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Hope on the Horizon for Advanced Breast Cancer

New Treatments Are Prolonging Survival and Improving Quality of Life

Chemotherapy continued...

Isaacs predicts that state-of-the-art care for advanced breast cancer in the future may also combine chemotherapy with newer types of drugs: immunotherapy, hormone therapy, and even vaccines.

"The big move is to look at novel agents given in conjunction with standard chemotherapy. That may be a way to really make a dent on prolonging survival," Isaacs says. Genentech, the company that developed Herceptin, is now testing an antibody that blocks a growth factor that's important to the formation of new blood vessels. Such an antibody could work in combination with chemotherapy to choke off the growth of cancerous cells.

In a one-two punch, Herceptin is also being combined with the chemotherapy drugs, Taxol and carboplatin (brand name Paraplatin), in a large clinical trial by the U.S. Oncology Group and McGill University. Other studies have shown potential in Gemzar -- a drug currently approved to treat other types of cancer -- especially for women with metastatic cancer.

The Promise of Vaccines

At the University of North Carolina's Lineberger Cancer Center, scientists are about to complete a early human study of a therapeutic vaccine to treat advanced breast cancer. This type of cancer vaccine doesn't work the way that vaccines for infections like measles do. Those are given to people to prevent disease. Therapeutic cancer vaccines are being studied to help the body's immune system "rev up" to fight the disease. Initially, at least, they would be used in women who have exhausted all other treatments.

In this case, the vaccine is customized for each individual woman. Doctors take a woman's dendritic cells -- a type of white blood cell that alerts the immune system to the presence of abnormal proteins present in breast cancer cells -- and engineer them to boost their response against a particular type of abnormal protein.

"We're looking for ¼ regression of established tumors. By definition, this means at least a 25% shrinkage of established tumors," said researcher Jonathan Serody, MD, when the trials began. He can't say yet whether they got the expected response, but he notes that the vaccine was well tolerated by the dozen or so women in the trial. Serody expects the vaccine to be most effective in combination with other treatments, such as hormone therapy or chemotherapy. The study at the University of North Carolina is only one of several that are evaluating possible vaccines for breast cancer.

"With things like vaccines, combination therapies, and other fascinating possibilities, we're starting to look beyond standard chemotherapy and into novel agents to attack advanced breast cancer," says Isaacs. "We're developing an array of treatments that work by different mechanisms of action, that give women with advanced breast cancer more options than they've ever had before."


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