On October 19 the World Health Organization celebrates World Breast Cancer Day with the goal of not only bringing awareness to this deadly disease but also highlighting the need to ensure all women have access to effective screenings and treatments. At MEDSIR, we embrace this day and are dedicated to developing treatment options for each and every patient.
Dr. José Manuel Pérez, deputy director of the International Breast Cancer Center and MEDSIR collaborator, recently had a conversation with Spanish radio (audio in Spanish only), IVOOX, about HER2 positive breast cancer, the advances in treatment that have occurred over the past few years, and the importance of regular screenings to catch breast cancer early. He also talks about his hope that the ongoing research will one day be strong enough to give patients a treatment option that no longer requires the use of chemotherapy.
Read the full transcript of the interview below:
Currently one of the main challenges of cancer research is to find effective treatments that carry fewer side effects than chemotherapy, which would improve the quality of life of people with cancer. Related to this, we have been able to read in different media that 40% of patients with HER2 positive breast cancer could do without chemotherapy, this is news that fills many women with this disease with optimism. We are going to discuss this study with Dr. José Manuel Pérez, deputy director of the International Breast Cancer Center.
Victoria Caro (journalist): Doctor, José Manuel, good morning.
José Manuel Pérez: Hello, good morning, thank you for the invitation.
VC: Thanks to you, well, let's get down to it first. I don't know how to say the name of this cancer. HER2 positive? How is it said correctly?
JMP: It's HER2 positive breast cancer.
VC: What are the characteristics of it?
JMP: Well, it must be said that it is basically a type of breast cancer that represents around 15% of all tumors currently diagnosed, and is characterized by the presence of this protein, which is called HER2 and which resides on tumors. It has a greater aggressiveness, a greater growth speed, and a greater capacity to have metastatic dissemination, that is, the extension of the tumor to other organs of the body.
VC: We are talking about a very serious cancer.
JMP: Yes, it is a very serious cancer, but what is certain is that in recent years, is that much progress has been made in the knowledge of this cancer, the same as in other types of tumors, both of the breast and of other locations, and have been new treatments developed that act specifically against this protein, against HER2, and this logically has drastically improved the prognosis of these patients.
VC: Doctor, what does the treatment currently consist of? You are telling me that the last few years there have been advances, so I understand that it is not only a chemotherapy treatment.
JMP: What I can tell you first is to say that patients with localized HER2-positive breast cancer were included in this study, which means that they were patients who did not have metastases at the time of diagnosis, this comes first. So, today, a patient with localized HER2 positive breast cancer, treatment, in addition to surgery, is a combination of chemotherapy and these antibodies or vaccines against this protein called HER2, and this is the standard.
VC: Is this what has been done so far?
JMP: So far, with very high cure rates in people with localized stage, which are around 90%.
VC: How wonderful!
JMP: And what is certain is that in recent years, both independent researchers and research groups, such as MEDSIR, which is the promoter of the PHERGAIN study, what we have seen is that thanks to the introduction of these vaccines or of these antibodies against this protein, we have seen that we could treat these patients with localized HER2-positive breast cancer without the need for chemotherapy and without the omission of chemotherapy having a negative impact on the prognosis of these patients.
VC: So, just with the injection of this protein or would there be something else in that treatment?
JMP: No, basically what we want is to treat a group of these patients with localized HER2 positive breast cancer with these vaccines, antibodies against the HER2 protein without the need for chemotherapy.
VC: Well, it sounds so good it's almost hard to believe it, doctor.
JMP: Well, basically, it's hard to believe, but I'm telling you, the evidence is in favor of this. With this, logically, you always say the same in the multiple media in which it has been communicated, but what I want patients to see is that today they are diagnosed with localized HER2 positive breast cancer is that this study has not yet given us confirmation that chemotherapy can still be skipped.
VC: Sure, that's why they talk about de-escalation, right? How would that be?
JMP: We are talking about this treatment, but we still need a little more follow-up time for the study to confirm that in the coming years, these patients in whom chemotherapy has not been administered in the study have an excellent prognosis. Therefore, if today a patient has localized HER2 positive breast cancer and comes to the consultation with this news and tells you "Doctor, I want to be treated without chemotherapy", I would say "No, today we must continue to do chemotherapy and HER2 vaccines ”, except that the patient is included in a clinical study such as the one we have participated in and designed by us, in which this de-escalation of treatment is evaluated.
VC: Doctor, correct me if I'm wrong, I think that of these women who, as they don't say, had a localized HER2, they were also candidates for a surgical operation. I don't know if this new treatment can free them from the operation, or we are already going too far.
JMP: To this day, logically, it is still a long way from whether patients with localized breast cancer, be it HER2 positive or another type of breast cancer, can avoid surgery. Yes, it is true that patients with localized HER2 positive breast cancer, we know that this pre-operative treatment without chemotherapy can achieve that the tumor at the time of surgery, when the tumor is removed, supposedly the area where the tumor was, in up to 40% of patients, the tumor has disappeared. The problem is that the imaging tests that we currently have available to evaluate the response to treatment, which above all is magnetic resonance imaging, although in the magnetic resonance imaging the tumor has disappeared, we cannot be 100% sure that some microscopic cells may remain still in the breast.
JMP: For this reason, many patients ask, beyond whether I have to do chemo or not, if it has disappeared on the MRI, many times they say, "But why do I have to operate if the tumor has disappeared on MRI?" , and we always tell them the same thing, that they have to operate because the microscopic lumps can still be in the breast and the MRI cannot detect that.
VC: You don't see it, and you have to clean and secure the area, because in the end we are talking about the health and lives of these women, right?
JMP: That's it, that's it.
VC: I understand then that it would only work for women with a localized, non-metastatic HER2 positive cancer.
JMP: I give you an example, a triple negative breast cancer, which is another 15% of breast tumors, is also very aggressive, but in this, unfortunately, we do not have vaccines against any protein of that type of triple negative tumor that has achieved high efficacy without the need for chemo. For this reason, logically, I already told you, what has led to this research is the possibility of having new drugs that act against this protein; and this is what will allow us in the future, and I am convinced, of being able to omit chemotherapy in a significant percentage of these patients.
VC: How good, really, to listen to you. Doctor, taking advantage of the fact that there are many people who are listening to us, we have to talk about prevention, and also a little about the signs that this breast cancer gives, for example. How to take care of ourselves, how should women take care of themselves, how to detect breast cancer?
JMP: Obviously, it is essential to carry out population-based breast cancer screening programs, which logically include mammography. It is true that these programs can change between regions in Spain, but what the guidelines recommend is to start mammography after 50 years of a biannual frequency, every two years. It is true that in many places you start at age 40, in other places it is done annually and not biannually. But the important thing is that people trust that mammography is good and allows us to detect breast cancer earlier, and at the lifestyle level, since logically it is essential to lead a healthy lifestyle, with a moderate alcohol consumption and above all avoid weight gain, because we know that obesity and alcohol consumption are two lifestyle factors that have been associated with a higher incidence of breast cancer. For this reason, when a patient of mine has overcome breast cancer, I always advise her that she can do the diet she wants, cut out foods, eat exotic foods, but the most important thing that all the guidelines recommend is to reduce alcohol consumption, and above all to be well of weight and to do physical exercise.
VC: Well, one last question to finish, Doctor. They say that cancer is not a single disease, correct me if I am wrong that you are the expert, that between one cancer and another there are many differences, there remains a lot, because it is true that, in the last 20 years, life expectancy, treatments have improved tremendously. Is it very far to be able to find a cure for cancer in general?
JMP: I think there is logically a lot, a lot remains, especially patients who have metastatic breast cancer, whatever type it may be. Yes, it is true that breast cancer with metastases is HER2 positive or of other types, every day it is more treatable. It is a disease that is more treatable thanks to the introduction of new treatments, but it is true that today it is still a disease that is not curable. Yes, it is true, what I tell my patients, it is not the same to have metastatic pancreatic cancer than metastatic breast cancer. But today, it is true that we do not have the remedy or the solution to cure these patients or achieve a very long remission of the disease. We are working on it.
VC: We are working on it. I told you it was the last, but now it is, pandemic and cancer. It was very worrying in the middle of the pandemic, I remember last summer, even at the beginning of the course, it worried the oncologists that the delay in diagnosis would later lead to advanced cancers and that it increased the chances of the risk of dying from the disease. How's this going?
JMP: I believe that in the end the health systems logically have a saturation capacity, that the COVID pandemic has saturated them, it is evident, and logically most of the resources have had to be brought or delivered to COVID, and that is a reality. Other important diseases such as oncology have been neglected, that is true, and I think that thanks to vaccination we are starting luckily to return to normality. So the message is that you have to try to cover all the needs, but it is true that the system, we have all seen it, has become saturated, and in the end logically it has become saturated even above oncological diseases.
VC: We can almost say that we are returning to normality, so we can breathe and calm down.
JMP: Yes, luckily yes.
VC: Dr. José Manuel Pérez, thank you very much, have a good day and good weekend.
JMP: Thank you and have a good weekend.