Medication for Women with Advanced Breast Cancer

IMAGE All women with advanced breast cancer face a difficult and uncertain future. Most of them endure long courses of treatment that leave them looking to alternative or experimental therapies for a cure. A drug called trastuzumab (Herceptin) attacks a particularly aggressive form of breast cancer in a novel way.
One aggressive form of breast cancer is characterized by an overabundance of a protein known as human epithelial growth factor receptor-2 (HER2). This protein stimulates the growth of breast tumors. Trastuzumab is a monoclonal antibody, which blocks the HER2 receptor. This inhibits the growth of cancer cells.
Scientists have known since the 1980's that women whose breast cancers produce too much HER2 have cancers that are more aggressive and more likely to metastasize, or spread. Trastuzumab can enhance the effectiveness of standard chemotherapy treatments by targeting the HER2 receptor and inhibiting its activity.

Trastuzumab May Delay Cancer Progression

Several clinical studies show that women with HER2-positive tumors using trastuzumab with chemotherapy have slower cancer growth and better response to treatment. An early study from 2001 showed that trastuzumab when added to chemotherapy was effective in slowing disease progression in HER2-positive breast cancer patients. In women with HER2-positive operable breast cancer, trastuzumab combined with chemotherapy improved survival outcome compared to those without trastuzumab.
Combined results of two studiesinvolving over 3,300 women found longer survival rates after one year of treatment with trastuzumab added to chemotherapy compared to those without trastuzumab.
In another study (the HERA trial), one year of treatment resulted in significant survival and less disease progression. In follow-up studies at two and four years, disease-free survival was maintained. Women who began treatment with trastuzumab after the first year of the study had similar results. There was little difference however, in overall survival or risk of death at the four-year follow-up.
Unfortunately, although trastuzumab may be able to slow the growth of cancer cells, it is also associated with some serious side effects.

Side Effects

Cardiomyopathy is a potentially life-threatening heart muscle weakness that can lead to heart failure . This side effect is particularly common in women receiving chemotherapy with anthracyclines and cyclophosphamide. For this reason, woman considering trastuzumab have a thorough cardiac assessment before taking the drug and during treatment.
Other serious side effects include:
  • Damage to the lungs
  • Life-threatening allergic reaction
  • Anemia
More common side effects include:

Applications

Trastuzumab is used only in cancers that overproduce HER2. It is now used for:
  • Breast cancer after surgical treatment along with or after chemotherapy
  • Breast cancer that has spread to other parts of the body along with or after chemotherapy
  • Stomach cancer or cancer at the junction of the stomach and esophagus that have spread to other parts of the body along with chemotherapy

RESOURCES

American Cancer Society http://www.cancer.org

National Cancer Institute http://www.cancer.gov

CANADIAN RESOURCES

Canadian Cancer Society http://cancer.ca

Canadian Breast Cancer Foundation http://www.cbcf.org

References

Gianni L, Dafni U, Gelber RD, et al. Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial. Lancet Oncol . 2011;12(3):236-244,

HER2 inhibitors for breast cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated December 17, 2012. Accessed December 21, 2012.

Herceptin. Daily Med website. Available at: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=492dbdb2-077e-4064-bff3-372d6af0a7a2. Updated October 2010. Accessed December 21, 2012.

Hortobagyi GN. Trastuzumab in the treatment of breast cancer. N Engl J Med. 2005;353:1734-1736.

Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after Adjuvant Chemotherapy in HER2-positive Breast Cancer. N Engl J Med. 2005;353(16):1659-1672.

Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353:1673-1684.

Slamon DJ, Leyland-Jones B, Shak S, et al. Concurrent administration of anti-HER2 monoclonal antibody and first-line chemotherapy for HER2-overexpressing metastatic breast cancer: A phase III, multinational, randomized, controlled trial. N Engl J Med. 2001;344:783-792.

Smith I, Procter M, Gelber RD, et al. 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet. 2007;369(9555):29-36.

Trastuzumab. American Cancer Society website. Available at: http://www.cancer.org/treatment/treatmentsandsideeffects/guidetocancerdrugs/trastuzumab. Updated November 3, 2010. Accessed December 21, 2012.

Trastuzumab. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 10, 2012. Accessed December 21, 2012.

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