Anyone who has survived chemotherapy knows how brutal it can be. But thanks to an experimental procedure, Barbara Link, 55, of Cary, North Carolina, found that parts of the treatment were "actually pleasant." Her enthusiasm is all the more surprising because she was given two especially toxic drugs in high doses. The difference is that Link received her chemo in fat-coated droplets that release their contents when they're heated to 102 degrees--a higher temperature than the body normally reaches. By gently --warming her breast, her doctors unleashed the cell-killing compounds in the vicinity of the tumor without poisoning the rest of her body. All she had to do was lie face down on a padded table, her affected breast protruding through an opening into a tub of warm water. Then she blissed out to the music of Yanni while radio waves heated the breast. "Most patients really enjoy the table," says Dr. Kimberly Blackwell, the medical oncologist at Duke University who treated Link. Patients have even coined their own name for it--the "boobie Jacuzzi."
Sometimes it's a tossup which is worse--having breast cancer or undergoing treatment for it. Therapy can be toxic, disfiguring and ultimately futile. But breast cancer is one malignancy that doctors think they're finally starting to beat. "Almost every month, I have a drug or an option I didn't have the month before," says Blackwell.
Some of the most exciting advances involve genetic profiling, a technique that could soon enable doctors to tailor treatment to the precise genetic signature of a tumor. In January a test became available to help doctors figure out which breast-cancer patients would benefit from the estrogen-receptor blocker tamoxifen alone and which needed additional chemotherapy. The test, from Genomic Health, Inc., of Redwood City, California, assesses 21 key genes in a tumor-tissue sample, then crunches the data into a single score from zero to 100. "The higher the number, the worse the woman will fare on tamoxifen alone," says CEO Randy Scott. "It's the first test of its kind going beyond age and tumor size for prognosis in cancer."
Doctors would like to use gene profiles to answer all kinds of treatment questions. Who should receive radiation? Who should take certain drugs and for how long? "Genetic profiling is doing for breast cancer what the Hubble telescope did for astronomy--enabling us to see things we've never been able to see before, with much better detail and higher resolution," says Tom Baer, CEO of Arcturus Bioscience in Mountain View, California.
But better targeting through genetics is only half the battle. The other half is improving the cancer-fighting arsenal. Tamoxifen is arguably the most successful drug in cancer history, having cut rates of breast-cancer recurrence by as much as half. But most patients derive no further benefit after five years. Major studies have recently found that recurrence can be slashed by a further 30 to 50 percent when women switch to one of three aromatase inhibitors (Femara, Aromasin or Arimidex) after varying periods of tamoxifen treatment. "The use of aromatase inhibitors is going to have a major impact on outcomes," says Trevor Powles, a British oncologist who participated in an Arimidex trial. "These drugs are going to seriously reduce mortality rates."
Perhaps the ultimate new weapon against cancer would be one that vaporized a tumor without surgery. In pilot studies at M.D. Anderson Cancer Center in Houston and Victoria General Hospital in British Columbia, doctors have used radiofrequency waves to "ablate" small tumors in older women. A radioprobe is inserted into the breast and guided to the tumor site by ultrasound. When the power is turned on, radio waves heat the tumor until its proteins shrivel like bacon in a frying pan. The body should eventually reabsorb the dead cells. Bev Brown, 69, a retired X-ray technician, was one of roughly two dozen patients who received the treatment in Canada. "It was so much easier than surgery," she says. "It didn't even leave a bruise." Because the technique is experimental, she still needed surgery to make sure the tumor was fully eradicated. But it helped make breast cancer far less traumatic than it might have been. And that in itself is a victory.