Quality of Life and More Certainty for Breast Cancer Patients
Jul 15, 2015
Professor Oscar Di Paolo and his team at Hospital Provincial del Centenario in Rosario, Argentina, are successfully trying out a blood test for the HER-2/neu biomarker. It may help to determine, at a very early stage, whether or not a treatment is working.
Challenge: Approximately 20% of all breast cancer patients are HER-2/neu positive. Finding a way to monitor treatment success would be ideal.
Solution: Professor Di Paolo believes the assay can be used to determine treatment efficacy.
Result: In the future, Di Paolo believes the treatment of HER-2/neu positive breast cancer patients could be more targeted thanks to the biomarker. It could also become more important in the early detection of metastases.
Wouldn’t it be great to be able to determine via a blood test whether a breast cancer patient was developing metastases after removal of a tumor? Is the postoperative treatment working or should the doctors start looking for alternatives? Professor Oscar Di Paolo and his team at Hospital Provincial del Centenario in Rosario, Argentina, are convinced that this is possible.
Di Paolo has been heading up a research project since 2010 in which he and his staff regularly ask HER-2/neu positive breast cancer patients for blood samples. HER-2/neu is a gene that promotes cell growth and produces an oncoprotein and HER-2 positive breast cancers tend to be more aggressive than other types of breast cancer.
Trastuzumab: A Blessing with Possible Side Effects
Breast cancer patients who have a high level of HER-2/neu in their blood have a slim chance of survival without a targeted therapy. HER-2/neu stands for “Human Epidermal Growth Factor Receptor 2.” Treatment with trastuzumab – a monoclonal antibody that blocks the receptor for this growth factor – can prevent the growth and proliferation of cancer cells.
Unfortunately, the side effects are troubling. The drug can induce cardiotoxicity particularly when combined with anthracyclines although their mechanism is different. Doctors need to keep an eye out for cardiological effects of the therapy – even years after treatment with trastuzumab. In particular, this drug is used in women with a high risk of relapse or when the tumors exceed a certain size. Taking beta blockers and ACE inhibitors as a preventive measure can possibly prevent heart damage.1
The team of researchers working with Oscar Di Paolo at Hospital Provincial del Centenario in Rosario, Argentina and the hospital’s cardiology department are planning to observe the effects of trastuzumab on HER-2/neu positive patients. Since the side effects of trastuzumab are considerable, it is important to know as soon as possible whether the therapy is really working, and the HER-2/neu biomarker can provide an indication of this. If the therapy is not working, heart damage can quite possibly be prevented and the treatment tailored to the patient’s individual needs.
Early Recognition of Therapy Success
“Approximately 20 percent of all breast cancer patients are HER-2/neu positive. We believe we can determine whether or not the treatment is working by checking the HER-2/neu levels in these patients’ blood samples,” says Oscar Di Paolo. Our theory is that if the concentration remains below a threshold, then everything is okay. If the HER-2/neu level exceeds the threshold, then the therapy may not be working. Our goal is to spare the patient a treatment that has no benefit for him or her – and an effective alternative can be tried instead. Moreover, the researchers have so far discovered that metastases were found sooner or later in all patients whose HER-2/neu level increased again after removal of the tumor.
Research Focus on the Patient
At first glance, the University Hospital does not appear to be a hotspot of international cancer research. The plaster on the walls is crumbling, students scribble on the hallway walls without fear of repercussions. Oscar Di Paolo and his team, however, are well known in the region. Even patients from expensive, private facilities come to them to participate in the study. “The patients proactively ask: ‘How are my levels?’ as they are monitored. “They are very interested in being engaged in their care and want the optimal treatment with the least side effects,” says Di Paolo. He is one of those doctors who always focuses on the patient. He is passionate about their care and quality of life. The warmth with which patients are greeted at Hospital Centenario is very apparent. The doctors sometimes even pay the bus fare for poorer patients or pick them up from home.
The Study is Far from Over
Early on, the researchers examined 200 healthy women from the Rosario area to determine a threshold for HER-2/neu in the blood (20 ng/mL). In the second phase, they have so far observed the course of the disease and measured the HER-2/neu concentration in more than 50 breast cancer patients. “We must continue our research,” Di Paolo emphasizes. In the long term, Professor Di Paolo believes that it should not just be about determining whether or not a therapy is working. Di Paolo and his team want to know whether the biomarker can be used effectively in the early detection of metastases, which may improve survival chances and save money because patients would need fewer biopsies or even diagnostic imaging. “There is a lot to discover,” says Di Paolo.