Gut Reaction

A breast cancer drug delivers a heavy blow to certain stomach cancers. 

KAREN PATTERSON
PUBLISHED: DECEMBER 23, 2009
Talk about this article with other patients, caregivers, and advocates in the Gastric Cancer CURE discussion group.
J.P. Gallagher understands the ins and outs of gastric cancer. He knows how hard it can be to find the right treatment team. He realizes that even the experts can disagree on how and when chemotherapy and radiation are best administered. And he knows what life is like without a stomach.

Gallagher, 40, of Redwood City, California, also remembers how hard it was, after his early-stage diagnosis, to find information that was useful and hopeful amid an online sea of dire data. “For me, having the right mind-set and having a faith and belief that you can be better is so important,” says Gallagher, who underwent surgery followed by chemotherapy and radiation.

Gallagher’s cancer was caught before it spread, but for about one-fifth of people with advanced, inoperable gastric cancers, new scientific data promises to change the treatment landscape.

That data, first presented this summer at the annual meeting of the American Society of Clinical Oncology, involves the targeted treatment Herceptin (trastuzumab), a breast cancer therapy on the market for more than a decade.

The new study found that Herceptin can improve survival among advanced gastric cancer patients whose tumors overproduce human epidermal growth factor receptor 2, or HER2, a sort of “dock” (formally known as growth factor receptor) that sits on the surface of the cancer cells. (An understanding of its role in breast cancer has led scientists to look for HER2 overproduction in other cancers.) Herceptin, which is a biological treatment—meaning it works with the body’s immune system—attaches to those HER2 docks, interfering with chemical traffic that signals the cells to grow.

“For gastric cancer, that’s probably one of the largest differences we’ve seen in overall survival with the addition of just one agent.”

David Ilson, MD, PhD, a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City, notes that research has been able to make only small inroads toward increasing survival times in advanced gastric cancer. 

“I would consider all of these developments a modest improvement,” he says of the Herceptin finding, as well as gains made by modifying chemotherapy regimens. “We have not made the kind of advances we’ve made in colorectal cancer, where combined chemotherapy and targeted agents have doubled the survival.” 

Even so, Ilson believes the use of Herceptin, which has become an important treatment for HER2-positive breast cancers, will become widespread against HER2-positive advanced gastric cancers. “I think once the data get out there, it’s going to very quickly become the standard of care.”

A representative of Roche’s Genentech, which makes Herceptin, says the company is discussing with the Food and Drug Administration the possibility of submitting an approval application for the drug as a treatment for advanced HER2-positive gastric cancer. The drug was filed for approval in Europe in September.

Bekaii-Saab says his hospital has begun to screen gastric tumors for HER2 expression, and doctors are beginning to test whether and how insurance covers the medicine. “On the first few patients we’ve had, we haven’t had problems with insurers,” he says. “But of course … this is an expensive drug; you have to make the case.”

Talk about this article with other patients, caregivers, and advocates in the Gastric Cancer CURE discussion group.
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