Oct. 25, 2005 - Adriana Jenkins was 31 when she learned that the lump in her breast was not a cyst, as she'd suspected, but breast cancer. "My first reaction was: I can't have cancer, I am getting married in three months!" remembers Jenkins, a jewelry designer in Boston. Then she thought: "Am I going to die?"
Had she gotten her cancer just a decade earlier, there's a good chance she would have. "Fifteen years ago, women with metastatic cancer [as Jenkins had] would die within a year or two," says Dr. Christine Pellegrino, an oncologist at the Montefiore Medical Center in New York. "If you get breast cancer now, it's no longer a death sentence. We have so many more treatment options today, it takes awhile to exhaust them all."
Breast cancer is still the most common form of the disease in women besides cancers of the skin. About 211,240 women (and an estimated 1,690 men) in the United States will be diagnosed with invasive breast cancer this year, and more than 40,000 will die from the disease. But there are also more than 2 million women living with the disease today--and surviving much longer than they would have in the past. "It is amazing what we know now," says Dr. Aman Buzdar, deputy chair of the department of breast and medical oncology at the M. D. Anderson Cancer Center in Houston. "The earlier you seek help, the higher probability you will be treated successfully and cured. But even at later stages, with all the interventions and therapies now available, a very high percentage can remain alive and free of cancer."
Perhaps the most significant new treatment to emerge in the past few years is the one Jenkins credits for saving her life: Herceptin. The prospects weren't especially encouraging for her initially. Not only did she have cancer, she had a particularly aggressive form of it. The disease had already progressed to stage III and spread to her lymph nodes. Her doctors told her that even with surgery and traditional chemotherapy, she had only a 30 to 40 percent chance of being cancer free in five years But there was some good news. The overproduction of protein that had made Jenkins's breast cancer so virulent, she learned, had also made her eligible to participate in a trial at the Dana Farber Cancer Institute to analyze the use of Herceptin as an adjuvant, or additional, therapy. Her tumor was expressing a protein called human epidermal growth factor receptor-type 2 (or HER2), a problem that affects 20 to 30 percent of all breast cancer patients.
The excess protein signals for cells in the breast to divide, multiply and grow at a faster rate than normal cells, contributing to the progression of cancer. It used to be a guarantee of a poor prognosis. But Herceptin, which is made by Genentech, specifically targets HER2, blocking the effects of the protein.
Within two weeks, Jenkins had enrolled in the trial and started the treatment. For 12 weeks, she got a weekly infusion of Herceptin and Navelbine, a chemotherapy drug. By the fourth week, her tumor had shrunk so much her doctor could no longer feel it. Not only that, the drug appeared to mitigate the effects of chemotherapy. When she got married, in September 2001, Jenkins still had her long dark hair, but her tumor had shrunk dramatically. She was able to wait until after her wedding to undergo a mastectomy and a course of chemotherapy, and finally, six weeks of radiation. Then the newlywed received another 52 weekly infusions of Herceptin. By the time Jenkins got her last treatment in the summer of 2003, there were no signs of cancer. "It was a miracle for me," she says. "It basically erased my cancer."
Herceptin was initially approved by the Food and Drug Administration in 1998 for use in HER2-positive women with metastatic breast cancer (meaning the cancer has spread beyond the breast to other parts of the body). Later trials revealed a 24 percent increase in median overall survival for women with HER2-positive metastatic breast cancer who were treated initially with Herceptin and chemotherapy, like Jenkins, rather than with chemotherapy alone. Studies have also shown that the drug may cause cardiac problems, but only in a small percentage of patients. (In another three-year trial, about 3 to 4 percent more patients taking Herceptin plus chemotherapy, versus chemotherapy alone, had congestive heart failure or other cardiac problems).
Earlier this year, HER2-positive breast cancer patients got even more good news. In May, the interim results of an analysis of 3,300 patients in two major trials that compared the use of Herceptin with chemotherapy to chemotherapy alone were released at the annual meeting of the American Society of Clinical Oncology. "You could have heard a pin drop when they released the results," remembers Pellegrino, the Montefiore oncologist, who attended the conference.
The results of the analysis, which were also published last week in The New England Journal of Medicine, showed that women with early stage HER2-positive breast cancer who received Herceptin in combination with chemotherapy cut their risk for breast cancer recurrence by 52 percent, and their risk of death by 33 percent, when compared with women who just received the chemotherapy. After four years, only 15 percent of women who'd been treated with Herceptin plus chemotherapy experienced a recurrence of the cancer, compared to one third of the women who'd just had chemotherapy. "We found something that is directly affecting people's lives, bringing them hope," says Dr. Edith A. Perez, an oncologist at the Mayo Clinic in Jacksonville, Fla., who chaired one of the two trials (known as the North Central Cancer Treatment Group). "We are curing women here."
Donna Fagan counts herself among them. It's been five years since Fagan, a patient of Pellegrino's, was diagnosed with breast cancer. "I really believe I am alive because of Herceptin," says the 49-year-old artist, who lives in New York City. "It's part of the personality of my cancer that it grows really fast. And Herceptin just zapped it."
Herceptin may be creating the most buzz, but it is not the only new treatment giving breast cancer patients hope. Up to half of those with breast cancer have tumors that are dependent on the female hormone, estrogen, to grow. Tamoxifen, which was approved in 1977, remains the standard treatment for postmenopausal women with this type by blocking a tumor's ability to use estrogen. But new data has shown that switching certain breast cancer patients at two years from tamoxifen to a new form of treatment called aromatase inhibitors, which lower the body's production of estrogen, may provide more protection against recurrence. Three aromatase inhibitors have been approved by the FDA already: AstraZeneca's Arimidex, Pfizer's Aromasin and Femara by Novartis. And they are all showing promising results in trials (though not as dramatic as the risk reduction shown with Herceptin).
There's also encouraging new data on the link between diet and breast cancer. Another study presented at the American Society of Clinical Oncology meeting found that eating a low-fat diet reduced the risk of breast cancer recurrence by 20 percent over five years in postmenopausal women compared with women following a standard diet. The data was drawn from the Women's Intervention Nutrition Study, a large-scale clinical trial of more than 2,400 women, but focused on postmenopausal breast cancer survivors who'd had surgery and radiation plus hormonal treatments or chemotherapy. "We know it is highly protective to eat a plant-based diet, packed with nutrients," says Dr. Christine Horner, a New Mexico surgeon and author of "Waking the Warrior Goddess: Dr. Christine Horner's Program to Protect Against & Fight Breast Cancer," which was published this spring by Basic Health Publications. Horner, who treats many breast cancer patients, recommends a low-fat diet that includes cruciferous vegetables like broccoli and cauliflower, green tea, maitake mushrooms and spices like turmeric (a yellow spice used extensively in Indian cooking)--all of which, she says, have demonstrated anticancer effects. Researchers have also been examining the role of fat tissue in breast cancer recurrence. Though it's still not clear if extra body fat increases the risk of recurrence, many health experts like Horner recommend exercise--even if it's moderate, like walking--and other weight-management techniques for their patients. Low-fat diets and regular exercise have been shown to help lower the risk of other diseases as well. And as more people survive breast cancer, adopting healthy habits to ward off other diseases becomes more important.
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