Could Herceptin cut mastectomies?

Can the 'wonder drug' Herceptin spare women breast cancer surgery? Emma Baines reports.

What is the story?
Thousands of women in the UK who face the threat of breast cancer could be spared surgery by early use of Herceptin, according to media reports.

The newspapers claimed that when given before surgery, Herceptin can shrink and even eradicate a breast tumour, removing the need for mastectomy.

In nearly half of women given this treatment, the tumours completely disappeared, they said.

But the media reports added that Herceptin would not be available to NHS patients awaiting breast cancer surgery until NICE approves this new use of the drug.

What is the research?
The stories are based on data from the NeOAdjuvant Herceptin (NOAH) trial, a phase-three clinical trial into using trastuzumab (Herceptin) to reduce the need for surgery in patients with locally-advanced breast cancer.

It was presented at the 2007 annual meeting of the American Society of Clinical Oncology in Chicago last week.

Trastuzumab works by blocking the function of HER-2, a protein produced by a specific gene which can cause cancer. Around a fifth of women with breast cancer are HER-2 positive, and in many cases do not respond well to chemotherapy.

Previous studies have shown that trastuzumab improves outcomes in these women at both the advanced and early stages of the disease.

Trastuzumab was licensed for the treatment of metastatic HER-2 positive breast cancer in 2000, and for the treatment of early HER-2-positive breast cancer in 2006.

This study was designed to see if trastuzumab could be used to improve outcomes in women with advanced HER-2 positive breast cancer prior to surgery.

It included 228 breast cancer patients with a locally-advanced HER-2-positive tumour. The average size of their tumour before treatment was 5.5cm.

The patients were treated with weekly adjuvant chemotherapy for a year, in order to shrink the tumour as much as possible before surgery.

A group of 113 patients received chemotherapy alone, while 115 patients also received weekly treatment with trastuzumab.

The researchers found the tumours were more likely to shrink following adjuvant trastuzumab treatment.

The number of tumours that shrank in response to adjuvant therapy was increased from 73 per cent in the patients given chemotherapy alone, to 81 per cent in those given trastuzumab.

Also, the rate of complete eradication of the tumour by adjuvant therapy was 87 per cent higher in those treated with trastuzumab than chemotherapy alone.

This means that no surgical intervention was required in 43 per cent of the women treated with trastuzumab, compared to 23 per cent of those treated with chemotherapy alone.

What do the researchers say?
Lead researcher Professor Luca Gianni, director of Medical Oncology at the Fondazione IRCCS Istituto Nazionale Tumori in Milan, said: 'HER-2-positive breast cancer remains a serious clinical diagnosis, because many patients will experience disease recurrence and progression.

'Neoadjuvant chemotherapy is administered to patients to help render inoperable tumours removable. The addition of Herceptin to neoadjuvant chemotherapy shows positive benefits.'

What do other experts say?
Dr Alexis Willett, senior policy and information officer at the charity Breakthrough Breast Cancer, said this treatment could improve the quality of life of those HER-2-positive breast cancer patients who are identified when the cancer is locally advanced.

'Many of these women would undergo a mastectomy, but more women can be offered breast-conserving surgery, which would provide both clinical and cosmetic benefits for the patient.'

She added it would be several years before trastuzumab would be available on the NHS.

Informing patients

  • Herceptin can reduce the need for surgery in women with an aggressive form of breast cancer.
  • This form is found in fewer than a fifth of women with breast cancer.
  • Herceptin is only licensed for use after surgery.
  • It will be years before Herceptin treatment will be given to women prior to surgery.
What do you think? Comment below or email healthcare.republic@haymarket.com

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus