New Ways to Treat Breast Cancer
A new generation of drugs and treatment options gives patients new hope in the fight against breast cancer.
Aggressive Chemotherapy and Radiation
On the other end of the spectrum is a nod to the past, with an extremely aggressive use of both chemotherapy and radiation combined.
"We now treat all women with stage II breast cancerbreast cancer or higher with chemotherapy prior to surgery, and if there is breast conservation, we follow with radiation, sometimes followed by more chemotherapy," says Therese B. Bevers, MD, medical director of the Cancer Prevention Center and Prevention Outreach Programs at M.D. Anderson.
Bevers says she believes chemotherapy prior to surgery shrinks tumors, allowing some women to have a lumpectomy instead of a mastectomy. Moreover, she says, "It also ensures that any renegade cancer cells that may be floating in the body are killed prior to surgery."
Bevers believes the extra kick of chemo reduces cancer recurrences.
"We are seeing fewer women developing this disease again down the road," says Bevers.
Not everyone, however, agrees. Hudis says several clinical trials show chemotherapy before surgery does not prolong survival or decrease cancer recurrences. Smith believes it's best used only for large tumors when the chance of cancer spreading is greatest.
"The downside of chemotherapy can be enormous. This is not something you want to use unless you are certain it's going to make a significant difference," says Smith.
Predicting Future Care
According to Cheryl Perkins, MD, director of clinical affairs for the Susan G. Komen Breast Cancer Foundation, determining who benefits most from chemotherapy may soon be a cancer-care reality.
"Right now a screening known as Oncotype DX uses a panel of 21 genes to evaluate the likelihood that a woman's breast cancer will recur, and some of that information may be used to determine who benefits most from chemotherapy," says Perkins.
Indeed, a new clinical trial known as TailorRx is using Oncotype DX to see if some of the genes involved in breast cancer recurrence can also determine the need for chemotherapy -- and more importantly, who will do better without it.
"We may soon know exactly who benefits most from these treatments and who should avoid them," says Perkins.
"Ultimately the goal is personalized treatment for every woman with breast cancer and a prescription that is targeted specifically for her."