Breast Cancer Guide Calls for Personalized Therapy

To make the best possible decisions about breast cancer treatment, you and your doctor need to know all the details of your unique medical situation, including the "personality" of the cancer as described in your pathology report.

A large group of cancer experts from around the world met in Europe and created new guidelines for treating early-stage breast cancer. The guidelines recommend that:

• chemotherapy
• targeted therapies
• radiation therapy
• hormonal therapy

should be based on the characteristics of each individual cancer being treated.

Called the 2009 St. Gallen International Expert Consensus, the meeting was attended by about 5,000 breast cancer experts. A group of 43 experts wrote the guidelines based on discussions among the entire group.

Every breast cancer is different. A breast cancer's personality is based on its:

• stage, which is based on:
  • the cancer's size
  • whether it's invasive or non-invasive
  • whether lymph nodes are involved
  • whether the cancer has spread beyond the breast
• grade, which is based on how different the cancer cells are from normal cells
• hormone-receptor status, which tells whether or not the cancer cells have receptors for estrogen and/or progesterone
• HER2 status, which tells whether or not the cancer cells are making too many copies of the HER2 gene or have too many HER2 receptors

The new guidelines for treating early-stage breast cancer are based on the best scientific knowledge available right now.

The guidelines recommend:

Hormonal therapy, which can reduce the risk of early-stage breast cancer coming back, should be used to treat all early-stage breast cancers with any detectable level of estrogen receptors. Tamoxifen and the aromatase inhibitors are examples of hormonal therapy medicines.

Herceptin (chemical name: trastuzumab), a targeted therapy, which can reduce the risk of early-stage breast cancer coming back, should be used to treat only breast cancers that are HER2-positive. Chemotherapy, either before or during Herceptin treatment, also is an important treatment for HER2-positive breast cancer.

Chemotherapy, which can reduce the risk of early-stage breast cancer coming back, always should be used to treat triple-negative early-stage breast cancer. Triple-negative breast cancer is cancer that is estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative. Hormonal therapy medicines and Herceptin usually don't work on triple-negative breast cancer.

The new guidelines also point out that hormone receptor and HER2 test results must be accurate and reliable.

The panel of experts couldn't agree on whether gene assay tests, such as the Oncotype DX test, were helpful in making treatment decisions. The Oncotype DX test looks at the behavior of a specific group of genes in breast cancer cells. The genes' activity can affect how likely a cancer is to respond to treatment. The Oncotype DX test is used on estrogen-receptor-positive breast cancers and can help doctors decide if the cancer is likely to come back; if so, chemotherapy may be recommended. Even though the expert panel's new treatment guidelines for early-stage breast cancer don't recommend using the Oncotype DX test, many doctors believe results from the Oncotype DX test can help decide which hormone-receptor-positive early-stage breast cancers also need to be treated with chemotherapy.

If you've been diagnosed with early-stage breast cancer and are deciding on treatment, ask your doctor to go over ALL the information about the breast cancer with you. This should include your pathology report. Then, together, you can make the best treatment decisions for your specific situation.