Battling Cancer 25 Years Apart and the Improved Treatments Over Time
- Actor Stephen Amell, 42, calls his mom – a two-time breast cancer survivor – his superhero for her ability to beat the disease. Her diagnoses came about 25 years apart, and Amell notes the improvements in treatment between the late 1980s and today.
- A study published this year in JAMA found that since 1975, the breast cancer mortality rate dropped 58% thanks to improved early detection screenings and treatment for patients in later stages of the disease. The Centers for Disease Control and Prevention (CDC) says the overall 5-year survival rate for breast cancer is 90%.
- As early detection efforts show continued promise, advancements in treatments for harder-to-treat metastatic (stage 4) breast cancer also offer hope.
- Patients with this advanced form of cancer have more treatment options today to improve their overall quality of life. Examples include FDA-approved drugs like Trodelvy (drug name sacituzumab govitecan) and alpelisib (also known by its brand name, Piqray), which have proved to be promising treatments.
- Several factors go into determining which breast cancer treatments a patient will be given and in what order those treatments will be given. Some subtypes of breast cancer are better off receiving chemotherapy before surgery, while the majority get surgery first.
Actor Stephen Amell, 42, known for his role as a hooded vigilante in “Arrow” says his real-life superhero is his mom after she beat cancer twice. Her breast cancer journeys fueled Amell’s passion for breast cancer awareness and early detection.
“I’ve admired her over the years; she’s a two-time cancer survivor, and she lives her life like tomorrow’s not promised, and it’s a really admirable trait,” Amell told entertainment news outlet Hollywire.
“A lot has changed. A lot actually remains the same, which is a little peculiar, but there certainly have been advances. I’ll never forget going and visiting her in the hospital in the ‘80s…obviously, we are in an oncology ward and there was this hut for people to go and smoke,” Amell said.
He says his mom’s diagnosis had its ups and downs, but she maintained a positive attitude throughout and relied on her support system.
“She handled it really well, having gone through it before and having a good support system around her. I felt very confident in her and comfortable being away working,” Amell added.
Amell has participated in many Fck Cancer events, which have helped raise awareness about the disease. A few years ago, while speaking before a crowd about why he got involved in cancer awareness advocacy, he described his mom as his true superhero.
“My mom is my superhero…[and I’m]…a proud mama’s boy,” he said.
Expert Resources on Breast Cancer Screening
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- I Have Dense Breasts. Do I Need a 3D Mammogram?
- Inaccurate Mammograms Miss Breast Cancer in 18 Women At Virginia Center: Guidance For Safe Screening
Improved Breast Cancer Treatment and Awareness
Amell noted the improvements in breast cancer treatment between his mom’s first and second diagnoses 25 years apart.
According to a study published this year in the medical journal JAMA, researchers say improvements in screening and treatment are associated with a “58% reduction in breast cancer mortality” for breast cancer.
“In 2019, the combination of screening, stage 1 to 3 treatment, and metastatic treatment was associated with a 58% reduction in breast cancer mortality. Of this reduction, 29% was associated with treatment of metastatic breast cancer, 47% with treatment of stage 1 to 3 breast cancer, and 25% with mammography screening,” the study says.
Breast cancer mortality varied depending on whether the cancer was estrogen-fueled (ER-positive or negative, HER2 positive or negative).
According to the Centers for Disease Control and Prevention (CDC), the overall 5-year survival rate for breast cancer is 90%. When the cancer remains localized, the survival rate is 98%. When breast cancer is regionalized within the body, the survival rate is 86%. When the cancer has spread to distant parts of the body – metastatic cancer – the survival rate is much lower at only 32%.
The CDC adds that survival is higher when breast cancer is detected in its early stages when it is easier to treat. “Among females diagnosed with breast cancer from 2015 to 2019, 1,097,918 were still alive on January 1, 2020.”
How to Decide the Right Course of Treatment?
Dr. Elisa Port is the Chief of Breast Surgery at Mount Sinai Health System. She explains that many factors determine what type of treatment a patient will receive and in what order.
“Breast cancer has multiple different subtypes. These different subtypes can behave extremely differently, almost like different diseases,” Dr. Port said.
WATCH: Deciding if surgery or chemo is needed first.
HER2-positive breast cancer or triple-negative breast cancer are subtype examples that sometimes benefit from having treatment first and then surgery. However, the majority of other types of breast cancer undergo surgery first, and then doctors use the information they learn during surgery to determine what additional treatment is needed.
“We know that there’s no one size fits all, and we customize and tailor treatment, both the treatments that people get and the order in which they get them, based on the subtypes of cancer and a variety of different factors,” she added.
Ongoing Progress for Breast Cancer Patients
If you are diagnosed with late-stage breast cancer, you should know you still have many treatment options to improve your quality of life. For metastatic breast cancer patients, the drug Trodelvy (drug name sacituzumab govitecan`) is showing promise. Metastatic or stage 4 cancer means the cancer has spread to distant parts of the body.
Trodelvy is a type of drug called an antibody-drug conjugate, which is an antibody and drug combined. It works because the anti-cancer drug is attached to an antibody that recognizes cancer cells. When the drug enters the bloodstream, the antibodies deliver the anti-cancer drug directly to the cancer cells by IV infusion. Since the drug goes straight to cancer cells, it has minimal effects on healthy cells.
WATCH: How Trodelvy Offers Hope
Traditional chemotherapy, on the other hand, doesn’t target cancer cells as strictly. It can damage healthy cells, too. That’s what causes the side effects for which chemo is well known.
That doesn’t mean that Trodelvy is without side effects. Roughly one in ten people who take the drug have severe diarrhea, and roughly half hit very low levels of the type of white blood cell (neutrophils) that help fight bacterial infections.
Results from a trial show that Gilead’s drug, Trodelvy, demonstrated exciting results for breast cancer patients with hormone-sensitive tumors who tested negative for a receptor called HER2 and who had stopped responding to at least two earlier courses of therapy. The phase III TROPiCS-02 study, presented at the European Society for Medical Oncology (ESMO) Congress 2022, showed that Gilead’s drug had a positive effect on patients with hormone-sensitive tumors that tested negative for a receptor called HER2 and who had stopped responding to at least two earlier courses of therapy.
Hormone-positive (HR+) and HER2-negative (HER2-) breast cancer is the most common type of breast cancer, accounting for about 70% of new cases worldwide per year. HER2 stands for human epidermal growth factor receptor 2. It’s a protein that helps breast cancer cells grow quickly. The presence of HER2 has been divided into two groups, either positive or negative, leaving about 50 percent of patients somewhere in the middle. These groupings are based on how the tumors appear under a microscope when graded by the pathologist or with additional testing a pathologist may perform.
Patients with HER2-positive tumors have tumors that show HER2 over-expression, while patients with HER2-negative tumors show minimal or no expression.
Phase III trials represent one of the highest levels of scientific evidence available in medicine.
The study presented at the ESMO’s annual meeting in Paris compared Trodelvy to chemotherapy in 543 patients. Trodelvy extended by 3.2 months the survival of patients with advanced stages of a common type of breast cancer. Put another way, the Gilead drug reduced the risk of death by 21%.
“This is very encouraging data for women whose cancers are hormone receptor-positive. So yes, it’s very, very exciting. I don’t think we can actually start using the drug in the clinic until we have approval. That may be forthcoming, we hope it is,” Dr. Ruth Oratz, a medical oncologist at NYU Langone Perlmutter Cancer Center in New York City, told SurvivorNet.
Last year, the U.S. Food and Drug Administration (FDA) approved alpelisib (also known by its brand name, Piqray), a drug that could help metastatic breast cancer patients.
“Now our patients will have one more non-chemo option,” Dr. Jame Abraham, Director of Breast Oncology at Cleveland Clinic, told SurvivorNet. “Most importantly, it is a first-in-class drug, which showed significant improvement in progression-free survival.”
As a “first-in-class drug,” Piqray is the first PI3K inhibitor to enter the market for breast cancer treatment. A PI3K inhibitor works by blocking the PI3K (phosphoinositide 3-kinase) enzyme, which is essential for allowing cells, including cancer cells, to grow.
For breast cancer patients diagnosed with triple-negative breast cancer – an aggressive form of the disease – Trodelvy (sacituzumab govitecan) significantly prolonged life and progression-free survival. It’s called triple-negative because it does not have any of the main drivers of breast cancer, the estrogen receptor, the progesterone receptor, and the HER2 receptor, and doesn’t respond to the currently available treatments that target them. However, experts tell SurvivorNet that the disease often responds well to chemotherapy.
WATCH: Understanding triple-negative breast cancer.
The FDA approved Trodelvy for the treatment of metastatic triple-negative breast cancer in women who had already received two previous types of treatment. Trodelvy works by attaching the anti-cancer drug to an antibody that recognizes cancer cells and then kills it directly with minimal effects on healthy cells, reducing side effects.
The new data released last week, based on 468 patients, show that women who take Trodelvy survive a median of 12.1 months compared to those who survive a median of 6.7 months on chemotherapy. The drug halted disease progression for a median of 5.6 months, compared to 1.7 months on chemotherapy.
Questions for Your Doctor
If you have a breast cancer screening coming up or recently had one, you may have questions you want answered. SurvivorNet suggests the following questions to kickstart your conversation with your doctor.
- Do my mammogram results indicate I have breast cancer, or am I at higher risk?
- If I’m at higher risk, what are my treatment options?
- What side effects should I expect related to my treatment?
- How much will this diagnosis prevent me from working or fulfilling my daily activities?
- Will insurance cover my breast cancer screening, or are there other financial resources available?
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