Treating Breast Cancer - Five Things to Remember
The consensus recommendations for treating breast cancer, known affectionately as the “standard of care” or “current guidelines”, are rapidly changing due to advances in the efficacy of chemotherapy and targeted therapy. The way it works is like this: patients who enroll in a randomized clinical trial are given either one treatment or another, then followed for years to determine which group had the better outcome. What outcomes are measured, you ask? Here are the biggies:
1. Whether or not the tumor decreased in size substantially with treatment, called the response rate.
2. The percentage of patients who are still alive as time goes by, called the overall survival rate.
3. The length of time it took for the cancer to reappear in the body, called the time to progression.
4. The percentage of patients who are not just alive but also still free from any signs of their cancer, called the relapse-free survival rate.
These are the main outcomes that breast cancer researchers study when trying to determine if a new treatment is superior to the current “standard of care.” If the new treatment is proved to produce better outcomes, and not just due to dumb luck (example: flipping a quarter five times, observing the results and then selling it on eBay as a coin that always lands on heads), or finagling good results by sneaking bias into the study (example: “Gee, do you think it’s possible that the reason your patients treated with apricot pits lived so long is because most of them didn’t have metastatic cancer to begin with?”), this treatment will be adopted as a new guideline.
With that introduction, here are five bits of information to remember the next time you run into a relative or friend who has just been diagnosed with breast cancer. The treatments mentioned have been proven in randomized clinical trials to be effective enough for consideration as a new standard of care in the treatment of breast cancer. Of course, as with all medical advances the results will be under continued scrutiny to see if their advantage holds up over the years. The five things are:
1. Breast tumors can be diagnosed with a simple core needle biopsy (rather than an excisional biopsy), leaving the tumor in place. Then gives the patient the option of shrinking the tumor first - called primary systemic therapy or induction therapy, and a smaller tumor increases the chance that a mastectomy will not be necessary at the time of definitive surgery.
2. Large primary tumors can be transformed into small ones, or even be made to disappear, by giving chemotherapy before surgery. Not every patient is a good candidate for aggressive chemotherapy though, especially the elderly. Fortunately there are several oral medications called aromatase inhibitors that are highly effective in reducing tumors - with minimal side effects. These medications are part of primary systemic hormone therapy of breast cancer.
3. Patients with negative axillary lymph nodes who are also estrogen-receptor, progesterone-receptor and HER-2 negative (called “triple negative”) have such an elevated risk of relapse that they should be considered for the more aggressive chemotherapy regimens typically given only to lymph node-positive patients. And with that in mind:
4. Patients with positive axillary lymph nodes should be offered a chemotherapy regimen that includes the class of drug known as a taxane (either paclitaxel or docetaxel), as the addition of this agent has produced superior outcomes compared with regimens that do not contain it.
5. Finally, all patients whose tumors overexpress the HER-2 receptor should be considered for adjuvant treatment with the monoclonal antibody trastuzumab (brand-name Herceptin), as the addition of this targeted therapy to chemotherapy improves both overall and relapse-free survival.
For more information (albeit somewhat technical) try this site from the NCI, and thank you for your time.
