As we have learned more about the gene changes that cause cancer, researchers have been able develop newer drugs that are aimed right at these changes. These targeted drugs do not work the same as standard chemo drugs. They often have different and less severe side effects. At this time, they are most often used along with chemo.
Trastuzumab (Herceptin)
Trastuzumab is a monoclonal antibody — a man-made version of a very specific immune system protein. It attaches to the growth-promoting protein called HER2/neu. HER2/neu is found in small amounts on the surface of normal breast cells and in large amounts on some breast cancer cells. Breast cancers that have too much of this protein are called HER2/neu-positive (or just HER2 positive). The protein makes them grow and spread faster. Trastuzumab can stop this protein from causing breast cancer cell growth. It may also help the immune system to better attack the cancer.
Trastuzumab is given into a vein (IV), usually once a week or as a larger dose every 3 weeks. Doctors do not yet know how long it should be given, but studies are looking at this.
The side effects of this drug are fairly mild. These are rare and may include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache. They are often mild. These side effects are less common after the first dose. But some women may develop heart damage during or after treatment. For most (but not all) women, this effect has been short-term and bets better when the drug is stopped. If you are getting trastuzumab, you should tell your doctor right away if you have any shortness of breath, swelling, or trouble with physical activities.
Lapatinib (Tykerb)
This is another drug that targets the HER2/neu protein. This drug is given as a pill, most often along with chemo. It is used for some women with cancer that is no longer helped by chemo and trastuzumab. In advanced breast cancer, giving lapatinib along with trastuzumab helped patients live longer than giving it alone. The most common side effects with this drug include diarrhea, nausea, vomiting, rash, and hand-foot syndrome (this was discussed in the section about chemo). Diarrhea is common and can be bad. It is very important to let your health care team know about any changes in your bowel habits as soon as they happen.
Bevacizumab (Avastin®)
This is another monoclonal antibody that has been used in patients with breast cancer that has spread. It is always used along with other chemo drugs. This antibody helps to keep tumors from making new blood vessels to feed the tumor. Bevacizumab is given by intravenous (IV) infusion. There can be some rare, though serious, side effects and high blood pressure is very common. It very important that your doctor watches your blood pressure carefully during treatment and that you let your health care team know about any changes in how you feel.
New study results did not show a real benefit for the women receiving bevacizumab as a part of their treatment, so on November 18, 2011, the FDA removed the breast cancer "indication" for bevacizumab. This does not cause the drug to be removed from the market, as it is FDA-approved for some other cancers. It does mean that the company making the drug can’t market it for breast cancer. The company can’t tell doctors or patients that the drug is useful in treating breast cancer. At this time, women who are taking bevacizumab can keep on doing so, but they should discuss this treatment with their doctors.
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