Hope drug for breast cancer: Oncologist calls for trials in early stage patients

A new study, that shows how a new drug targeted cancer cells with “laser-like precision” and helped prolong the lifespan of terminal patients with metastatic breast cancer, has created a buzz among oncologists.

The New York Times reported that the study, which was presented at the annual meeting of the American Society of Clinical Oncology and published Sunday in the New England Journal of Medicine, showed that the drug slowed down tumour growth and extended life “to an extent rarely seen with advanced cancers”.

One of the oncologists who has been tracking this study since 2021 was Dr Ramesh Sarin, senior consultant and surgical oncologist with Indraprastha Apollo Hospital, New Delhi. “We had discussed this new line of treatment at a medical conference in the US in 2021. Now since the second round of trials is over, there is hope that this could be rolled out. But I must clarify that the trial was conducted on patients with advanced and recurrent cancer who did not benefit at all from established lines of treatment. Now, it has to be tried out in early cases of breast cancer and we must see if the results are just as good. The patients who took the experimental drug, Trastuzumab Deruxtecan, survived for 23.9 months with a good quality of life, as compared to 16.8 months for those who received chemotherapy. If its efficacy is as good in the early stages of the disease, then it should work at least in about 90 per cent of the cases. Once trials in early stage cancer patients are equally successful, then we can actually see hope. Besides, its impact has also got to be assessed at varying levels of HER2 protein.”

The trial focused on a particular mutant protein, HER2. “In patients who are HER2-positive, this protein multiplies and produces copies. This leads to a much larger spread of breast cancer. Now, 15 to 20 per cent of invasive breast cancers are HER2 positive. That’s a sizeable number. Since 2005, the research and development has ensured that new drugs can target and block HER2, rapidly increasing survival chances in early stages of cancer patients. Herceptin was approved for the treatment of early-stage breast cancer and was found effective in combination with chemotherapy in 60 per cent of patients, by destroying the tumour completely. Since then, many Herceptin-like drugs have been included in the treatment protocol and have pushed recovery rates up to 70 to 75 per cent. We have been using Pertuzumab, which is a monoclonal antibody used in combination with Trastuzumab and Docetaxel for the treatment of metastatic HER2-positive breast cancer. It is also used in the same combination as a neoadjuvant in early HER2-positive breast cancer. This latest drug is also an upgrade of that except that it also integrates the chemotherapy component and the results have been the most positive till date,” Dr Sarin explained.

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According to The New York Times, the clinical trial was sponsored by pharmaceutical companies Daiichi Sankyo and AstraZeneca and led by Dr Shanu Modi of Memorial Sloan Kettering Cancer Center. “It involved 557 patients with metastatic breast cancer who were HER2-low. Two-thirds took the experimental drug, Trastuzumab Deruxtecan, sold as Enhertu; the rest underwent standard chemotherapy. In patients who took the drug, tumors stopped growing for about 10 months, as compared with five months for those with standard chemotherapy,” the report said.

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