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Professor Christopher Twelves is Professor and Honorary Consultant in Medical Oncology at the University of Leeds in addition to being the Deputy Director of Cancer Research UK’s Clinical Centre at St James’s Hospital, Leeds. Professor Twelves is a medical oncologist with a particular interest in clinical pharmacology; his clinical practice has been in colorectal and breast cancer.
Prof Twelves heads the Cancer Medicine Group and Experimental Cancer Medicine Centre in Leeds and is a member of the Cancer Research UK New Agents Committee.
In this interview he discusses new agents approved for Metastatic Breast Cancer.
The war against breast cancer is one that we’ve been fighting for many years and I’m afraid that we’re going to be continuing to fight it for many years to come. I think what’s very encouraging is that in the UK certainly whereas we saw for many years an increase in the number of women dying from breast cancer, over the last 25 years we’ve seen that process change we’re now seeing year by year, few women dying of breast cancer. There are a number of things that have contributed to this; screening, hormone therapy but also chemotherapy treatment. So I think we’re getting there but we’re not there yet.
When we treat women with breast cancer, we do it in two different situations. The first is when a woman has had the initial operation for her breast cancer, when there’s no visible sign that the cancer has spread but we often give a woman systemic therapy just in case. In case there’s disease that we can’t see but that might come back in the future and cause problems. We call that “adjuvant”. The other situation or some years later on when the woman may have received her previous treatment but sadly the cancer has come back and there we’re looking to give treatment to control the cancer and prolong her life.
The therapies which work best we use wherever possible as the adjuvant treatment when the woman has had her initial surgery. And that means that many of the therapies that we were using later in the course of the disease some years ago. Now that we see that they work well later in the disease, we now use them earlier on, after the woman’s operation. That’s good because they are having their maximal effect but the down side is that if that woman is unfortunate and the cancer comes back, we’ve already used up one or two of our best options. So the need for new ones which are effective comes earlier for that woman where we’ve already limited our options for controlling her metastatic disease.
We hear a lot about targeted therapies but chemotherapy remains the most important part of our treatment for women with metastatic breast cancer. This is an important addition because it works where others don’t. A situation where women have already received the best tried and tested ones, we are often faced with the situation of scratching our heads and really not being clear what we can do to give that woman the best chance of controlling her disease, prolonging her life and maintaining that quality of life. The clinical trial shows very clearly that it can prolong survival of these women by two and a half months – something that no other single agent has been able to do in the past. So these data, this evidence gives us a clear steer as to something that we can discuss with our patients, discuss what the treatment involves, how they may benefit from this, and make that, hopefully, available as an option, in the future.
We completed a trial where we compared the new one, to the otherwise available treatment in women who’d completed many previous lines of chemotherapy. We completed that trial a year ago. In about another year’s time from now, a second trial will be reporting. In that trial women who’d received a little less therapy for their disease were randomised either to receive the new one, or to receive another oral chemotherapy. So that trial has completed its accrual, all the patients have been treated on that study and we’re now waiting for the results. There will also be newer trials and there’s one that we’re carrying out in Leeds in particular and also at other sites in the UK where we’re looking to combine them to see if we can give them both together and potentially that may be better than giving either of them on their own. So those trials are on-going as we talk.
I think that for women who hear about it, it’s going to be difficult, they’re going to be keen to learn as much as they can about this. At the moment there’s only a limited amount of information in what you might call the public domain, I think as months go by more information will be available on the usual websites for the time being I think that a woman that’s got metastatic breast cancer for whom this may be an option who thinks that she may fit the bill, what I’d recommend for her to do is to speak to her oncologist and discuss whether it might be suitable for her and whether it is going to be available in her particular area.
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Cancer patient Melanie shows how she continues to enjoy life while being treated for advanced breast cancer.
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