May 4, 2010 > Breast and Ovarian Cancer
Breast and Ovarian Cancer
New Research Expands Treatment Options
Years ago, the only treatment option for breast and ovarian cancer was radical surgery. Today, thanks to ongoing research, those days are gone. Now patients have a wide range of treatment choices such as less-disfiguring surgery, more precise radiation treatments, combination chemotherapy, hormonal therapy, and even newer therapies that use substances such as antibodies or inhibitors that block various signals for cancer cells to grow.
"The advances in treatments for breast cancer are dramatically improving patients' chances for survival and extending their lives," says Dr. Vandana Sharma, Ph.D., a medical oncologist at Washington Hospital. "We also are making strides in improving treatments for ovarian cancer, which has been more difficult to combat because it often is not detected in the early stages."
To learn more about the latest advances in treatments for breast and ovarian cancer, women are invited to a special evening lecture featuring Dr. Sharma at the Washington Women's Center. The lecture is scheduled for Tuesday, May 11 from 7 to 8 p.m. The Women's Center is located at 2500 Mowry Avenue (Washington West) in Fremont, across the street from Washington Hospital.
One promising new area in breast cancer research involves clinical trials of drugs such as Fosamax and Boniva, which currently are used to treat osteoporosis (loss of bone density).
"There is some evidence that various osteoporosis medications may help prevent breast cancer from spreading to the bones," Dr. Sharma notes. "Washington Hospital recently participated in a clinical trial that was just completed. While our results have not been published yet, there are some published reports that suggest these drugs may reduce recurrence of breast cancer in the bones by up to 30 percent."
Another new class of drugs called PARP (poly ADP-ribose polymerase) inhibitors also is showing promise in treating certain types of breast and ovarian cancers.
"PARP is an enzyme that helps repair the DNA of cancer cells," Dr. Sharma explains. "By blocking the action of this enzyme, PARP inhibitors reduce the ability of tumor cells to repair themselves, making them more vulnerable to being destroyed by chemotherapy. These drugs may help us fight breast and uterine cancers that are caused by mutations in the BRCA1 and BRCA2 genes."
Recent studies of PARP inhibitors also have shown improved outcomes for patients with "triple-negative" breast cancer. Most breast cancers have "receptors" for estrogen and/or progesterone on the cells, so these hormones promote the growth of the cancer. Breast cancer growth also can be promoted by signals from a protein called HER2 - also called human epidermal growth factor 2. Triple-negative breast cancer is diagnosed when a patient's breast cancer cells have tested negative for all three receptors: estrogen, progesterone and HER2. Only 10 to 20 percent of breast cancers are found to be triple-negative.
"Because patients with triple-negative breast cancer do not have receptors for estrogen or progesterone, their cancer does not respond to hormonal therapy such as tamoxifen or aromatase inhibitors," Dr. Sharma says. "They also do not respond to therapies that target HER2 receptors, such as Herceptin. But triple-negative breast cancers do seem to be sensitive to drugs that inhibit the PARP enzyme."
In addition to these most recent developments, which are still limited to clinical trials, Dr. Sharma also will discuss other treatment advances that are being used more and more commonly:
* Treating the cancer locally with surgery and radiation and then preventing the spread of the cancer with a combination of chemotherapy drugs.
* Using chemotherapy prior to surgery to shrink tumors that are large or inflammatory - or that have spread to multiple lymph nodes that can be easily felt.
* Blocking the production of hormones or inhibiting cancer cells' response to estrogen and progesterone, since approximately 60 percent of breast cancers are positive for hormone receptors.
* Targeting therapy with various drugs that can identify and attack specific cancer cells without harming normal cells.
"Not all treatments are suited to every patient," she notes. "That's why we have a multidisciplinary team of surgeons, radiologists, pathologists, medical oncologists and radiation oncologists working together to develop individual treatment plans for each patient.
"The most important factor in developing a course of treatment for breast or ovarian cancer is to determine the 'stage' of the cancer, finding out if the cancer cells have spread to other parts of the body," she adds. "It's also important to find out how aggressive the tumor is."
Stage I cancer is very small and has not spread to nearby tissues. Stage II cancer has spread to nearby areas, bit is still in the primary site. Stage III cancer has spread throughout the nearby area, and Stage IV cancer has spread to other parts of the body.
"Stages I, II and III for breast and ovarian cancer are generally possible to cure," Dr. Sharma says. "Stage IV disease is not curative, but it is highly treatable, and there are a variety of treatment options that can make the cancer go into remission and thus extend and improve the quality of life. We've made many advances in reducing the toxicity of chemotherapy drugs, and we've also developed new supportive medications that reduce and prevent adverse side effects such as nausea and infections."
To register for the May 11 lecture or to obtain more information about the Women's Center's Evening Lecture Series and a variety of special events and support groups, visit the Washington Hospital website at www.whhs.com and click on the link for Women's Health under "Programs and Services."