EULALEE THOMPSON
A NEW use for an 'old' drug, Herceptin, has cracked open the window of hope for improved breast cancer management.
Herceptin (trastuzumab) is normally used in women with advanced stages of a particularly aggressive kind of breast cancer (linked to the HER2 gene) following chemotherapy. It has been in usage in the United States since 1998, to block the activity of the protein and in so doing prevent the recurrence of the cancer.
However, clinical trials of Herceptin (recently published in the New England Journal of Medicine) show a significant reduction in the risk of recurrence of the cancer in the early stage after chemotherapy. The trials were conducted by the Breast International Group, together with the European manufacturer of Herceptin, Roche. The trial began with 5,000 women in 2001, living in 39 countries, experiencing HER2 cancer in the early stages.
The news, in a field where good news is hard to come by, has been greeted, by many overseas scientists, with many superlatives such as 'simply stunning' and that Herceptin could possibly lead to 'a cure' for breast cancer. The chairwoman of the Breast International Group, Dr. Martine Piccart, was quoted as saying that results were significant and huge for women threatened by breast cancer.
"I can't stress enough how crucial it is that all patients' breast tumours are tested appropriately at initial diagnosis, and if patients are HER2-positive, that they have access to Herceptin," Piccart was quoted as saying.
CONTROLLED ENTHUSIASM
The drug is also used here in Jamaica for breast cancer management but enthusiasm about its proposed new use was much more controlled.
"(The drug) is going to go to a specific group (those with the aggressive form of the cancer) and it is very expensive ... for these two reasons, it is not going to be accessible to all patients and not practical for use generally," said Dr. Michael McFarlane, consultant surgeon and lecturer, University of the West Indies.
The drug costs about $150,000 per course here in Jamaica and it is usually used by breast cancer patients, who can afford it, for one year. In the U.S., the wholesale cost is about US $48,000 (for a year's supply) and about 30,000 pound sterling in the United Kingdom.
Another drug, Tamoxifen, has similar benefits to Herceptin but is not used in breast cancer patients with the oestrogen-positive version of the disease.
So, it seems that even if the drug, Herceptin, can present a breakthrough in breast cancer management, most people still can't afford it. Are we back to square one?
"The overall approach (to breast cancer management) hasn't changed a great deal. The most important thrust is trying to improve early recognition by improving awareness and education so, people can detect (the cancer) at the early stage because it is only early detection and treatment that can alter the natural history of the disease," said Dr. McFarlane.
Hinged to that approach, he said, is that people who detect their tumour early are the ones more suited to breast conservation (lumpectomy) operations. This allows the patient to retain their breast.
INCREASED PLASTIC SURGERY
"Also linked to that is that there is increased awareness of plastic surgery usage, this is referred to as onco-plastic surgery, to achieve adequate cancer care by a surgical procedure and at the same time use the plastic surgery procedure," Dr. McFarlane said.
So it seems that surgery is at least rethinking its readiness to mutilate women's bodies and instead is helping them, as far as possible, to keep their breasts. Dr. McFarlane explained for example, that in one procedure, skin-sparing mastectomy, surgical removal of the disease leaves skin behind for a plastic surgery procedure that reonstructs the patient's breast.
"The results are superb and in a selected group of patients, the nipples can be spared," he said.
There are also procedures called nipple-sparing procedures to at least preserve the woman's nipple and natural appearance of the body.
The surgical procedure is determined by the stage of the cancer, the size of the tumour and the extent of the spread of the cancer.
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