How far has research come since the first Breast Cancer Awareness Month 27 years ago?
BY NANCY McVICAR
For 37 years, Dr. Charles L. Vogel, director of the Women’s Center at Sylvester at Deerfield Beach, has devoted his practice to treating only breast cancer and searching for new ways to improve survival rates.
As the annual Breast Cancer Awareness Month approaches in October, Vogel took some time to talk about the advances that have been made and other promising new approaches.
“What patients need to know,” he says, “because some are afraid of being guinea pigs if they go into a clinical trial, is that’s where you get the most exciting stuff.”
Vogel was among the first to test Herceptin (trastuzumab), a treatment that greatly improves survival chances for women with a particularly aggressive type of tumor classified as HER2 positive, which accounts for about 20 percent of breast cancers. And some of his patients got it in clinical trials years before it was approved by the Food and Drug Administration.
He was a pioneer in expanding trials to local oncologists’ offices, not just major university medical centers, giving patients greater access to promising drugs. The Cancer Research Network he founded is affiliated with the University of Miami Miller School of Medicine’s Sylvester Comprehensive Cancer Center.
“A lot has happened since Herceptin was first approved [in 1998)],” Vogel says. “We’re making really rapid strides in HER2 positive disease. One new drug, Perjeta, (pertuzumab) has just been approved; another exciting one is soon to be approved, and another one next year.”
Perjeta is classified as a monoclonal antibody like Herceptin, but acts in a different way, Vogel says. Monoclonal antibodies are engineered to attach to a defect in the cancer cells, helping your body’s immune system to find and destroy them.
Another approach Vogel says is “very exciting” uses Herceptin as a Trojan horse to deliver a potent chemo drug directly to tumor cells where it is unleashed without harming healthy cells. Results of the study on this combination called T-DM1 were reported in June at the American Society of Clinical Oncology conference.
“It was a very positive study that will allow the company [Genentech] to go to the FDA” for approval, he says.
Advances in other types of breast tumors, those classified as estrogen or progesterone receptor positive, which account for about 65 percent of cases, have also been life-extending. They include tamoxifen, which blocks estrogen from breast tumors in premenopausal women, and a class of drugs called aromatase inhibitors, (anastrozole, exemestane, letrozole), used to cut off the fuel needed by the tumors to grow in post-menopausal women.
In patients who have developed a resistance to hormonal therapy, Vogel says approval of a drug called everolimus is imminent.
“Although not a hormone, it is designed to overcome resistance to hormonal therapy,” he says. “It is the first advance in hormonal therapy in 20 years.”
Vogel says research is continuing to find more effective treatments for an aggressive subtype of breast cancer that accounts for 10-15 percent of cases. They are classified as “triple negative” because they are not HER2, estrogen or progesterone positive.
“We have very little new for them right now, so everybody is looking genomically for targets for triple-negative disease,” he says. “However, we still have chemo which can be very effective in curing early stage triple negative disease and extending life in later-stage disease.”