Towards personalized breast cancer treatment
Posted: Wednesday, October 10, 2007 4:50 PM by Barbara Raab
By Robert Bazell, NBC News chief science correspondent
Something called "personalized medicine" has been the holy grail of biomedical science for several years now. The idea is that every patient is different and that a disease like breast cancer, even though it has one name, comes in many forms. The goal, then, is to tailor the therapy to the specific patient and the specific form of disease to maximize the benefits and minimize the side effects.
Tonight we report on two big movements toward personalized medicine in breast cancer treatment. For several decades some of the biggest progress against breast cancer has come through the use of something called adjuvant therapy. Soon after the initial surgery and radiation the patient gets either hormones and/or chemotherapy drugs to reduce the chances the cancer will return.
In many cases doctors have been using a "one size fits all" approach – giving the same combinations of drugs to many patients. But the drugs don’t help all patients and they can have severe side effects. The good news is that as scientists are understanding more about the biology of breast cancer they are learning which drugs work, and which don’t, as adjuvant treatments.
In one study a group of doctors looked at which patients benefit from taxol and similar drugs. The study found that about half the women who have been getting it might not benefit. If confirmed by further studies this would be crucial information because taxol-like drugs cause not just the familiar nausea and hair loss but can bring on temporary or permanent nerve damage.
You can read the actual research from the New England Journal of Medicine and the editorial about them.
Other studies concern drugs called antrhacylines; adriamycin is the most familiar. These can cause heart damage in and rare cases leukemia. I wrote a column when this information was first being talked about at a cancer meeting last June. Since then much of it has been published.
A crucial word of caution here: Many oncologists worry that women will over-react to this information and forego treatments that could be life saving. Determining which patients benefit from which drugs is a difficult and evolving science. It involves knowing not just familiar things about tumors, such as whether they are fed by the female hormone estrogens, but also whether they have certain molecules on their surface such as Her-2 which affect how the tumors grow. New tests are appearing regularly. So the answer to the question of "What treatment is best for me?" will become more complex. But that is good because it shows that we are moving toward personalized medicine.
