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O N C OL OGY B efore the targeted breast-cancer drug Herceptin (trastuzumab) was developed, women with high levels of HER2+ protein — human epidermal growth factor receptor 2-positive — had aggressive tumors that were less likely to respond to standard therapies. Now, these women, approximately 25-to-30 percent of those diagnosed with breast cancer, have among the highest survival rates. “The HER2+ story demonstrates that we can provide more effective and less toxic treatments by targeting therapies that are most appropriate for the genetic changes present in each patient’s tumor,” says Dennis Slamon, MD, director of the Jonsson Comprehensive Cancer Center’s Revlon/ UCLA Women’s Cancer Research Program and the Translational Oncology Research Laboratory at UCLA. Led by Dr. Slamon, UCLA scientists pioneered the research leading to the development of Herceptin. The drug is now standard treatment for women with HER2+ tumors. When used in combination with other therapies, including chemotherapy or surgery, it can dramatically reduce breast- cancer recurrence rates. “The earlier you use Herceptin in the disease course, the better,” Dr. Slamon says, adding Herceptin also is one of the few drugs that can improve survival in late-stage breast cancer. And despite recent theories about the optimal period of time to use Herceptin, there is no evidence that prolonging treatment beyond one year will improve outcomes, he says. “We believe there is a finite amount of time that you need to be treated with the drug to derive benefit if used correctly,” Dr. Slamon says. “By using the drug beyond that time, patients do not gain additional benefit, and by discontinuing use, they do not lose benefit.” In addition to fine-tuning the amount of time to use Herceptin, researchers are also working on ways to make the drug more powerful and developing new treatments for women with other types of tumors. “The real excitement is around a new drug called T-DM1,” Dr. Slamon says. T-DM1 is Herceptin coupled with an experimental chemotherapy drug, emtansine, or DM-1. “It is like a smart bomb — Herceptin armed with a warhead,” he says. Initial studies in women with late-stage HER2 breast cancer found that T-DM1 had few side effects and increased progression- free survival (the time between the start of treatment and the time the cancer gets worse) by three months, on average. Most recently, UCLA researchers are targeting a different and larger subset of patients — women with advanced breast cancers who are estrogen-receptor positive (ER+) and HER2-negative, which accounts for 60-to-65 percent of breast cancers in most countries. Preliminary results show that women taking the investigational drug palbociclib, in addition to letrozole, a commonly used drug for ER+ breast cancer, had significantly higher progression-free survival than patients taking standard treatment alone. “The benefit is the largest we’ve seen to date in this large subgroup, tripling disease-control times from seven- and-a-half months with the available standard therapies to more than two years and counting with the experimental therapy,” Dr. Slamon says. “By identifying the correct targets for treatment in the right patient population, we move forward with personalized oncology that we hope will greatly improve the outcomes for this group of patients with breast cancer,” Dr. Slamon says. For information about breast-cancer clinical trials at UCLA, go to: UCLA Breast Centers Offer Broad Range of Services in One Place UCLA’s specialized breast centers in Westwood and Santa Monica offer women with breast cancer one-stop locations where they can receive integrated care that includes the latest in imaging technology and care coordination to assist them through the process. The multidisciplinary clinics enable a patient to see all the specialists necessary for her diagnosis and treatment, and leave with a comprehensive care plan. The latest imaging technology available at the two centers includes tomosynthesis, which provides a three-dimensional image that improves breast-cancer diagnosis by increasing detection of invasive breast cancers and by reducing false positives. Care coordination also is available to help schedule appointments, answer questions and guide patients through interactions with the health system during diagnosis, treatment and follow-up. Revlon/UCLA Breast Center UCLA Breast Center Santa Monica 200 UCLA Medical Plaza, Suite B265 (B2 Level) Los Angeles, California 90095 (310) 825-2144 1223 16th Street, Suite 1100 Santa Monica, CA 90404 (424) 259-8791 Vital Signs Winter 2014 Vol. 61 5