In February 2007, Debbera Drake was diagnosed at Massachusetts General Hospital in Boston with stage 4 breast cancer, which was spreading to her right lung. Soon afterward, she sought a second opinion at another hospital nearby. The oncologist, not one to sugarcoat her opinions, told Drake, “You’re terminal. You have two years, max.” But six years later, the 67-year-old is cancer free and working hard to stay that way. Every day she exercise-walks for an hour, makes a fresh vegetable juice and eats two or three pieces of chocolate because, she says, “they have polyphenols, which fight cancer.” Most important, she takes olaparib: eight capsules in the morning, eight at night. The experimental drug is tailored to inhibit her specific condition: triple-negative breast cancer, a particularly aggressive variety that is often difficult to treat.
Drake has been using olaparib for four years—the first year in combination with other drugs, the last three by itself. Before that, she had a lumpectomy, radiation and chemotherapy, and surgery when the cancer spread to her brain. “Generally, when women are diagnosed from the start with advanced breast cancer and it spreads to the brain, they don’t have a terrific survival rate,” says Beverly Moy, MD, Drake’s oncologist. “But Deb enrolled in a clinical trial that has been remarkable for her. She is one of my superstars.”
Drake’s survival is likely due to a recent breakthrough in cancer treatment: the development of genetically targeted drugs that enable patients with previously intractable conditions such as lung cancer, melanoma and advanced breast cancer to live several years longer than expected. (These drugs are usually reserved for patients who have no other options, which is standard practice for drugs whose side effects are unknown.) “Genetic targeting is the future of cancer medicine,” says Jeffrey Abrams, MD, associate director of the Cancer Therapy Evaluation Program at the National Cancer Institute. “Now, for the very first time, doctors can profile most of a patient’s tumors, learn what’s abnormal about the tumors’ genes compared with normal genes and, with this information, treat that person’s cancer with a drug that specifically affects those abnormal genes.” So far, 33 targeted drugs are already approved by the FDA for treating specific cancers; dozens of clinical trials testing new drugs or new uses for existing medications are in progress.
A key advantage of the treatments is that they are generally less debilitating than much of the chemotherapy currently employed. Old-style chemotherapy is like a giant cannon that ravages both malignant and normal cells, causing collateral damage such as nausea, diarrhea and a weakened immune system; targeted therapy is more like an arrow shot by a marksman and, as noted in a recent study by the U.K.’s Institute of Cancer Research, leads to fewer serious side effects. The resulting improvement in people’s health is obvious. One longtime patient of oncologist Mark G. Kris at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City told the doctor, “When I’m sitting in the waiting room, everybody looks better than they used to” seven or eight years ago. The newer therapies are also much less disruptive to patients’ lives and work schedules. Says Kris: “When I started in 1983, patients treated for cancer for the first time were hospitalized for two or three days every month, just to get the treatment. With crizotinib [one of the new targeted drugs for lung cancer], you take a pill twice a day in your home.”
Mass General’s Theresa McDonnell, nursing director of the cancer center, is excited by how the new treatments affect her patients. “My image of cancer used to be the play Wit—bald, vomiting, emaciated, exhausted people just trying to cope with breathing and living,” she says. “Now we have stage 4 patients who are living full lives, working full time. And when we talk to patients, we have greater confidence and hope.”
How the new drugs work