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A Changing Arsenal

Doctors Make Most of New Technologies

Today, when it comes to treating cancer with drug therapy, the treatments are as unique as the cancer patient themselves, with more positive outcomes than ever before.

That represents a change over treatment in years past. The medical management of breast cancer used to be simple: a woman either got chemotherapy—a three-drug regimen called “CMF”—or she didn’t. If her cancer was “hormone responsive,” she took tamoxifen.

Today things aren’t so simple. There are over a dozen treatment regimens and therapy has expanded to include new classes of drugs. And that’s exciting news, according to the NorthBay Cancer Center team, led by oncologists Dr. James Long, Dr. Brian Vikstrom and Dr. Florian Ploch. “We’ve made really big strides,” says Dr. Long. “You don’t go into oncology because you’re a pessimist. Breast cancer is not a hopeless diagnosis. We are making a difference and saving lives.”

Gene profiling, new and more effective drugs, and targeted therapies now allow cancer treatments to be tailored to a woman’s individual medical situation and personal preference, and are used—where applicable—in conjunction with surgery and radiation.

Is the lump small or large? Has the cancer spread to lymph nodes? Is the newly diagnosed patient of child-bearing age (pre- or post-menopausal)? Does she have a heart condition? Answers to these questions help determine a patient’s particular course of treatment. “It’s no longer considered to be a ‘one-size-fits-all’ disease,” explains Keni Horiuchi, clinical nurse specialist/patient care coordinator.

Gene Profiling More Common

Oncologists are also asking another important question: What is the genetic make-up of the tumor? For selected patients, oncologists now have access to a new technology called genetic profiling. “Gene profiling has become much more common, especially over the past two years,” says Dr. Vikstrom. “Researchers have learned that different breast cancers express different genes to make different proteins in different quantities. These differences can affect the growth and behavior of the cancer as well as make it more sensitive or resistant to different therapies.”

Hormones and Proteins: Their Role in Cancer Growth

Hormones—estrogen and progesterone—stimulate growth of normal cells and have been found to play an important role in breast cancers. Tumors are tested to see if the cells have receptors for estrogen receptors (ER) and progesterone receptors (PR). If they do, certain drugs that block hormones or change the receptors on the tumor can stop the growth of the cancer. Up to 80 percent of breast cancers may be found to have some level of hormone sensitivity.

Researchers have also found that up to 20 percent of breast cancers have more HER2 genes in the cell and increased HER2 protein receptors on the surface of the cell. These tumors are more likely to grow and spread rapidly. Certain drugs, such as trastuzumab (Herceptin), target the HER2 receptor to stimulate the body to remove cancer cells and also block breast cancer cell growth. But they can affect the heart and may not be the treatment of choice for a woman with heart problems.

New Drugs ‘Target’ Cancer Cells

Trastuzumab belongs to a new class of medications called targeted therapy. This class of drugs can “target” a variety of proteins that are responsible for cancer growth. Other targeted drugs such as bevacizumab (Avastin) and lapatinib (Tykerb) are being used successfully to treat women with breast cancer.

Some side effects of breast cancer treatment­­—such as hair loss through chemotherapy—are mostly temporary, while others—such as infertility—may not be. With more drug options available, and a personal profile closely monitored by a pharmacist who specializes in breast cancer, “we can look at other drugs,” that may minimize unpleasant side effects, says Horiuchi.

The NorthBay Cancer Center team uses guidelines from the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO). “The guidelines really help us tailor treatment based on the disease’s characteristics, and the woman’s characteristics,” says Horiuchi. “Yes, breast cancer treatment has become more complicated over the past decade,” she adds, “but we have more drugs and more choices. And that’s a good thing.”

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