New treatments for metastatic cancer?
Meet the Experts
Andrew D. Seidman, M.D. is an attending physician for the Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, and a professor of medicine, Joan and Sanford I. Weill Medical College of Cornell University.
Jennifer Armstrong, M.D. is a breast cancer oncologist at Paoli Hematology-Oncology Associates in Paoli, Pa., with a special interest in physicians' communication skills.
Question from DJR: I was diagnosed with breast cancer in 2000, and did Adriamycin and Cytoxin. In 2004 I had metastasis to the liver and did taxol/carboplatin/Herceptin for 8 months. (It didn't help, so I did holistic for a year which lowered markers to normal and I felt great for a year.) I am now on my 6th treatment of Herceptin and Navelbine, which is lowering my markers. Since this is salvage treatment and will only work for so long, what treatment options are next? Is there anything new in the near future?
- Answers —Andrew Seidman, M.D.: Thank you for sharing your case with us, because I think it allows us to reflect on the management of breast cancer that has progressed despite Herceptin/chemotherapy combinations. Many physicians choose to continue Herceptin even when cancer progresses during its use with the hope that it will enhance the effectiveness of yet another chemotherapy drug that would be administered next. Unfortunately, whether this is true has never been studied in a clinical trial. The only study to show benefit for using a HER2 targeted therapy in a patient with advanced breast cancer with progression despite Herceptin was a study presented at ASCO (American Society of Clinical Oncology) just this past spring. In this trial, 528 women with HER2-positive metastatic breast cancer who, like yourself, had previously been exposed to an anthracycline such as Adriamycin (chemical name: doxorubicin) and a taxane such as Taxol were randomized to receive Xeloda (chemical name: capecitabine), or Xeloda plus lapatinib, also known as Tykerb. In this study presented by Dr. Charles Geyer, there was a significant improvement in the time it took for cancer to progress when lapatinib was added to Xeloda, compared to Xeloda alone. The drug lapatinib is not yet FDA approved, although its manufacturer, GlaxoSmithKline, has created an expanded use program which may be relevant for your future care and for the care of other women like yourself whose cancers have progressed despite Herceptin.
- Jennifer Armstrong, M.D.: There are also other chemotherapy agents that you may not yet have been exposed to, which might include Xeloda or Gemzar (chemical name: gemcitabine).
On Wednesday, July 19, 2006, our Ask-the-Expert Online Conference was called Targeted Therapies: What is Right for You?Andrew Seidman, M.D. and moderator Jennifer Armstrong, M.D. answered your questions about different kinds of targeted therapies and how they work.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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