What is cancer? Part 4

Thursday 30 August, 2007

Transcript:

Associate Professor Richard Bell (Senior Clinical Consultant): Here now, is Gwen. This is how Gwen was when I first met her, with her large ulcerated tumour, her large mass of nodes and this tumour growing out from the area where her nipple used to be.

This is three months later, and she has been treated with that drug, Herceptin. The big lump under the armpit is gone. The big lump where the nipple was is gone. The large patch of malignant tissue here has flattened out and is healing. So here is an experiment in one patient only but a very dramatic one, that shows that this treatment does work and is worthwhile.

Here is the only lady that I showed you. She also had this type of cancer with too much of the HER2 protein. And here are the before and after shots. This is a bit darker but you can clearly see that many of the holes that were there have disappeared, and look at her lung now. The mass is gone. The fluid is gone and she had become completely well.

So this is translating what science has delivered, into better treatments.

The problem in early breast cancer is shown in this slide here, from my friend John Fletcher. Cases with the normal amounts of the HER2 protein do well. Patients with early breast cancer and too much of this protein do not do well, and every time this curve falls somebody has died. So this is a very significant end point.

So if we can do what we showed with advanced breast cancer, can we do something with early breast cancer? I just want to briefly talk to you about the HERA study, which involved 5,102 women from all around the world, including Australia. Looking to see if Herceptin given early, for early breast cancer or non-metastatic breast cancer, would make a difference.

Here is the disease-free survival. The risk of cancer coming back - and this is with two years of follow up, so it's early - but the risk of cancer coming back is reduced by one third. So the hazard of cancer coming back is about 64% less if you received Herceptin. A 6.3% difference in absolute numbers, so six and a bit more patients alive at three years with the drug, than without. Overall survival, although the lines here appear close together, is also different, with a decrease of 2.7% in absolute terms or, again, a one-third risk-reduction, in the risk of death.

So the promise in advanced cancer is now carried to early cancer.

It didn't matter which of the Herceptin studies you looked at in this sort of thing - which is called a forest plot - if blocks are to the left it means the intervention worked. And here you have five studies. In every single case the intervention has clearly worked in early breast cancer. So this is one of the great successes of recent research in cancer.

And here is the survival benefit. This small study doesn't absolutely, convincingly show a survival benefit but the data is always consistent. So this is a very important step forward in the right direction.

So the new biology has moved. We now need not only our light microscope but we need to understand what is happening at a molecular level in the tumour, in order to select the best treatment for our patients.

Drugs cost money, and these new biologic drugs cost a lot of money. And if you, or one of your family, were faced with this problem, you wouldn't like this particular scenario where the patient's going to get offered a useless drug.

Modelling what happens out to a longer horizon, suggests somewhere between thirteen and eighteen per hundred patients treated will be alive at fifteen years because of the intervention.

So the improvement is somewhere between thirteen and eighteen depending on the settings that are used for the model. These are very important gains in terms of absolute survival. But the cost is around $50,000 to make that gain per patient treated. So the cost is not trivial.

Cancer research involves not just advising, what is the best question to ask. Is it ethical? Is the trial being well monitored and well conducted? Not just asking the right question, initiating a protocol, conducting research or publishing results, but it is very important to change practice.

Ultimately, if you do not change practice, all of this is for interest's sake, but the goal has to be, to make things better.

The Herceptin story is a very short one. The target molecule was only found in 1985. By 1995 studies were well in progress, by the year 2000 the drug had entered the clinic and by 2005 we knew how to save lives in early breast cancer. So this has been a very rapid development and assimilation of knowledge.

And in October 2006 this treatment became available to Australian women.

None of this would be possible without patients who help us in research and Donna is symbolic of those 5,102 patients who took part in this research. She is from Victoria. She was the first patient in the world to enter this study when many, many things were unknown.

And it is a very clear partnership from many members of the community - not just treating doctors but many different people that make research studies work.

Thank you for you attention. I hope this information has helped you understand some things about cancer.

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