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Treating HER2 Metastatic Breast Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: Twenty to 30 percent of breast cancers are of a type known as HER2-or HER2/neu-positive. These tumors tend to be more aggressive and more likely to metastasize.

WILLIAM GRADISHAR, MD: HER2-positive breast cancer historically has been thought to be a more aggressive type of breast cancer compared to its counterpart, HER2-negative disease. The implication being that those patients who are HER2-positive; all other features being similar, tend to have more recurrences and a shorter survival.

ANNOUNCER: But researchers have used their knowledge of how HER2-positive cancer grows to develop a targeted therapy. It's called Herceptin, and it's been shown to help extend survival for many people.

MARY CIANFROCCA, DO: Once breast cancer has metastasized, it's a very serious illness. It's an illness that generally we don't have the ability to cure, so we don't have the ability to make it go away and never come back again. What we try to do is turn it into a chronic disease that the woman can live with for many years. That's our general goal with our current therapies.

ANNOUNCER: In treating metastatic cancer, surgery is not used very often, for the cancer has already spread to other organs.

JOYCE O'SHAUGHNESSY, MD: Generally speaking, there is not a role for surgical resection for metastatic breast cancer, because when breast cancer metastasizes, it tends to metastasize to multiple areas in the same organ, not just one speck.

ANNOUNCER: Radiation therapy also plays only a limited role in treating metastatic breast cancer. But there are situations where it can be helpful.

MARY CIANFROCCA, DO: For example, a metastasis that is pressing on the spinal cord and causing dysfunction in that area can be very effectively treated with radiation. Also metastases to the brain are often treated with radiation. Another example where radiation is very useful is in metastatic disease to the bone that's causing significant pain.

ANNOUNCER: The main therapies for metastatic breast cancer are drugs that travel throughout the body, to attack cancer cells no matter where they may be.

WILLIAM GRADISHAR, MD: Treatment options in metastatic breast cancer include chemotherapy, either given as single agents or cocktails of a combination of drugs, anti-hormone therapy if a patient is hormone receptor-positive, and that refers to the expression of either the estrogen or progesterone receptor. Or even more recently targeted therapies such as trastuzumab, or Herceptin, for those who have HER2-positive disease.

ANNOUNCER: About half the women with HER2-positive breast have cancer that is also stimulated to grow by the presence of estrogen or progesterone. For these women, systemic therapy may include drugs that reduce those hormones in the body, or interfere with receptors for them on the cancer cell. Doctors don't always know which treatment is best.

MARY CIANFROCCA, DO: The role of Herceptin in combination with hormonal therapy in women who are both ER-positive and HER2/neu-positive is an ongoing area of investigation. There is a trial that has been presented in the past using a type of drug called an aromatase inhibitor in combination with Herceptin. Whether that is better than Herceptin alone or the aromatase inhibitor alone is currently an ongoing area of research.

ANNOUNCER: With breast cancer that is HER2-positive and hormone-negative, Herceptin is usually added to chemotherapy. The combination has proven more effective than chemotherapy alone.

WILLIAM GRADISHAR, MD: The survival of patients getting chemotherapy alone in the pivotal trials was about 20 months. When you add Herceptin to chemotherapy, it increases to 25 months. So that's a significant improvement in the outcome of a group of patients where six month survival with advanced disease can make a very big difference in a patient's life and their ability to interact with their family and friends and do the things they want to.

ANNOUNCER: Herceptin can also be used alone in some cases, where it may be appropriate to spare a patient the side effects of chemotherapy. When HER2-positive breast cancer metastasizes it is very serious. But research leading to new, targeted therapies, is helping lengthen survival for many women with this disease.

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