeks—we actually could help patients do better, that it was better to control the tumor, better to achieving a response and better tolerated by giving weekly chemotherapy.

Another example related to paclitaxel is there's a new derivative of paclitaxel called Abraxane, where they have reformulated the paclitaxel into a little albumin shell. When you do that, the drug dissolves better in water and patients don't get allergic reactions. Another example of that has been the drug capecitabine. Capecitabine is an orally available form of chemotherapy, but it's a very old chemotherapy called 5-FU. It turned out, then, when we used to give squirts of 5-FU in the clinic it wasn't all that effective. By developing it into a pill form, you more or less mimic a continuous exposure to the drug, and it turns out that capecitabine, which is marketed as Xeloda, is actually a very effective way of controlling breast cancer.

ANNOUNCER: Patients will be tested for the HER2/neu gene protein to determine if they are eligiable for targeted therapy.

HAROLD BURSTEIN, MD: Tumors that are HER2-positive are candidates for treatment with a new anti-HER2 drug called trastuzumab.

ERIC WINER, MD: This is an antibody therapy, an antibody that is targeted to the HER2/neu protein.

ANNOUNCER: Trastuzumab, also known as Herceptin is usually added to chemotherapy. In clinical trials this approach has shown impressive results.

HAROLD BURSTEIN, MD: Adding trastuzumab doubled the response rate to chemotherapy alone, substantially improved the length of time before the tumor got worse and contributed to much improved overall survival for women with HER2-positive breast cancer.

ANNOUNCER: Patients whose breast cancer has spread to the bone may be treated with bone strengthening drugs called bisphosphonates.

HAROLD BURSTEIN, MD: It alleviates some of the pain, it helps prevent fractures and it prevents the excessive absorption of bone which can give rise to something called hypercalcemia, when there's so much calcium that's leached out of the bone into the bloodstream it's actually bad for the patient.

ANNOUNCER: Many new therapies are being tested in clinical trials.

HAROLD BURSTEIN, MD: There's an explosion right now in the way of biotechnology drug development, so there are tremendous numbers of drugs that are flooding onto the market for clinical trials in breast cancer.

ERIC WINER, MD: For women with advanced breast cancer, clinical trials are often considered both to try to compare existing therapies that we have, and more importantly, to try to push the envelope a bit and to try to look at new therapies.

KIMBERLY BLACKWELL, MD: I think all women with metastatic breast cancer should talk to their physician about clinical trials. Clinical trials will give her an option of receiving some of the newer and, in some cases, more effective treatments earlier than waiting to get them outside clinical trial, once they've been approved. The drugs that are being developed work better than the drugs we had ten years ago. So we want to be able to access those early in your fight against metastatic breast cancer and clinical trials enable you to do that.

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