Evolving treatment landscape in breast cancer: leaps and hurdles
Since the first known description of breast cancer was written in an Ancient Egyptian text over 3,500 years ago and until the modern age, breast cancer has been known as a disease with no cure. However, our increased understanding of cancer generated over recent years coupled with earlier detection and better treatments mean that complete remission is often a reality for patients with early breast cancer, and for many patients with advanced disease, new treatments have also substantially helped improve both the quality and length of life. Overall, there are over 6.3 million women who have had breast cancer and are still alive today. During this year’s Breast Cancer Awareness Month (BCAM), we are taking a look at the progress made in the area of breast cancer and the potential hurdles still lying ahead on the path of finding cure for the disease.
A huge milestone in our understanding of breast cancer was the realisation that breast cancer cannot be defined as one disease. Increased knowledge of molecular subtypes of breast cancer and specific gene mutations allowed us to better understand a person’s risk of being affected by certain cancers, the impact of molecular characteristics on tumour behaviour and the prognostic association between the type of breast cancer and patient outcomes. This knowledge has paved the way to the development of better diagnostics and medicines we have today.
Building on our knowledge
HER2 is one example of an area of research that has benefitted from the expanded understanding of molecular characteristics of the disease. HER2-positive breast cancer is a form of the disease, affecting approximately one in five women with breast cancer and is characterised by aggressive growth and a poor prognosis. It is caused by the overexpression of a protein called HER2 on the surface of tumour cells, due to a gene mutation. This overexpression amplifies the signalling to the cell – driving the cancer cell to grow and multiply faster.
Roche and Genentech have spent 30 years studying the role of HER2 in the development of cancer. During this time we have supported hundreds of clinical studies in this area and have translated this research into the development of three innovative medicines that have been used to treat more than 1.7 million patients worldwide to date.
We need to do more
Despite the significant progress in breast cancer treatment in recent years, there is still so much more to be done. Many patients with early breast cancer continue to progress to advanced disease, and for people who are diagnosed with advanced disease, treatments are still needed to help them live longer, healthier lives. That is why we are committed to continuously challenging ourselves to find better ways to tackle breast cancer.
How we plan to meet the challenge
In pursuit of our vision, our approach is to continue to ask questions. We follow the science to discover how we can build and improve on the progress already made. One example of this is the recognition that we must attack cancer on multiple fronts, and combining targeted therapies to achieve better outcomes is a focus of our ongoing clinical trial programme in breast cancer, as well as across oncology.
Another example is recognising the importance of innovation in the way our medicines are delivered. Innovative formulations and delivery methods have the potential to reduce treatment administration times, increasing convenience for patients and potentially reducing healthcare costs.
We also try to re-think how we design clinical trials for the benefit of patients. For example, one challenge associated with getting new medicines to patients with early breast cancer is that it can take many years to demonstrate the benefit of the treatment in this setting. As such, there is often a significant lapse between the approval of a medicine for the treatment of advanced disease and approval for early disease. That is why we are using a newer endpoint called pathological complete response (pCR), which is used to measure the effectiveness of a medicine given prior to surgery (“neoadjuvant treatment” setting) in someone with early breast cancer. As pCR can be measured within weeks of starting a drug, it can provide a very early indicator of efficacy. This may help inform the approval processes of new medicines for early breast cancer, thus, potentially bringing new treatment options to patients sooner. Use of pCR as an endpoint in clinical trials is an accepted approach by a number of health agencies across the world, including the U.S. FDA, which has already allowed us to bring one treatment to patients with early breast cancer in those countries sooner than it was possible before.
Huge progress has been made in the fight against breast cancer, but until we find the cure there is more to be done. That is why Roche remains fully committed to continuously exploring, expanding our understanding of breast cancer and developing better diagnostics and treatments that lead to real benefits for patients with this devastating disease. For more information search for the #BCAM hashtag on Twitter.