Patients with advanced HER2-positive breast cancer most often develop brain metastases. When this happens, patients have little chance of surviving for the next few years with existing therapies such as surgery and radiation therapy. An international team of researchers under the joint leadership of Professor Nadia Harbeck, director of the Breast Center at LMU University Hospital, has tested a new drug in a clinical trial.
HER2-positive breast cancer: a new drug is on the way
With excellent results,” reports the oncologist. According to the results obtained so far, survival times increase significantly. The results of the experiment were published in the journal Nature Medicine.
Modern medicine divides breast cancer into different types based on biological tumor characteristics. Fifty percent of patients with HER2-positive breast cancer will suffer from brain metastases, which it has not been possible to successfully treat with drugs so far, as the blood-brain barrier often prevents active substances from penetrating the brain. New drugs are therefore urgently needed.
One of these active substances is a so-called antibody-drug conjugate (ADC) called “trastuzumab deruxtecan”. Trastuzumab is an antibody that, once injected into the body, attaches precisely to the HER2 protein. Its cargo is the active ingredient deruxtecan, which kills tumor cells and is active in tumor tissue and hardly anywhere else in the rest of the body.
“That’s why we can use this active ingredient in the first place,” explains Harbeck. “Otherwise, it would be too toxic.”
To determine the benefit of ADC for HER2-positive breast cancer, the LMU oncologist initiated the DESTINY-Breast12 study as one of two principal investigators. Over 500 patients with and without brain metastases, from 78 cancer centers in Western Europe, Japan, Australia and the United States, took part in the trial.
The results showed that on average patients, even those with brain metastases, survived for more than 17 months without any progression of their HER2-positive breast cancer. More than 60% of patients survived for 12 months without further tumor growth. The researchers detected regression of brain metastases in more than 70% of the participants. Ninety percent of all patients were alive one year after starting treatment.
“These findings,” Harbeck says, “offer hope especially to patients with brain metastases.” The drug is already approved for use in standard practice.
Overall, the cancer specialist attests that ADC has “great potential for the treatment of HER2-positive breast cancer.” An example of this is a large study, ADAPT HER2 IV, which has been ongoing for a year at the initiative of the West German study group.
This unique study in the world is available for patients with HER2-positive breast cancer early non-metastatic in Germany. Patients are given ADC infusions only four times before surgery, which significantly simplifies and shortens therapy. In total, three ADCs are currently approved for breast cancer in Germany, “and I think,” says Harbeck, “that there will be many more to come.”
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