It is easier to develop new treatments for common diseases than it is for rare diseases, because more patients can be enrolled on clinical trials. Clinical trials are the only way to develop safe, effective treatments for any disease. The fact that breast cancer is so common has allowed for development of many new treatments, thanks to thousands of women who have volunteered for cancer clinical trials. These clinical trials have resulted in rapid improvement in treatment options for patients with breast cancer.
Surgical treatment has evolved.
Surgical treatment has evolved since the first mastectomy over 100 years ago. Breast surgery has become less extensive, and some procedures do not require an overnight hospital stay. The original radical mastectomy was replaced by a more limited mastectomy, and now lumpectomy can be performed in many cases, as long as radiation is given afterwards. Lumpectomy just removes the lump, sparing the breast itself. Less invasive techniques to remove lymph nodes have been developed, to reduce chronic arm pain and swelling after surgery. Results on this sentinel lymph node procedure from a clinical trial in Europe were encouraging, and a second clinical trial in the US will be published in the next several years. This less extensive surgery for lymph nodes may soon become the standard procedure.
New chemotherapy is improving care.
Many women with breast cancer will relapse after surgery. The first evidence that chemotherapy could reduce relapses came in 1976, and since then new chemotherapy cocktails have given even better results. The newer chemotherapy has also increased our treatment options for relapsed patients. Some of the newer drugs include epirubicin, gemcitabine, navelbine, and xeloda. Treatments are probably more effective if given every two weeks, rather than the traditional 3 weeks, although there are more side effects. This approach is called dose-dense treatment, which requires extra injections to prevent low blood counts.
New ways to improve efficacy and reduce size effects
Another approach is mixing new additives with older drugs, to minimize side effects and increase their effectiveness. Tiny lipid particles called liposomes have been added to the older drug adriamycin, minimizing side effects but maintaining the effectiveness. Another new drug Abraxane was just approved by the Food and Drug Administration for breast cancer. Abraxane is produced by adding albumin to Taxol, an older drug, which results in a more effective treatment with fewer side effects.
Hormonal therapy is another exciting area, with many new drugs on the market. The original tamoxifen treatment has been surpassed by newer drugs called aromatase inhibitors, which include arimidex, femara, and aromasin. These drugs can reduce relapses after surgery, and can treat relapsed breast cancer better than tamoxifen, but are only effective in menopausal patients. Faslodex is another new drug, and may be even more effective than aromatase inhibitors.
Herceptin is another exciting drug that works in a subset of breast cancer called Her-2-Neu positive. It is a biotechnology product, which binds to the surface of breast cancer cells and kills them. Herceptin used alone or with chemotherapy is effective in relapsed breast cancer, and is
being tested for relapse prevention in patients who have had surgery.