The Miracle of Herceptin for Breast Cancer

Has your breast cancer been cured by Herceptin?

This is not a new story, but it is one worth remembering. Most women with breast cancer are aware of the "miracle drug" Herceptin/Trastuzumab. It has changed the prognosis for women with this kind of breast cancer from an often lethal disease to one that can often be effectively treated. I have heard several oncologists say that it has "leveled the playing field" for women with HER2-positive breast cancer as compared to those with other types of the disease. One oncologist even told me that, if she is ever diagnosed with breast cancer, she hopes that it is HER2-positive. This is a strong statement that reflects the incredible impact a single drug breakthrough can make.

The drug is a monoclonal antibody that is administered by IV, usually for a total of one year for adjuvant breast cancer treatment. Almost always, it is given together with chemotherapy. In 2010, the results of four important clinical trials were announced. The findings were that one year of Herceptin plus standard adjuvant therapy significantly reduced the risk of disease recurrence and extended overall survival. At the American Society of Clinical Oncology (ASCO) meeting where these results were shared, the room erupted in a standing ovation--not a typical medical conference experience. Several people who were there have told me that the crowd's reaction (and it was standing room only with others in rooms where they could watch a screen) was similar to the end of the Super Bowl.

This has also long been an important drug in the care of women who have HER2-positive metastatic breast cancer. One concern, in both settings, has been the risk of cardiac damage associated with the drug. Cardiac function is carefully monitored for women receiving Herceptin (or its close cousins), and sometimes women need to take treatment breaks. You can learn more about cancer treatments and care at BIDMC here and our cardio-oncology program here.

More recent studies have indicated that Herceptin does not cause long-term damage to cardiac function, other cardiac symptoms or overall QOL (quality of life) for women treated for HER2-positive breast cancers. Fortunately, only a very small percentage of women so treated experience serious cardiac issues. However, the risk is an especially important consideration for women who are being treated for metastatic breast cancer. Since they will be on treatment indefinitely, there has been worry about a drug that is very effective in fighting cancer but might cause harm in other ways. That is, it would not make a lot of sense to effectively treat the cancer while simultaneously damaging someone's heart.

When Herceptin was first being used in the US in the late 1990s, it was only available through clinical trials. I remember one woman who was diagnosed with this kind of breast cancer shortly after the highly successful trials were reported. The drug was just becoming available off trial, and she “begged” (her word) her oncologist to prescribe it for her. She did, and Carol is completely well 20 years later, something that she never expected might happen.

Thinking about Herceptin is a good way to consider the advances in breast cancer research and treatment. Many other drugs have been approved by the FDA since 2010, but I can’t think of one that has had the positive impact of this drug. Every now and then there is something revolutionary in cancer care; another example would be Gleevec for treatment of certain kinds of leukemia and gastrointestinal stromal tumor (GIST). Much more often, a drug becomes available that certainly helps, but takes us small steps forward. The common pace of research is slow step by slow step, each discovery building on those that have come before. It is easy to be frustrated by this trajectory and to wish for more miracle moments.

I am currently working with a wonderful gay man who is being treated for a brain tumor. He remembers the HIV/AIDS epidemic and the painful loss of so many friends. He says that the goal then was to stay around until more effective drugs were discovered. As we know, HIV/AIDS has been transformed to a chronic illness. Yes, people have to take many medications, and that can be challenging, but it is no longer a death sentence.We now have a similar challenge for all of us who are living with cancer: trying to stay alive and well as long as possible as we await more treatments that can help us.