New presurgery drug approved for early HER-2 breast cancer

Women with early-stage HER-2 positive breast cancer may benefit by taking a drug called pertuzumab (Perjeta) before undergoing breast surgery. By shrinking breast tumors before surgery, the drug is expected to lead to less invasive operations and a greater chance of a cure.

Perjeta was initially approved in 2012 to treat late-stage breast cancer that had spread to other parts of the body. Yesterday the FDA approved it for pre-surgery use.

Keep in mind that the use of Perjeta before surgery has only been approved for women with HER-2 positive breast cancer. In this form of the disease, which affects accounts for one in five cases of breast cancer, the malignant cells overproduce something called human epidermal growth factor receptor-2. Such tumor cells tend to be more aggressive than other types of breast cancer cells.

Changing treatments

In the 1950s, the standard treatment for breast cancer was removal of the entire breast, the surrounding lymph nodes, and tissues underneath the breast. This is known as a radical mastectomy. Most often the operation was followed by radiation.

By the 1970s, chemotherapy had been added to the mix. Powerful drugs killed rapidly dividing cancer cells. But the therapy also killed normal cells. Side effects could be horrendous and infections caused by killing bone marrow cells could be deadly.

Today there are other less invasive and less harmful approaches.

One of the most important strides forward is the understanding that breast cancers aren’t all the same. Thanks to advances in molecular biology, clinicians are better able to determine which breast cancers can be safely eliminated with surgery, which will respond to hormone treatments, and which require chemotherapy.

The HER-2 story is part of this new understanding. Until recently, a biopsy showing HER-2 positive cancer didn’t usually change a woman’s initial treatment. It was usually surgery, most often a lumpectomy, and possibly radiation to follow. A drug that directly attacks the HER-2 cells, such as trastuzumab (Herceptin) or lapatinib (Tykerb) would also be part of the mix.

The approval of Perjeta use before surgery offers women with HER-2 breast cancer another option.

Therapy is personal

Breast cancers are as diverse as the women who have them. And treatment options reflect those differences. Breast cancer specialists try to set up personal therapy based on details gleaned from a biopsy, staging results, and a woman’s personal preferences.

Key details include:

• The cell type of the cancer. Some abnormal breast cells that have been labeled as cancer don’t behave as typical breast cancers.
• The size of the cancer. This correlates with prognosis.
• The presence or absence of tumor markers. Is the tumor positive or negative for estrogen, progesterone and/or HER-2 receptors?
• Evidence of spread. Is there any evidence that the breast cancer cells have spread beyond the breast to lymph nodes?

These are just the basics. Cancer doctors today have additional targets for directed therapy, with more in the pipeline. But how soon we will hit the bull’s eye—higher cure rates with fewer side effects—is still anyone’s guess.