Breast cancer

Updated 01 October 2013

US approves first breast cancer drug

An agency has given American doctors the green light to use a biotech drug to treat breast cancer before surgery.


A biotech drug from Roche has become the first medicine approved to treat breast cancer before surgery, offering an earlier approach against one of the deadliest forms of the disease.

The US Food and Drug Administration, which monitors food and drug products for safety, approved Perjeta for women with a form of early-stage breast cancer who face a high risk of having the cancer spreading to other parts of the body.

Surgery to remove tumours is usually the first step in treating most forms of cancer.

Perjeta is the first drug to be approved as a pre-surgical step.

Earliest disease

Doctors hope that using cancer drugs earlier could help shrink tumours, making them easier to remove, and in some cases, that could allow women to keep their breasts rather than having a full mastectomy.

Doctors also say that treating the disease at its earliest stages could prevent tumours from returning later, though studies have not yet established that benefit.

"By making effective therapies available to high-risk patients in the earliest disease setting, we may delay or prevent cancer recurrences," said FDA's Dr Richard Pazdur, who directs the agency's office of cancer products.

Cancer specialists already use several chemotherapy drugs as initial treatments for cancer, but they are not formally approved for that particular disease.

Groundbreaking results

The FDA originally approved Perjeta to treat breast cancer that has spread to other parts of the body after surgery.

The FDA granted the drug accelerated approval for its new use, based on a study showing women who received the drug as an initial treatment were more likely to be cancer-free 12 weeks later than women who received older drug combinations. 

Accelerated approval is reserved for drugs that show groundbreaking results for treating life-threatening diseases in early studies.

As a condition of approval, Swiss-based Roche's Genentech unit must conduct a larger follow-up study showing the drug's long-term benefits.

That generally means showing that patients lived longer or had a higher quality of life due to taking the drug.

Follow-up data

Genentech, located in California, has already enrolled about 4 800 patients in the follow-up study, with results expected in 2016.

Dr Paula Klein, a breast cancer specialist, says she will start prescribing the drug for early-stage patients immediately, but stressed the importance of follow-up data on patient survival.

"This does not yet prove to us that using the antibody in this setting will result in more cures...that is still a hypothesis," said Klein, who directs the breast cancer programme at Continuum Cancer Centres of New York.

Approval based on study

The FDA said the approval had been based on study of 417 women comparing Perjeta in different combinations against older breast cancer treatments.

When Perjeta was combined with Herceptin, another Genentech drug, and standard chemotherapy, 39% of women saw their cancer reach undetectable levels.

Only 21% of women experienced the same results from taking Herceptin and chemotherapy alone.

After drug treatment all the women received standard breast surgery to remove any cancerous tumours.

Genentech says this surgery allowed researchers to confirm the presence or absence of cancer.

Like Herceptin, Perjeta only works in a subset of about 20% of breast cancer patients who have tumours that overproduce a protein known as HER-2. This protein causes cancer cells to divide and grow faster than usual.

A spokeswoman for Genentech said a regimen of Perjeta plus Herceptin would cost between $27 000 and $49 000, depending on how long the patient takes the combination. The new Perjeta label will recommend a course of treatment between nine and 18 weeks.

Facts on Breast cancer

Breast cancer is the second most deadly form of cancer in US women, behind only lung cancer, and is expected to kill more than 39 000 Americans this year, according to the National Cancer Institute.

About 6000 to 8000 deaths per year are attributed to the HER-2 form of the disease.

Breast cancer is highly treatable when detected early.

The institute says more than 98% of women who are diagnosed with first-stage breast cancer survive at least five years.



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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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