Beating The Odds
Finely tuned diagnoses and targeted drugs are creating optimism about surviving breast cancer
That was good news for Marcia Rosenberg, who had been diagnosed with HER2-positive breast cancer after a routine mammogram. It was the first time Rosenberg, a 58-year-old Maryland attorney, had been seriously ill. She recalls hearing the diagnosis: "You could have knocked me over with a feather."
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Rosenberg had a lumpectomy and then more surgery before doctors discovered the cancer had spread to her lymph nodes. Isaacs, her oncologist, suggested the Herceptin study, and Rosenberg trusted her. The trial was set up so that all the participants first got four cycles of chemo and then were told which arm of the study they'd been assigned to. Rosenberg learned she'd be assigned to the control group: She wouldn't be getting the drug.
Waiting. That was devastating news, since the word was out that Herceptin was showing encouraging early results. Isaacs told her to be patient, that some new findings were due out soon. Rosenberg didn't have to wait more than about 90 minutes: She was in the infusion room, having her chemo treatment, when a nurse handed her the phone and Isaacs told her the good news: The preliminary data looked so good that the patients in the trial, including her, would now be eligible for the drug. "It was one of the most dramatic days of my life," she says.
She's optimistic, and so are oncologists. "Probably thousands of women will be alive in a decade who wouldn't have been otherwise," says Sledge. Still, the study didn't extend long enough to tell if the early benefits will continue. "One must always be cautious looking into the future with these studies," says Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. There are also questions about how long patients should take the drug and in what combinations with other medicines.
And there are still women sitting on the sidelines whose cancers do not fall into the categories treatable with new drugs. "HER2 is the engine that drives this cancer cell, but what are the engines, other than estrogen, that drive these other cells?" asks Karen Gelmon, an oncologist and head of the investigational drug program at the BC Cancer Research Centre in Vancouver.
A new group of women needing even newer treatments is now being talked about: so-called triple negatives, whose cancers aren't estrogen-receptor positive, progesterone-receptor positive, or HER2 positive. Lisa Carey, medical director of the Breast Center at the University of North Carolina, is studying whether this broad group can be subdivided into smaller groups, one of which may respond to drugs like Iressa and Tarceva, which target another receptor known as EGFR. African-American women fall disproportionately into this triple negative category, which may explain why breast cancer in those women tends to occur at younger ages and be more aggressive than in Caucasian women.
The science of classifying tumors this way is still in its rudimentary stage, and even if the statistics show an increase in survival, doctors cannot yet tell an individual patient that she'll survive her cancer for a determined period of time. So the challenge is not only coming up with new treatments but figuring out for whom they do and don't work. One drug that isn't limited to a specific tumor type is Avastin, a drug already shown to help in other cancers by choking off the tumor's blood supply. Genentech and Roche recently reported that in patients with advanced breast cancer, the drug, combined with chemo, doubled the time they lived without a recurrence compared with chemo alone, from six months to 11 months.
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