October is officially tagged “Breast Cancer Awareness Month”. Of recent, there have been a lot of medical breakthroughs in the detection and treatment of Breast Cancer. Scientists have identified more accurate tools for screening younger women who are more likely to get the most dangerous forms and new strategies have also been developed for the treatment of newly diagnosed pregnant women.  Advanced research has led to the development of better, less toxic drugs to guard against recurrences.

In the Western world, breast cancer deaths have plummeted and survival rates are soaring. Research has made more headway in the fight against breast cancer than any other form of cancer. These milestone achievements are as a result of the constant campaigns, awareness creation and fundraising activities directed toward the cause. Early detection and a study which showed that hormone replacement therapy in postmenopausal women strongly contributed to the development of breast cancer are greatly responsible for the lower incidence rates.

In breast cancer, some cells in the breast for reasons poorly understood start growing abnormally, dividing more rapidly than normal cells and may spread (metastatize) to adjascent tissue, lymph nodes or other parts of the body.The most common type begins in the milk producing ducts while otherforms occur in other breast tissue. It is known that 5 to 10% of breast cancer cases areinherited. There is usually a defect in one of two genes namely BRCA1 and BRCA2 (Breast Cancer Genes 1 and 2).

Most genetic mutations related to breast cancer are not inherited and develop during one’s lifetime such as exposure to polycyclic aromatic hydrocarbons found in tobacco and charred meats and radiation exposure.

Newer drugs such as Herceptin and Tamoxifen that are specifically targeted for the treatment of pathologically different cancer types has greatly reduced deaths as a result of breast cancer. In the past, one drug was used to treat all forms of breast cancer with less than satisfactory results.

Types of Breast Cancer:

The majority of tumours (about 60%) are hormone sensitive and are stimulated by the female sex hormones oestrogen and progesterone. About 25% of cases are the deadlier form associated with an excessive amount of the protein known as HER2.

Some cancers are both hormone sensitive and HER2 positive. There is a form of breast cancer more likely to occur in younger women known as Triple Negative Breast Cancer because it is neither oestrogen sensitive, progesterone sensitive nor HER2 positive. Fortunately, there have been developments in treatments to help all three forms.

Hormone Responsive Cancer is usually treated with Tamoxifen which is given after surgery to suppress hormones that stimulate tumour growth. Tamoxifen has serious side effects such as vaginal bleeding, hot flashes, an increased risk of uterine cancer and the development of blood clots. There are newer oestrogen-blocking aromatase inhibitors namely Femara, Arimidex and Aromasin which have been found to offer the same or even better results.

HER2 Cancer due the HER2 protein triggering the growth of cancer cells is an aggressive form of cancer.

The drug Herceptin is used to stop the action of this protein and is combined with chemotherapy. Tykerb, also a protein suppressor, will be on the market in 2007 and has shown excellent results when combined  with the chemotherapeutic agent, Xeloda.

Triple Negative Cancer is tackled with the use of a colon cancer drug known as Avastin and is combined with chemotherapy with promising results.

In the past, a pregnant woman found to have breast cancer had to make the difficult decision of having to save her own life or the life of the unborn child. New treatment guidelines allow women to have a mastectomy or a breast conserving lumpectomy and commence chemotherapy as early as the second trimester. Some studies have shown that there have been little or no adverse effects on the foetus while others have shown that the development of the foetus may be affected by chemotherapy. Radiation and oestrogen therapy may  harm the foetus and should be delayed until after the birth of the child.

More than 75% of cases of breast cancer occur in women aged over 50 years. Other risk factors include having a first degree relative (mother, daughter, sister) who has had breast cancer, having had breast cancer previously, an abnormal biopsy result, a mutation in the breast cancer genes, postmenopausal obesity, hormone replacement therapy and prolonged exposure to oestrogen such as reaching puberty before the age of 12 years, starting menopause after age 55 years and having children after the age of 30 or not having children at all.

Women are advised to have routine mammograms once they reach age 40. MRI’s are useful for locating difficult to identify tumours.The risk of developing breast cancer may be reduced by checking breasts monthly for lumps, getting regular exercise which boosts immune function and cuts the risk in half, watching your weight as obesity encourages further storage of oestrogen in fatty tissue. Women who are about 30kg overweight are up to 3 times more likely to develop advanced metastatic cancers than women who are not overweight. Exposure to oestrogen should be minimized thus hormone replacement therapy should be dicouraged.

It should be noted that men may also develop breast cancer. As a matter of fact, a male case was the first I was presented with as a medical student. In men, like women, the most common sign of breast cancer is a lump (often painless) or thickening of breast tissue. Other signs include change in the size or contour of the breast, clear or bloody nipple discharge, retraction or indentation of the nipple, flattening or retraction of the skin overlying the breast and redness or pitting of the skin overlying the breast.

Iressa (gefitinib) Improves Progression-free Survival over Standard Chemotherapy in Patients with NSCLC with EGFR Mutations.

Researchers from Japan have reported that Iressa (gefitinib) alone improves outcomes of patients with non–small cell lung cancer (NSCLC) with epithelial growth factor receptor (EGFR) mutations compared with patients receiving Paraplatin (carboplatin) and Taxol (paclitaxel). The details of this study were presented at the Joint ECCO 15 – 34th ESMO Multidisciplinary Congress in Berlin, September 20-24, 2009.

Oral Iressa (gefitinib) is approved in the United States as a single-agent treatment for patients with advanced NSCLC who have failed platinum- and taxane-based treatment. Iressa is a selective inhibitor of EGFR-tyrosine kinase. Epidermal growth factor receptor is expressed, overexpressed, or dysregulated in many human solid tumors, including NSCLC. Activation of this receptor is believed to promote tumor growth by blocking apoptosis and by increasing cell proliferation, adhesion and invasive capacity, and motility. Responsive lung tumors are likely to be adenocarcinomas or bronchio-alveolar carcinomas and occur more frequently in non-smokers and women. Responses also occur more frequently in patients with specific mutations of EGFR. Recently, researchers from Asia have reported that first-line treatment with Iressa improves progression-free survival (PFS) over combination treatment with Paraplatin and Taxol in advanced NSCLC among nonsmokers and former light smokers.

The current study included 198 patients with NSCLC with sensitive EGFR mutations who had received no prior chemotherapy. They were randomly allocated to receive Iressa alone or Paraplatin and Taxol.

Overall response rate was 74.5% for patients receiving Iressa versus 29% for patients receiving Paraplatin and Taxol. Grade 4 neutropenia occurred in 1% of patients receiving Iressa and 33% of patients receiving chemotherapy. Grade 3-4 liver dysfunction occurred in 33% of patients receiving Iressa versus 1% receiving chemotherapy. Grade 3 neuropathy occurred in 0% of patients receiving Iressa and 5% of patients receiving chemotherapy. PFS was 10.4 months following Iressa treatment versus 5.5 months for chemotherapy. Overall survival was 28.0 months for patients receiving Iressa and 23.6 months for patients receiving chemotherapy (P=0.357).

This study shows that Iressa improves PFS in patients with NSCLC with EGFR mutations compared with conventional chemotherapy. These authors suggest that Iressa be considered the new standard treatment for “sensitive EGFR mutation-positive NSCLC patients.”

It is a fact unknown to many. For every 100 cases of breast cancer diagnosed in women, there is one case detected in men. Physicians warn that in recent years the number of men with this problem is growing alarmingly. To diagnose this type of cancer, the patient’s breast has to be analyzed for hard lumps, growth and swelling of the glands. Often the symptoms confuse physicians due to its similarity to gynecomastia – male breast growth caused by the accumulated fat.

According to doctors, usually the tumor is found by the patient or his partner. Along with the appearance of lumps, it is common for patients to have complaints of nipple discharge, signs of local dissemination with the retraction of the nipple and ulcers.The treatment is similar to that of a woman – it depends on the stage of the disease and the health status of the individual. The earlier the treatment, the better the results.

First the biopsy takes place, then perhaps a mastectomy is performed, followed by radiation therapy or chemotherapy. Breast cancer is more prevalent in men over 35 years of age and the risk increases with age. The disease is related to the same risk factors in women such as: family history, the appearance of malignant tumors in the past, excess weight and high-fat diet.

The American Cancer Society estimates that this year 1,910 new cases of invasive breast cancer will be diagnosed among men in the United States. About 440 men will die in 2009 due to this disease.

“The earlier it is diagnosed, the better the prognosis. Just like in women, the survival rates for early diagnosis is about 80 to 90 percent, whereas, if discovered later, this index falls dramatically, reaching only 10 to 20 percent,” according to Dr. Renato Santos, a surgeon/oncologist at the São Luiz Hospital and Maternity in Sao Paulo, Brazil. In turn, Carvalho believes his quality of life is better today than in the past.”You will ask why? Now I respect my limits more, the limits of my body, and I know that serious diseases do not only affect other people. A disease can knock on our door too,” he said.

Carvalho said that even among his friends there is a preconceived notion about this disease. “When I was asked what I had and I responded ‘breast cancer,’ I noticed that people did not believe me or for some reason thought I was the only case in the world. This ignorance is dangerous and is bad,” he said.

One of the people that has helped spread awareness of breast cancer among men is Peter Criss. The original drummer of the band Kiss was diagnosed with breast cancer in 2008 and escaped major complications due to early detection. “In ‘08, I was diagnosed with breast cancer, but with (early detection) my great doctor Alex Swistel & staff and the Lord above, who always looks over me, I am cancer free today! I wanted to let you know men get it like women do. Don’t be afraid to let someone know if you have a lump. Do the right thing for you and your loved ones and get it checked. Man or woman, there is no discrimination with breast cancer … we all don’t have nine lives,” wrote Peter Criss on his official website.

Four years after the cancer diagnosis, Carvalho said he is slowly returning to his lifestyle. “I have no hurry, I take life as it is … Beautiful and difficult to face, but is the only real asset that we have. So, now I live and allow those close to me to live,” said the carpenter, who also had to readjust at work after the breast surgery.

A research article to be published on September 28, 2009 in the World Journal of Gastroenterology addresses this question. The research team, led by Prof. Zong-fang Li from the Second Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, investigated the effects of Chrysanthemum indicum extract (CIE) on inhibition of proliferation and on apoptosis, and the underlying mechanisms, in a human HCC MHCC97H cell line.

They examined viable rat hepatocytes and human endothelial ECV304 cells by trypan blue exclusion and MTT assay, respectively, as normal controls. The proliferation of MHCC97H cells was determined by MTT assay. The cellular morphology of MHCC97H cells was observed by phase contrast microscopy. Flow cytometry was performed to analyze cell apoptosis with annexin V/propidium iodide (PI), mitochondrial membrane potential with rhodamine 123 and cell cycle with PI in MHCC97H cells. Apoptotic proteins such as cytochrome C, caspase-9, caspase-3 and cell cycle proteins, including P21 and CDK4, were measured by Western blotting.

The results showed CIE inhibited proliferation of MHCC97H cells in a time- and dose-dependent manner without cytotoxicity in rat hepatocytes and human endothelial cells. CIE induced apoptosis of MHCC97H cells in a concentration-dependent manner, as determined by flow cytometry. The apoptosis was accompanied by a decrease in mitochondrial membrane potential, release of cytochrome C and activation of caspase-9 and caspase-3. CIE arrested the cell cycle in the S phase by increasing P21 and decreasing CDK4 protein expression.

The researchers drew a conclusion that CIE exerted a significant apoptotic effect through a mitochondrial pathway and arrested the cell cycle by regulation of cell cycle-related proteins in MHCC97H cells without an effect on normal cells. The cancer-specific selectivity shown in their study suggests that the plant extract could be a promising novel treatment for human cancer.

The launch provides breakthrough therapeutics to cancer patients in India and is a significant advance in taxane therapy for treatment of cancer.
The drug would be 40 per cent less than that priced in the US.  It would soon be available at our sponsor genglob.com at similar rates. If you want to get the details or enquire more about it please contact genglob via live chat, call or through contact page.

Abraxane is the first nanotechnology based anti-cancer drug that is administered in albumin-bound particles of approximately 130 nanometres and takes advantage of albumin, to transport the drug to the tumour tissue. The launch of Abraxene is part of Biocon’s strategic licensing partnerships to advance therapeutics in India. Abraxis had established a licensing agreement with Biocon for commercialisation of Abraxene in India.