Biology in the News Explained

Cancer drug companies’ worst nightmare

The recent medical opinion that anthracyclines (such as Adriamycin) are not effective in breast cancer patients that are HER2 negative is now joined by a potential test to further refine who will benefit from these chemotherapy drugs, which generally make patients very sick and are dangerous enough to cause permanent heart damage in some people.

Two genes were studied, and the mechanism of the action of one of the genes is fascinating: cancer cells with this gene sequester the toxin outside the nucleus, where it needs to be to kill the cell. The result is high resistance to Adriamycin (doxorubicin), which up to this point has been offered commonly and indiscriminately to many women with stage II cancer and above. So women with the gene who suffer through a common chemotherapy such as TAC (Taxol-Adriamycin-Cytoxan) are much more likely to have a recurrence than women without the gene.

About 20% of sampled patients in the study had the gene, and they had worse outcomes than the majority of women. The good news is that the authors find that cancer cells resistant to this class of chemo drugs are still susceptible to others. And, genetic tests these days are pretty simple and cheap to conduct (despite what companies like Myriad Genetics might tell you).

Big Pharma shouldn’t be too worried. Surely they will fight tooth and nail to patent as many genetic tests related to cancer as possible. But they’d better get cracking, because they missed this one. And it’s easy to imagine that perhaps an executive or two at a few companies would secretly rather this information weren’t available at all, because that will cut in on their profits. But perhaps this is overly cynical – surely it’s just those who don’t know someone with breast cancer who would have a tendency to feel that way. Of course, at the rate things are going, eventually most of them will.

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2 Responses to “Cancer drug companies’ worst nightmare”

  1. Brian in Idaho says:

    I came here via tigerhawk and read this post with great interest. My wife was diagnosed with triple negative breast cancer 30 months ago. Of all the hard things she had to endure the “red death” (Adriamycin) was the worst. Medicine is imperfect but I wish we had known this then.

    The test you speak of are not the brac 1 and 2 genes I think. What are their markers? Do you believe it would benefit one such as my wife to be tested? Also what are the effective medicines that are that you referred to for HER2 negative patients?

    Sorry to curbside you like this but I would appreciate your kind response. Thank you for an interesting post.

  2. biotunes says:

    The genes used can be seen in the link to the Nature abstract in my post. You are right, these are not BRCA genes, but others. This is new so a genetic test is not available yet, but as one of the researchers commented in the article about the paper, the test itself would be easy enough to do (as are most genetic tests). Hopefully, hopefully! this test will be available soon, and it’s clear to me it should be automatically done for any woman who is strongly encouraged to take Adriamycin.

    Here’s more information about adriamycin that you might not want to pass on to your wife, since what’s done is done:

    As a side note, my own oncologist says that he is getting away from anthracyclines as time passes because of the availability of other drugs. For example, I (after absolutely refusing adriamycin) ended up on a relatively new one called Abraxane, which is simply Taxol blasted into nanoparticles that are suspended in albumin. This allows much more of the drug to get in the cancer cells because the albumin acts as a “trojan horse”, and the result is that you need a much lower dose of the drug, so a lot fewer of your healthy cells are damaged, so a big reduction in side effects (e.g. my white count was not reduced at all on this drug as it was on the taxane Taxotere, which I was given until it turned out I was allergic :-) ).

    The best of luck to you and your wife – hopefully neither of us has to do this again, so that as far as we’re concerned it’s moot!

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