In the fight against breast cancer, 2012 was a very promising year.
Two new drugs were approved, with possibly a third coming late next year. We got our first complete look at the genetic changes driving breast cancer. And thanks to a guideline change from the National Comprehensive Cancer Network, some women are being spared extensive lymph node surgery that sometimes has long-term consequences.
“It was a blockbuster year,” said Ann Partridge, the medical oncologist and clinical researcher who handpicked the latest and greatest news to share with 75 people—mostly breast cancer survivors—who gathered Wednesday morning in San Antonio. The special session, hosted by the American Association for Cancer Research and the Alamo Breast Cancer Foundation, coincided with the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.
“Any time you have two drug approvals in one year, it’s a big year,” said Partridge, director of the Adult Cancer Survivorship Program at the Dana-Farber Cancer Institute in Boston.
In June, the Food and Drug Administration green-lit Perjeta (pertuzumab) for HER2-positive breast cancer. About a month later, the agency approved Afinitor (everolimus) for hormone-sensitive tumors. Now, a third powerful new drug called T-DM1 is poised for approval.
The buzz surrounding T-DM1 has been intensifying since June. That’s when news broke at the American Society of Clinical Oncology’s annual meeting that T-DM1 could put the brakes on worsening metastatic breast cancer for almost 10 months—a three-month improvement over the popular drug combo Tykerb (lapatinib) and Xeloda (capecitabine). Plus, it was safer.
T-DM1 is specifically for HER2-positive breast cancer and it’s made of two parts: a potent toxin attached to an antibody. DM1 is the toxic chemotherapy and the antibody drug is Herceptin, generically known as trastuzumab. Together, they work as a Trojan horse, Partridge said.
“T-DM1 sneaks chemotherapy into cancer cells that are HER2-positive, without damaging the rest of the body. It makes a very toxic chemotherapy very tolerable,” she said. Possible side effects of T-DM1 include diarrhea, nausea, fatigue and sometimes severely low platelet counts.
In November, the Food and Drug Administration announced it would expedite the review of T-DM1, also called trastuzumab emtansine. The agency will make its decision by Feb. 26, 2013.
There are more studies already under way for T-DM1, Partridge said, including one that combines the drug with the newly approved Perjeta.
Other big headlines covered by Partridge:
TAKING AN AX TO THE KNIFE: Some patients can now skip the extensive surgery where surgeons remove all the lymph nodes under the arm, the first place breast cancer is likely to spread.
New research prompted the National Comprehensive Cancer Network, an alliance of the country’s top cancer centers, to change its breast cancer guidelines in 2012. No longer must women have all their underarm lymph nodes removed if only one or two test positive for cancer. Now, these women can avoid so-called axillary lymph node dissection as long as the tumor is no bigger than 5 centimeters and the treatment plan includes lumpectomy, radiation and no pre-surgery chemotherapy.
“The new guidelines are changing the care of women today,” Partridge said.
This change, she said, will result in fewer breast cancer survivors developing lymphedema, a chronic swelling of the arm. The condition requires long-term management that can take a toll on a woman’s quality of life. A recent study found that about 35 percent of women who receive axillary lymph node dissection develop lymphedema, compared to roughly 5 percent who receive a sentinel lymph node biopsy to remove only a few nodes.
CLEVER MOVES: This year also gave us our first complete look at the genetic changes driving breast cancer—insight that could help researchers craft a more clever approach to treating breast cancer in the future.
“The better you understand breast cancer, the better you can pick it apart and attack it. This was a big step,” Partridge said of the research, reported in October in the journal Nature. “But we have more to do.”
Among those listening to Partridge discuss the year’s breast cancer headlines Wednesday was Ginny Mason, who has become a fixture at the San Antonio symposium. This year marks her 10th time here, which is 10 times more than she ever expected.
Mason had been given a year to live after being diagnosed in 1994 with inflammatory breast cancer. Now she’s the executive director of the Inflammatory Breast Cancer Research Foundation. “I just turned 60 in October and I don’t think I ever expected to live that long,” Mason said.
“I try to wrap my brain around everything that’s happened since that diagnosis,” she continued. “All the things that you didn’t know you were going to get the chance to experience.