ONS Connect - January 2008 - (Page 25)

NEwTREATmENTS,NEwhOpE Study Finds That Hormone Status May Predict Chemotherapy’s Effectiveness on Breast Cancer [By Deborah McBride, RN, MSN, CPON ®, Contributing Editor] he knowledge of which drugs work for which patients opens the door for healthcare professionals to develop more effective treatments than those used today. Recent news that one of the most common breast cancer chemotherapy drugs may not work for half of the women taking it might be considered good news. According to an article published in the New England Journal of Medicine (Hayes et al., 2007), a widely used breast cancer chemotherapy drug helps far fewer patients than originally believed. If further studies concur, more than 20,000 women each year in the United States (more than half of all patients with breast cancer who would receive chemotherapy according to today’s criteria) might be spared from the side effects of this drug or similar ones without significantly raising the risk that their cancer will return. This study and others from the past five years demonstrate that certain markers on breast cancer cells can help doctors predict chemotherapy’s effectiveness for each patient. Hayes et al. (2007) looked at a large sample of 1,322 women whose cancer had spread to the lymph nodes. All patients received four cycles of doxorubicin and cyclophosphamide. Half of the women were given an additional four courses of paclitaxel. The study was a new analysis of a study done in the 1990s using modern genetic tools not available then. It found that adding paclitaxel benefited women only when their cancers were estrogenreceptor negative or HER2 positive, that T is, overexpressing the HER2 protein, a sign of a more aggressive cancer. For those women, paclitaxel boosted the chance of disease-free survival for 10 years by 30%–50%. But for roughly half of the patients in the study whose cancer cells were estrogen-receptor positive and HER2 negative (the most common type of breast cancer), the drug did no discernible good. Paclitaxel frequently causes neurologic side effects, including numbness and tingling in the hands and feet. In the original study, 18% of the women experienced the effects for months and even years after taking paclitaxel. The study authors do not advocate a change in clinical practice yet. The stakes are high, and women should not stop treatment based on early findings. Still, the future of patient-specific breast cancer therapy looks bright. Individually tailored chemotherapy treatments could further boost each woman’s odds of recovery and prevent the costs and side effects of unnecessary, unhelpful treatments. This study provides useful information as healthcare professionals seek to refine treatment recommendations for patients with early-stage breast cancer. Hormone responsiveness is the key to tailoring therapy in the future fight against breast cancer, and this study may have positive implications for patients with the disease years from now. ✱ Hayes, D.F., Thor, A.D., Dressler, L.G., Weaver, D., Edgerton, S., Cowan, D., et al. (2007). Her2 and response to paclitaxel in node-positive breast cancer. New England Journal of Medicine, 357(15), 1496–1506. Contributing Editor Deborah McBride, RN, MSN, CPON ®, is a nurse at the Kaiser Permanente Oakland Medical Center and a faculty member at Samuel Merritt College in Oakland, CA. JANUARY 2008 ONS CONNECT 25

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ONS Connect - January 2008 Contents Editor's Note Just In Up Front You Tell Us Up Close & Professional Web Connect Capitol Connection Notice Nursing Now Caregiver Care Five Minute In-Service New Treatments, New Hope Calendar of Events ONS Election Working For You Staying On Top

ONS Connect - January 2008

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