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Breast Cancer and the BioDrug revolution
[mis à jour le 6 June 2007 à 15h59]
With the dawn of the 21st century came trastazumab (Herceptin), a monoclonal antibody that attaches to tumour cells with HER2 surface receptors – the cells that govern the formation of metastases. This signalled a genuine revolution because when used in combination with chemotherapy following surgery, “it increased the pre-relapse period of the disease by 50%”, explained Professor Xavier Pivot of Besançon University Hospital.
Lasting results according to a study by the American National Cancer Institute, coordinated by the Mayo Clinic in Rochester. In fact, the 4-year survival rate in women on the chemotherapy programme who also received Herceptin reached 92.6% compared with 89.4% in the control group. And the clinical cure rate was 85.9% in the first group compared with 73.1% in the second.
Another HER2 receptor inhibitor, lapatinib (Tyverb) developed by the British pharmaceutical firm GSK is currently giving results that are “very significant in progression-free survival of the disease. As a result it has received rapid registration in the United States and we should soon see it in Europe, pointed out Jean-Yves Blay, Scientific Director of CLARA, the Lyons Auvergne Rhône-Alpes Cancer Study Centre. Although not registered in France, this drug nevertheless has a temporary use certificate (ATU). Where cerebral metastases are concerned, “there is a far lower incidence when (lapatinib is) combined with capecitabin (Xeloda)”. An effect that appears to be due to this prodrug’s ability “to cross the hematocerebral barrier. Cerebral metastases represent the most serious threat to women affected by metastatic breast cancer.”
And then there’s anti-angiogenesis…
To complete the chapter of drugs that target HER2 receptors, we can look at the phase II study presented by Spanish researcher José Baselga from Barcelona. This study combined Herceptin with a new humanised monoclonal antibody called pertuzumab. This attaches to HER2 receptors and prevents them from interacting with other receptors of the same family located on the surface of cancer cells. In patients at a very advanced stage with few therapeutic options available, the results were judged to be promising. “One patient in five responded to treatment”, explained José Baselga during a press conference. “Also, in one case in five we obtained stabilisation of the patient for 6 months or longer”. In the light of these encouraging results a phase III trial is being prepared.
Another great advance in this field, and one that concerns patients at a more advanced stage, is the fight to control angiogenesis. A phase III trial combining bevacizumab (Avastin), which is an angiogenesis inhibitor, with chemotherapy has shown a clear increase in the response rate (36% instead of 16%). And also an almost doubling of the progression-free median survival time.
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