Neoadjuvant Therapy Advancement

Uploaded by drjayharness on 23.12.2011

>>> DR. DAVID MARGILETH: The research in breast cancer in neoadjuvant and adjuvant therapies
revolves around several different components. Obviously, we are trying to combine known
drugs in different ways, different doses, different schedules to maximize cure rate,
minimize time on treatment, and minimize toxicity.
The other big push in breast cancer and in all cancers to date is this concept of what
is known as ‘personalized medicine’. That is “Are there characteristics of that patient’s
tumor that can help us to give more specific therapies?”
In breast cancer, we are lucky to have several targeted agents, the two most common being
the anti-estrogen pills that target the estrogen-receptor of breast cancer, and Herceptin and other
anti-HER2 drugs that target the HER2 pathway that stimulates breast cancer growth in those
25% of patients that over-express the HER2 gene.
Herceptin is by far the best anti-HER2 drug that we found to date, but there’s another
drug Tykerb-Lapatinib which is now commonly used, especially in metastatic breast cancer.
One of the ongoing trials in neoadjuvant chemotherapy is asking the question “Is it better or
does it improve cure rates to combine two anti-HER2 drugs (that is Lapatinib or Tykerb
plus Receptin)?” The data to that initially looks quite good.
There was also a report in this week’s San Antonio Breast Conference of another new anti-HER2
drug called Pertuzumab that, given in combination with Herceptin and with chemotherapy, improves
response rates in patients with metastatic disease.
There’s also another anti-HER2 drug, a very interesting drug called TDM-1, that combines
Herceptin and has attached a chemotherapy drug called Maytansine to the Herceptin molecule.
The Herceptin then acts as a transport mechanism, so to speak, to take this chemotherapy molecule
to the cancer cell and one would hope, have a higher kill rate with the TDM-1, that is
the Herceptin chemotherapy conjugate, rather than Herceptin alone, and that’s another
drug that’s coming down the pike, so to speak, that looks very exciting.
Other areas of research are obviously newer drugs: Afinitor, it’s what’s called an
mTOR inhibitor targeting one of the other pathways of breast cancer growth that again,
in a recent San Antonio meeting, seemed to indicate that Afinitor, in combination with
hormone therapy, may double the length of response to hormone therapy.
There are innumerable targeted agents coming down the pike from various pharmaceutical
companies looking at all of the different pathways that are involved in breast cancer
growth. So I think that in the next five or ten years, we can expect a multitude of new
drugs, many of which are probably targeted to a small population of breast cancer patients,
based on measurement of their particular pathways, but they will ultimately be given in combination,
and we would hope, with less toxicity and higher cure rate.
Hi, I am Dr. Jay Harness and I want to share with you important information that I believe
that every newly diagnosed patient with breast cancer needs to know.
Susan Denver: I am a breast cancer survivor.
Katherine Stockton: I am a breast cancer survivor.
Coree: I am a breast cancer survivor.
Susan Denver: And I want every woman to know…
Katherine Stockton: …about personalized breast cancer treatment…
Susan Denver: …and the genomic test.
Coree: A test that helps guide a woman and her doctor…
Katherine Stockton: …to the best treatment options for her.
Susan Denver: Pass it on!