The Tribune Democrat, Johnstown, PA

Breast Cancer

October 1, 2012

Chemo isn’t only weapon in battle against breast cancer

JOHNSTOWN — Chemotherapy is no longer the only option for controlling the spread of breast cancer.

Medical oncologists in Johnstown, Windber and Somerset have a battery of weapons to target individual types of cancer.

“It is personalized medicine,” said Dr. Paul  Woolley of the Conemaugh Cancer Center in Johnstown.

“You are making decisions not on the basis of figures in a textbook, but the characteristics of that individual person’s tumor. It gives reassurance to people who are getting treatment that they are getting it for a reason.”

Pathology of the tumor removed in a lumpectomy or mastectomy will tell the medical oncologist if the cancer has receptors for the female hormones estrogen or progesterone. Both can help the cancer grow and spread, Woolley said.

“If the receptors are present, we have a whole class of drugs that can be used,” Woolley said, adding that the hormone therapy has fewer side effects than traditional chemotherapy.

Hormone therapy is also important for treating carcinoma in situ, which Woolley describes as “tissue on the road to cancer.”

“Identifying these is very important,” he said. “It makes a difference in outcomes and what sort of treatment you require.”

Another class of drugs targets cancers where genes called human epidermal growth factor receptor 2, or HER2/neu genes are overproducing. Herceptin has been the mainstay for HER2/neu positive breast cancer, but a new drug was approved last summer to supplement the treatment, Dr. Rashid Awan said at UPMC’s John P. Murtha Regional Cancer Center in Johnstown.

Perjeta, given along with Herceptin, has been shown to increase life expectancy for women with advanced breast cancer, Awan said.

Both drugs are considered immunotherapy because they work with the body’s immune system to fight cancer. Perjeta is a synthetic protein that “locks” the effects of the HER2/neu gene.

Although the new drug may add only 20 months to some cancer patients’ lives, Awan says that advances come slowly.

“We are doing all we can to increase our patients’ survival,” Awan said. “Every day we are making small steps, but each step is better than it was before. They have more time with a better quality of life. Who knows what comes up in the next two years?”

Even traditional chemotherapy has seen advances, and new treatments have been introduced to reduce side effects, Woolley said.

“Chemotherapy is still important and necessary,” Woolley said. “There is a lot of work going on with those drugs in ways of minimizing their toxicity. We now have multiple choices in terms of the traditional type of drugs.”

Breast cancer patients can find encouragement in advances that have improved lives for those with other types of cancer, Woolley said.

Not too many years ago, a diagnosis of chronic myelogenous leukemia was a virtual death sentence, Woolley said.

“A paper came out in 1976 and said survival was six years maximum – that’s as long as you lived,” Woolley said.

Then oncologist Brian Druker, working at Harvard University, came up with a novel approach, Woolley said.

“A characteristic of the (leukemia) is an enzyme,” Woolley said. “It really is the driving force of that leukemia.

“(Druker) thought what would happen if we found inhibitors to this enzyme? We ought to be able to construct inhibitors to the altered enzyme and leave the normal enzymes alone.”

The result was a drug named Gleezic, which is now standard treatment for that type of leukemia.

“It is a brave new world,” Woolley said. “We have patients here already 17 years out.”

Now experts are wondering how long these patients must continue taking Gleezic, or if they can be weaned off the drug.

“It just goes on and on,” Woolley said. “It’s very exciting. We answer one question and six more come up.”

In breast cancer, epidermal growth factor receptor inhibitors have been developed to reduce the effects of the HER-1 cancer gene’s acceleration of metastasis. Epidermal growth factor receptor inhibitors are also fighting lung and bowel cancers.

“This is a class of drug that is very innovative and a promising addition,” Woolley said. “It is a very hot area. Ramifications go far beyond (these cancers). It is personalized because you have to start looking at the structure of certain genes to see which  patients are going to respond the best.

“It is something that we do every day. We try very hard to include into each person’s therapy the best and most specific treatment possible.”


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