Sometimes it’s a tossup which is worse–having breast cancer or undergoing treatment for it. Therapy can be toxic, disfiguring and ultimately futile. But breast cancer is one malignancy that doctors think they’re finally starting to beat. “Almost every month, I have a drug or an option I didn’t have the month before,” says Blackwell.
Some of the most exciting advances involve genetic profiling, a technique that could soon enable doctors to tailor treatment to the precise genetic signature of a tumor. In January a test became available to help doctors figure out which breast-cancer patients would benefit from the estrogen-receptor blocker tamoxifen alone and which needed additional chemotherapy. The test, from Genomic Health, Inc., of Redwood City, California, assesses 21 key genes in a tumor-tissue sample, then crunches the data into a single score from zero to 100. “The higher the number, the worse the woman will fare on tamoxifen alone,” says CEO Randy Scott. “It’s the first test of its kind going beyond age and tumor size for prognosis in cancer.”
Doctors would like to use gene profiles to answer all kinds of treatment questions. Who should receive radiation? Who should take certain drugs and for how long? “Genetic profiling is doing for breast cancer what the Hubble telescope did for astronomy–enabling us to see things we’ve never been able to see before, with much better detail and higher resolution,” says Tom Baer, CEO of Arcturus Bioscience in Mountain View, California.
But better targeting through genetics is only half the battle. The other half is improving the cancer-fighting arsenal. Tamoxifen is arguably the most successful drug in cancer history, having cut rates of breast-cancer recurrence by as much as half. But most patients derive no further benefit after five years. Major studies have recently found that recurrence can be slashed by a further 30 to 50 percent when women switch to one of three aromatase inhibitors (Femara, Aromasin or Arimidex) after varying periods of tamoxifen treatment. “The use of aromatase inhibitors is going to have a major impact on outcomes,” says Trevor Powles, a British oncologist who participated in an Arimidex trial. “These drugs are going to seriously reduce mortality rates.”
Perhaps the ultimate new weapon against cancer would be one that vaporized a tumor without surgery. In pilot studies at M.D. Anderson Cancer Center in Houston and Victoria General Hospital in British Columbia, doctors have used radiofrequency waves to “ablate” small tumors in older women. A radioprobe is inserted into the breast and guided to the tumor site by ultrasound. When the power is turned on, radio waves heat the tumor until its proteins shrivel like bacon in a frying pan. The body should eventually reabsorb the dead cells. Bev Brown, 69, a retired X-ray technician, was one of roughly two dozen patients who received the treatment in Canada. “It was so much easier than surgery,” she says. “It didn’t even leave a bruise.” Because the technique is experimental, she still needed surgery to make sure the tumor was fully eradicated. But it helped make breast cancer far less traumatic than it might have been. And that in itself is a victory.
title: “Fresh Weapons For An Old Battle” ShowToc: true date: “2023-01-28” author: “Michael Tucker”
Sometimes it’s a tossup which is worse–having breast cancer or undergoing treatment for it. Therapy can be toxic, disfiguring and ultimately futile. But despite the statistics–215,000 new cases a year and 40,000 deaths–breast cancer is one malignancy that doctors think they’re finally starting to beat. “Almost every month, I have a drug or an option I didn’t have the month before,” says Blackwell. At every step of the process, from surgery to chemo and radiation, doctors are experimenting with new techniques that are making treatment less painful and toxic, yet more efficient at wiping out tumor cells. “The improvements are incremental, but each step is taking us closer to better outcomes, with longer and better survival,” says Dr. David Johnson, president-elect of the American Society of Clinical Oncology.
Some of the most exciting advances involve genetic profiling, a technique that could soon enable doctors to tailor treatment to the precise genetic signature of a tumor. “Today doctors make the best guesses they can about treatment, based on limited information like the patient’s age, the size of the tumor and whether it has spread to lymph nodes,” says Dr. Daniel Haber, director of the Cancer Center at Massachusetts General Hospital. But these general guideposts can be misleading. For example, a large tumor isn’t necessarily a virulent one. Sometimes it’s just a slow grower that was caught late. How aggressive should a doctor be in treating it?
In January a test became available that can help answer that question for certain women–those whose tumors are classified as “node negative” and “estrogen positive.” (The first term simply means that the cancer hasn’t yet spread to any lymph nodes. The second term means that the tumor’s growth, like two thirds of breast cancers, is fueled by estrogen.) Within this group, only 15 percent of women who take the estrogen-receptor blocker tamoxifen have their cancer recur after surgery. Yet doctors usually recommend that most of these women receive cell-killing chemotherapy, too, since it will further reduce the recurrence rate to 11 percent. That’s a benefit to an additional four out of 100 women. The question is, which four? That’s where the new test from Genomic Health, Inc., of Redwood City, Calif., comes in. It assesses 21 key genes in a tumor-tissue sample, then crunches the data into a single score from zero to 100. “The higher the number, the worse the woman will fare on tamoxifen alone,” says CEO Randy Scott. “It’s the first test of its kind going beyond age and tumor size for prognosis in cancer.” At $3,400, it’s not cheap, but it certainly costs less than chemo.
Doctors would like to use gene profiles to answer all kinds of treatment questions. Who should receive radiation and who should not? Who should take certain drugs and for how long? At what dose? All these questions are under active investigation. “Genetic profiling is doing for breast cancer what the Hubble telescope did for astronomy–enabling us to see things we’ve never been able to see before, with much better detail and higher resolution,” says Tom Baer, CEO of Arcturus Bioscience in Mountain View, Calif.
But better targeting through genetics is only half the battle. The other half is improving the cancer-fighting arsenal. Tamoxifen is arguably the most successful drug in cancer history, having cut rates of breast-cancer recurrence by as much as half. But most patients derive no further benefit after five years. Newer drugs called aromatase inhibitors may extend disease-free survival. Major studies have recently found that recurrence can be slashed by a further 30 to 50 percent when women switch to one of three aromatase inhibitors (Femara, Aromasin or Arimidex) after varying periods of tamoxifen treatment. The drugs work only in postmenopausal women, but they have fewer side effects than tamoxifen. “In aggregate, the studies tell us that five years of standard tamoxifen is no longer adequate treatment,” says Dr. Stephen Jones of U.S. Oncology Research in Houston, who participated in the Aromasin trial.
Perhaps the ultimate new weapon against cancer would be one that vaporized a tumor without surgery. In pilot studies at M.D. Anderson Cancer Center in Houston and Victoria General Hospital in British Columbia, doctors have used radiofrequency waves to “ablate” (rather than surgically remove) small tumors in older women. A radioprobe is inserted into the breast and guided to the tumor site by ultrasound. When the power is turned on, radio waves heat the tumor until its proteins shrivel like bacon in a frying pan. The body should eventually resorb the dead cells. Bev Brown, 69, a retired X-ray technician, was one of roughly two dozen patients who received the treatment in Canada. “It was so much easier than surgery,” she says. “It didn’t even leave a bruise.” Because the technique is experimental, she still needed surgery to make sure the tumor was fully eradicated, but the operation was easier than it would have been otherwise. Large trials must still confirm the procedure’s efficacy, says Dr. Stuart Silver, Brown’s radiologist. “And this won’t be an option for younger women with denser breasts and more aggressive cancer or those with large tumors,” he adds. But for patients like Brown, breast cancer is already far less traumatic than it might have been. And that in itself is a victory.
title: “Fresh Weapons For An Old Battle” ShowToc: true date: “2023-01-08” author: “Linda Groll”
Sometimes it’s a tossup which is worse—having breast cancer or undergoing treatment for it. Therapy can be toxic, disfiguring and ultimately futile. But despite the statistics—215,000 new cases a year and 40,000 deaths—breast cancer is one malignancy that doctors think they’re finally starting to beat. “Almost every month, I have a drug or an option I didn’t have the month before,” says Blackwell. At every step of the process, from surgery to chemo and radiation, doctors are experimenting with new techniques that are making treatment less painful and toxic, yet more efficient at wiping out tumor cells. “The improvements are incremental, but each step is taking us closer to better outcomes, with longer and better survival,” says Dr. David Johnson, president-elect of the American Society of Clinical Oncology.
Some of the most exciting advances involve genetic profiling, a technique that could soon enable doctors to tailor treatment to the precise genetic signature of a tumor. “Today doctors make the best guesses they can about treatment, based on limited information like the patient’s age, the size of the tumor and whether it has spread to lymph nodes,” says Dr. Daniel Haber, director of the Cancer Center at Massachusetts General Hospital. But these general guideposts can be misleading. For example, a large tumor isn’t necessarily a virulent one. Sometimes it’s just a slow grower that was caught late. How aggressive should a doctor be in treating it?
In January a test became available that can help answer that question for certain women—those whose tumors are classified as “node negative” and “estrogen positive.” (The first term simply means that the cancer hasn’t yet spread to any lymph nodes. The second term means that the tumor’s growth, like two thirds of breast cancers, is fueled by estrogen.) Within this group, only 15 percent of women who take the estrogen-receptor blocker tamoxifen have their cancer recur after surgery. Yet doctors usually recommend that most of these women receive cell-killing chemotherapy, too, since it will further reduce the recurrence rate to 11 percent. That’s a benefit to an additional four out of 100 women. The question is, which four? That’s where the new test from Genomic Health, Inc., of Redwood City, Calif., comes in. It assesses 21 key genes in a tumor-tissue sample, then crunches the data into a single score from zero to 100. “The higher the number, the worse the woman will fare on tamoxifen alone,” says CEO Randy Scott. “It’s the first test of its kind going beyond age and tumor size for prognosis in cancer.” At $3,400, it’s not cheap, but it certainly costs less than chemo.
Doctors would like to use gene profiles to answer all kinds of treatment questions. Who should receive radiation and who should not? Who should take certain drugs and for how long? At what dose? All these questions are under active investigation. “Genetic profiling is doing for breast cancer what the Hubble telescope did for astronomy—enabling us to see things we’ve never been able to see before, with much better detail and higher resolution,” says Tom Baer, CEO of Arcturus Bioscience in Mountain View, Calif.
But better targeting through genetics is only half the battle. The other half is improving the cancer-fighting arsenal. Tamoxifen is arguably the most successful drug in cancer history, having cut rates of breast-cancer recurrence by as much as half. But most patients derive no further benefit after five years. Newer drugs called aromatase inhibitors may extend disease-free survival. Major studies have recently found that recurrence can be slashed by a further 30 to 50 percent when women switch to one of three aromatase inhibitors (Femara, Aromasin or Arimidex) after varying periods of tamoxifen treatment. The drugs work only in postmenopausal women, but they have fewer side effects than tamoxifen. “In aggregate, the studies tell us that five years of standard tamoxifen is no longer adequate treatment,” says Dr. Stephen Jones of U.S. Oncology Research in Houston, who participated in the Aromasin trial.
Perhaps the ultimate new weapon against cancer would be one that vaporized a tumor without surgery. In pilot studies at M.D. Anderson Cancer Center in Houston and Victoria General Hospital in British Columbia, doctors have used radiofrequency waves to “ablate” (rather than surgically remove) small tumors in older women. A radioprobe is inserted into the breast and guided to the tumor site by ultrasound. When the power is turned on, radio waves heat the tumor until its proteins shrivel like bacon in a frying pan. The body should eventually resorb the dead cells. Bev Brown, 69, a retired X-ray technician, was one of roughly two dozen patients who received the treatment in Canada. “It was so much easier than surgery,” she says. “It didn’t even leave a bruise.” Because the technique is experimental, she still needed surgery to make sure the tumor was fully eradicated, but the operation was easier than it would have been otherwise. Large trials must still confirm the procedure’s efficacy, says Dr. Stuart Silver, Brown’s radiologist. “And this won’t be an option for younger women with denser breasts and more aggressive cancer or those with large tumors,” he adds. But for patients like Brown, breast cancer is already far less traumatic than it might have been. And that in itself is a victory.
