Beating The Odds
Finely tuned diagnoses and targeted drugs are creating optimism about surviving breast cancer
Scientists were already on the right track and indeed reported recently in the Lancet that middle-aged women treated with chemotherapy and hormonal therapy had their risk of death cut in half over 15 years. The benefit of the chemo and drug therapy increased over time, suggesting that many of them may never have a recurrence. But that news doesn't include the newer variations in chemotherapy introduced over the past several years. Just last week, for example, researchers writing in the New England Journal of Medicine reported that replacing an older chemo drug, fluorouracil, with a new one, docetaxel, cut the risk of death by nearly 30 percent among breast cancer patients. Also not yet reflected: even newer drugs, some of which can target specific cancer cells, sparing the rest of the body.
New forms of treatment have now been added to the arsenal, most of them based on a fundamental shift in the way we think about the disease. With recent biological advances, especially in genetics, we now know that--as with other cancers--the term "breast cancer" has actually become somewhat quaint. More accurate, scientifically, would be "cancers that happen to be in the breast," some of them more aggressive than others.
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A woman diagnosed with breast cancer today now faces a much different situation from one diagnosed 20, 10, or even five years ago. The debate used to be over which form of chemo to use or how often to use it. Says Sledge: "It was like arguing whether toothpaste A is better than toothpaste B." Doctors now use the "divide and conquer" approach, classifying breast cancers into specific categories and treating them accordingly. Women whose tumors are influenced by the hormones estrogen and progesterone, for example, can benefit from treatments that change the action of those hormones. Many of these women are still treated with tamoxifen--the former gold standard, but not without serious side effects. But a new class of drugs is gaining ground. Aromatase inhibitors, like Arimidex and Femara, were first examined for use after tamoxifen and are now candidates to replace it, at least in some women.
Indeed, one recent study showed that Femara is more effective than tamoxifen in preventing breast cancer recurrence. Those who took the newer drug had a 19 percent lower chance of a recurrence. Since the newer drug has only been in use for six years, it's still too early to know whether it will show a difference in overall survival, says David Epstein, president of the oncology division of Novartis, which makes Femara. One of the patients taking Femara is Joan Syron, a 72-year-old in Annandale, N.J., who was diagnosed with Stage II breast cancer. She started taking Femara in 2001, after five years on tamoxifen, and is still on it. "It's getting to be nine years [after diagnosis], and I'll never really stop worrying," she says, "but I feel comfortable with what I'm doing with my life."
Breast cancer tumors can also be classified by whether or not they make too much of a protein called HER2. Women with this type of cancer, who tend to be younger, until quite recently had little help specific to their cancer after completing chemotherapy. "We would see these women and we knew enough to tell them that they had aggressive disease, but we couldn't do anything for them," says Marisa Weiss, an oncologist in Philadelphia and founder of breastcancer.org. Herceptin targets this specific kind of cancer. It was first approved by the Food and Drug Administration for use in the latter stages of breast cancer but later was tested in women with an earlier stage of the disease. When the researchers checked the results after a few years, the successes were so dramatic that they halted the study, arguing it was unethical to deny any patient Herceptin.
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