HER2 Metastatic Breast Cancer Treatment

In this clip, Dr. David A. Margileth discusses the recent advances in treatment options for HER2 metastatic breast cancer patients and the various instances in which they may be used. He also goes on to mention some promising new drugs that are currently in clinical trials and have not yet reached the market.

David A. Margileth, MD:  Probably the biggest advance in breast cancer in the last 10 years has been the discovery of the effectiveness of the drug called Herceptin.  This was developed and initially researched at UCLA by a physician Dr. Dennis Slamon and Herceptin has transformed the treatment of HER2 positive breast cancer in a sense that many many patients are cured with chemotherapy regimens, including Herceptin but unfortunately not all.

In the past, HER2 positive breast cancer was one of the more aggressive kinds of breast cancer and treatment with Herceptin has increased the cure rate of patients newly diagnosed with HER2 positive breast cancers.  Unfortunately, not all patients are cured and will have a recurrence of HER2 positive breast cancer in bone, liver, lung, and unfortunately often brain.  HER2 positive breast cancers do have an increased incidence of brain metastases, which obviously can be very difficult to treat.

In patients with metastatic HER2 positive breast cancer, one would approach the treatment with some anti-HER2 drug.  If the time between the initial therapy and the recurrence is over a year, one would generally go back to a Herceptin-based regimen such as Herceptin plus Taxol or Herceptin plus Navoban, or any one of any combinations of anti-Her2 therapy.  The other anti-HER2 drug that is available is a drug called Tykerb, which is an oral drug, which can also be quite effective in patients who have progressive metastatic disease on Herceptin.

Some anti-HER2 therapy should be continued indefinitely in such patients and various chemotherapy regimens can be used to treat the disease and hope to cause a response to the metastatic disease and therefore increase the patient’s life expectancy.

One of the most common and one of the most researched areas of breast cancer now is looking at a whole series of other anti-HER2 drugs.  The two that probably will be coming on the market, possibly in the next six months, is a drug called Pertuzumab and another drug called TDM1.  Both of these have had some excellent results in metastatic breast cancer and once approved, will be available for such patients and we will hope would further extend the patients lives who have metastatic HER2 positive disease.

In addition, those drugs will start to be used in the adjuvant setting, possibly in combination with other anti-HER2 drugs to increase the chance of cure and therefore decrease the incidence of metastatic disease.

Dr. David A. Margileth practices medical oncology at St. Joesph Hospital in Orange, CA specializing in oncology, hematology, and internal medicine (board certified). His selected area of interest is breast cancer. Dr. Margileth graduated from Baylor College of Medicine in 1971 and has since spent time treating patients at the National Cancer Institute and Methodist Hospital in Houston, TX.
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