Breakthrough anti-cancer drug takes direct aim at tumours

Yes, Dr. Slamon is the man behind Herceptin.  And Dr. Tak Mak is an absolutely brilliant medical researcher, one of the most respected cancer researchers in the world. He has been working on immunology and cancer for much of his career but  turned his focus to breast cancer after his first wife was diagnosed - and ultimately succumbed - to breast cancer. 

I'm not a Wikipedia fan, but this is a pretty good write-up on him:  Tak Wah Mak

jenrio, your comment "For too long the focus on cure has been hijacked by marketers" was really unnecessary (and totally irrelevant) in the context of this thread. You might find it interesting to read the bio on Dr. Mak, because it notes that his work that has led to "important breakthroughs in immunology and understanding cancer at the cellular level" happened during a time when he was sponsored by a major biotech company.  He continues to work out of that same lab today (which was built by the biotech firm), as it was turned over by the biotech company and evolved to become the Campbell Family Institute for Breast Cancer Research.  The Campbell Family Institute for Breast Cancer Research, part of Princess Margaret Hospital in Toronto, is funded largely by both corporate and individual donations to the Campbell Institute.   

Sorry, jenrio.  My comment may have been out of place. Your post was fine, but that one line got my back up. I'm tired of the constant negativity on this board about big pharma and how research is all screwed up because there is no cure yet and how focusing on treatments and not the cure is all wrong, etc., etc., etc..

The way I see it, we need better treatments, and we need a cure, and we need to find a way to prevent BC from ever developing.  All efforts made, whether it be by an independent researcher or by someone in the lab at a pharmaceutical company, or by someone funded by a "marketing" company, are welcome.  We don't know which one might lead to the big breakthrough.  Each provides a piece of the puzzle. 

Then there is the issue of the constant slamming of "marketing". I spent my career in marketing. There is a lot more to marketing than most people understand and that's pretty obvious from the negative comments I read here. I am tired of people who don't have a clue about what's involved with marketing but who think it's okay to badmouth "marketing" and by extension, everyone who works in that field. Yes, there is some crappy marketing out there, including drug marketing (particularly in the U.S. where you can advertise prescription drugs, which personally I think is nuts) but next time you go to a store and buy a product that you really enjoy, or next time you reach for your vitamin supplement, remember that it was marketing that made that product available to you.

I started a thread about what I think is a great piece of research news.  It would have been nice to keep the discussion positive, and that's why I felt that your one line was unnecessary.

Yes to Herceptin and Palbociclib, and to the fact that they come from Dr. Slamon.  Much of his work on Palbociclib was funded by Pfizer.  And what about Perjeta, what about the Aromatase Inhibitors, what about Tamoxifen? Big pharma is behind all that. And what about the development of protocol changes for rads, such as the research released this week that suggests that IORT appears to be as effective as traditional rads, with fewer side effects and long term risks?  There have been developments, not all are as noticeable as Herceptin, but there are lots of smaller and very meaningful successes out there.

Where are the competitors? Why are we pinning hopes on every preclinical drugs from a single lab?  No one is doing that.  There are thousands of clinical trials going on, with new drugs, new protocols, different combinations of drugs, use of existing drugs for different purposes, etc..  If you go to the U.S. government clinical trials website, and type in "Breast Cancer" you'll find that there are currently 5,354 clinical trials going on.  Of course, not all are for new drugs or new protocols, but there is a lot of activity. If you type in "Breast Cancer and Drug", you get 3,879 trials. And that's just the U.S..  Development goes on in the rest of the world too.

Dr Slamon/Dr Mak Tak are not immortal. Where should we look for next breakthroughs for the next 3 decades? There are hundreds - or probably thousands - of scientists looking to step into their shoes. Some are working on traditional mass-market drugs; others are trying to harness the advances in genomics and are working on individualized medicine. 

If we have a cure, will we really NEED "prevention"?  Oh maybe for cost cutting, but do we really NEED prevention?   Why are we wasting time/money on prevention instead of powering the competition for the "cure"?  Isn't it better to avoid the diagnosis of breast cancer altogether, rather than get the disease and need the cure? Every treatment - probably even an eventual cure - comes with side effects so isn't it better to avoid those treatments if we can?

Because of the specifics of my diagnosis, I tend to focus my attention on DCIS and early stage breast cancer.  Recently someone in the DCIS forum asked for the latest research on factors that predict DCIS's evolution to IDC.  Here are the studies that I provided:

ASPN and GJB2 Are Implicated in the Mechanisms of Invasion of Ductal Breast Carcinomas  2012

Down-regulation of ANAPC13 and CLTCL1: Early Events in the Progression of Preinvasive Ductal Carcinoma of the Breast  2012

Silencing of HSulf-2 expression in MCF10DCIS.com cells attenuate ductal carcinoma in situ progression to invasive ductal carcinoma in vivo  2012

Differentially Expressed Genes Regulating the Progression of Ductal Carcinoma in Situ to Invasive Breast Cancer  2012

ER81 Expression in Breast Cancers and Hyperplasia  2011

Breakthrough Method Predicts Risk of Invasive Breast Cancer  2010

Biomarker Expression and Risk of Subsequent Tumors after Initial Ductal Carcinoma In Situ Diagnosis  2010

Loss of Protective Barrier May Link DCIS to Invasive Breast Cancer  2008

Portraits of breast cancer progression  2007

These are just some of the articles/studies that talk about how DCIS progresses to become IDC and what the key factors or triggers may be. Obviously a big problem is that it seems that almost every study comes up with a different answer.  But to me the really good news is that there are so many medical scientists looking into this.  Someone is going to figure this out. And of course, we may discover that there are multiple triggers or combinations of triggers.  But whatever they are, once we know what it is that causes DCIS to progress to become IDC, then we will be able to develop treatments and/or drugs to stop this progression. This type of research will lead both to better information about how and when to treat DCIS, and it likely will lead to a significant reduction in the number of cases of IDC.  Prevention of IDC. Wouldn't that be a good thing? If you never get the disease, you don't need the cure.  That's better for your body, it's better for your physical and emotional health, and it's probably better for your wallet.

So has the agenda of breast cancer "cure" been hijacked? I don't think so.  But then I don't think that a cure is the only reasonable objective of research.  I think that better treatment - easier on the body, fewer side effects, more efficacious - is a valid goal.  I think prevention is a valid goal.  And I think that the development of drugs or treatments that cure breast cancer is a valid goal. Breast cancer is such a complicated disease, which so many different variables.  To better address all women who potentially will be diagnosed in the future, I think we need to pursue all of these goals. For me, it's good news that some research scientists prefer to focus in one area, and others have a greater interest in another area.  I don't want to muzzle or direct or tie the hands of any researcher who has an idea in any of these areas.

As for marketing, your comment gets to my point about how many people don't understand marketing. Marketing is so much more than some "positive marketing campaign".  For many of the years that I was in marketing, I never was involved with any marketing campaigns or promotions or advertising.  That's just a small part of the function and it's not always even done. 

Marketing happens to include market research, including managing the research studies, analysing the results, explaining those results, and putting forth recommendations based on the research. When a new drug is developed and approved, it is the marketers who use the clinical trial data to put together the materials that ensure that the medical community understands how the drug works, what it is for and which patients should be considered for the drug. I've mentioned on this board that I like digging through the research studies because I've spent 30 years working with research studies (non-medical). That was part of my job as a marketer.  Numbers talk, and it's the marketers who explain those numbers in plain English to everyone else (in the case of medical research, to everyone who isn't a medical scientist). The other thing that marketers do is ensure that their target market (in the case of medicines, patients who require or would benefit from a drug) have access to their product. Getting the product to the patient in the way that is easiest for the patient, offering up reduced payment options for patients who can't afford the drug, etc... that's all marketing too.  So in actual fact patient's lives are extended by marketing, because it's a marketer's role to get the drug into the hands of the patient who needs the drug. 

Does drug advertising in the U.S. go overboard?  Absolutely.  But that's just a tiny part of what's involved with marketing.

I agree completely with your last paragraph.  And doesn't that answer your first and second questions?

I think the AIs and Tamoxifen are breakthrough drugs.  Drugs that can significantly reduce the number of women who ever even get breast cancer.... while at the same time helping many women with breast cancer avoid the development of mets.  These drugs save thousands upon thousands of lives.  They aren't right for everyone, and they aren't 100% effective (or even close to that) but they have saved the lives of many women who would otherwise have died from breast cancer.

As for prevention vs. cure, maybe you and I define these terms differently. The way I see it, if a case of breast cancer can be prevented, then for that individual, there is no need for a cure. She never was diagnosed so she doesn't need the disease to be cured.  Someone who is diagnosed with breast cancer requires a cure, a treatment that will 100% guarantee that the disease can be eliminated and won't threaten the patient's life again. If I am ever diagnosed again, I hope that it doesn't happen until after there is a cure, so that I can be treated with the certainty of success.  Still, I'd much prefer that I never be diagnosed again, that any future diagnosis be prevented. 

Having said that, in reality, given the complexity of the disease, while I think that some cases of breast cancer may be preventable, and while I think that a cure might be found for some types of breast cancer, I don't think all breast cancer will be prevented or cured. And that has nothing to do with the effort put against it.  So I guess I just don't agree with your question, "Are we focused enough on the big prize?"  I don't think we should be focused only on the big prize. I don't agree with you that the only reasonable goal is a cure. And that's why I don't see the same failure (or lack of effort) that you see. I see success in the development of better treatments and drugs that can prevent some women from ever developing this disease. And I see this success continuing.

Again, I'm not suggesting a trade-off between preventation and cure.  I'm suggesting that both need to be pursued at least in part because we don't know which one we will get to first.

"We've had 40-50 years of experience with adjuvant tamoxifen, 50+ years experience with mammogram.   To this day, massive and expensive clinical trials have been run to PROVE the benefit of either, and still we could not conclude that they are indeed beneficial to any particular patient or for subpopulations or for the population as a whole."

Do you just choose to not believe the clinical trial data on Tamoxifen and the AIs and Evista? (For this discussion I'm grouping them together as a general category of recurrence reduction and BC prevention drugs.)

Long-Term Data from 20 Trials Confirm Tamoxifen’s Long-Lasting Benefit

"In a pooled analysis of data from participants in 20 clinical trials, women with estrogen receptor-positive breast cancer who were assigned to receive about 5 years of adjuvant treatment with tamoxifen had a lower risk of recurrence in the 15 years after starting treatment than women who did not receive tamoxifen. Women who took tamoxifen also had a one-third reduction in the risk of dying from breast cancer throughout the 15-year follow-up period....

...The fact that, 15 years after the start of treatment, rates of relapse for women who took 5 years of tamoxifen remain lower than those for women who did not take the drug, “means that 5 years of tamoxifen can prevent a high proportion of recurrences and potentially cure many patients"

As far as prevention is concerned, I refer you to NSABP P-1 and the Star trial. 

Tamoxifen for Prevention of Breast Cancer: Report of the NationalSurgical Adjuvant Breast and Bowel Project P-1 Study

.

"In fact, I'll even boldly state: to prove that any intervention could "prevent" the cancer in any individual is almost impossible unless you wait out the natural lifespan of this individual (with current technologies)." 

True, but isn't the same true about any drug or treatment that claims to "cure" breast cancer?  How do you really know that someone is cured until they die of something else?

I'm done.

I know, I said I was done, but I can't resist.

jenrio, you favor all research aiming towards a cure and you are against any research efforts that go towards prevention.  Okay, I got that. I don't agree but I understand.

But then you decide to set your own definitions for what constitutes a "cure" and what constitutes "prevention". You put forth a ridiculously low bar to prove a "cure" (live 5 years without the need for drastic intervention) and an impossibly high bar to prove "prevention" (wait out the entire lifetime of the individual until they die of something else). Seriously? Let me just say that, "oops, your bias is showing!"  

I get that you are looking for the Sputnick moment. What you don't get is that I'm not.  Or maybe I just define it differently.

This time for sure, over and out.