New presurgery drug approved for early HER-2 breast cancer

Women with early-stage HER-2 positive breast cancer may benefit by taking a drug called pertuzumab (Perjeta) before undergoing breast surgery. By shrinking breast tumors before surgery, the drug is expected to lead to less invasive operations and a greater chance of a cure.

Perjeta was initially approved in 2012 to treat late-stage breast cancer that had spread to other parts of the body. Yesterday the FDA approved it for pre-surgery use.

Keep in mind that the use of Perjeta before surgery has only been approved for women with HER-2 positive breast cancer. In this form of the disease, which affects accounts for one in five cases of breast cancer, the malignant cells overproduce something called human epidermal growth factor receptor-2. Such tumor cells tend to be more aggressive than other types of breast cancer cells.

Changing treatments

In the 1950s, the standard treatment for breast cancer was removal of the entire breast, the surrounding lymph nodes, and tissues underneath the breast. This is known as a radical mastectomy. Most often the operation was followed by radiation.

By the 1970s, chemotherapy had been added to the mix. Powerful drugs killed rapidly dividing cancer cells. But the therapy also killed normal cells. Side effects could be horrendous and infections caused by killing bone marrow cells could be deadly.

Today there are other less invasive and less harmful approaches.

One of the most important strides forward is the understanding that breast cancers aren’t all the same. Thanks to advances in molecular biology, clinicians are better able to determine which breast cancers can be safely eliminated with surgery, which will respond to hormone treatments, and which require chemotherapy.

The HER-2 story is part of this new understanding. Until recently, a biopsy showing HER-2 positive cancer didn’t usually change a woman’s initial treatment. It was usually surgery, most often a lumpectomy, and possibly radiation to follow. A drug that directly attacks the HER-2 cells, such as trastuzumab (Herceptin) or lapatinib (Tykerb) would also be part of the mix.

The approval of Perjeta use before surgery offers women with HER-2 breast cancer another option.

Therapy is personal

Breast cancers are as diverse as the women who have them. And treatment options reflect those differences. Breast cancer specialists try to set up personal therapy based on details gleaned from a biopsy, staging results, and a woman’s personal preferences.

Key details include:

  • The cell type of the cancer. Some abnormal breast cells that have been labeled as cancer don’t behave as typical breast cancers.
  • The size of the cancer. This correlates with prognosis.
  • The presence or absence of tumor markers. Is the tumor positive or negative for estrogen, progesterone and/or HER-2 receptors?
  • Evidence of spread. Is there any evidence that the breast cancer cells have spread beyond the breast to lymph nodes?

These are just the basics. Cancer doctors today have additional targets for directed therapy, with more in the pipeline. But how soon we will hit the bull’s eye—higher cure rates with fewer side effects—is still anyone’s guess.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Suppose you find fifty righteous people living there in the city—will you still sweep it away and not spare it for their sakes? (Genesis 18:24) And the Lord replied, “If I find fifty righteous people in Sodom, I will spare the entire city for their sake.” (Genesis 18:26)

And be sure to say, ‘Look, your servant Jacob is right behind us.’” Jacob thought, “I will try to appease him by sending gifts ahead of me. When I see him in person, perhaps he will be friendly to me.” (Genesis 32:20)
to say to you: ‘Please forgive your brothers for the great wrong they did to you—for their sin in treating you so cruelly.’ So we, the servants of the God of your father, beg you to forgive our sin.” When Joseph received the message, he broke down and wept. (Genesis 50:17)

“Forgive my sin, just this once, and plead with the Lord your God to take away this death from me.” (Exodus 10:17)
Pay close attention to him, and obey his instructions. Do not rebel against him, for he is my representative, and he will not forgive your rebellion. (Exodus 23:21)

Moses Intercedes for Israel The next day Moses said to the people, “You have committed a terrible sin, but I will go back up to the Lord on the mountain. Perhaps I will be able to obtain forgiveness for your sin.” (Exodus 32:30) So Moses returned to the Lord and said, “Oh, what a terrible sin these people have committed. They have made gods of gold for themselves. (Exodus 32:31) But now, if you will only forgive their sin—but if not, erase my name from the record you have written!” (Exodus 32:32)

The Lord passed in front of Moses, calling out, “Yahweh! The Lord! The God of compassion and mercy! I am slow to anger and filled with unfailing love and faithfulness. (Exodus 34:6) I lavish unfailing love to a thousand generations. I forgive iniquity, rebellion, and sin. But I do not excuse the guilty. I lay the sins of the parents upon their children and grandchildren; the entire family is affected— even children in the third and fourth generations.” (Exodus 34:7)

And he said, “O Lord, if it is true that I have found favor with you, then please travel with us. Yes, this is a stubborn and rebellious people, but please forgive our iniquity and our sins. Claim us as your own special possession.” (Exodus 34:9)
just as he does with the bull offered as a sin offering for the high priest. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:20) Then he must burn all the goat’s fat on the altar, just as he does with the peace offering. Through this process, the priest will purify the leader from his sin, making him right with the Lord, and he will be forgiven. (Leviticus 4:26)

Then he must remove all the goat’s fat, just as he does with the fat of the peace offering. He will burn the fat on the altar, and it will be a pleasing aroma to the Lord. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:31) Then he must remove all the sheep’s fat, just as he does with the fat of a sheep presented as a peace offering. He will burn the fat on the altar on top of the special gifts presented to the Lord. Through this process, the priest will purify the people from their sin, making them right with the Lord, and they will be forgiven. (Leviticus 4:35)

The priest will then prepare the second bird as a burnt offering, following all the procedures that have been prescribed. Through this process the priest will purify you from your sin, making you right with the Lord, and you will be forgiven. (Leviticus 5:10) Through this process, the priest will purify those who are guilty of any of these sins, making them right with the Lord, and they will be forgiven. The rest of the flour will belong to the priest, just as with the grain offering.” (Leviticus 5:13)

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