Cancer research has made it possible for oncologists today to create personalized cancer treatment plans. Each plan varies based on the specific type of breast cancer. One of the key indicators of which treatments will work best for a patient is based on their hormone-receptor status and HER2 status.
What is HER2-Positive Breast Cancer?
HER2 is a protein that helps breast cancer cells grow quickly. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than breast cancers that are HER2-negative. There is also a category of patients who are considered HER2-low. This means there is some overgrowth of the HER2 protein, but not as much as a patient who is HER2-positive.
How is HER2-Positive Breast Cancer Treated?
Rocky Mountain Breast Specialists’ Dr. Ling Ma focuses on creating personalized breast cancer treatment plans for patients based on whether there are hormones causing the cancer to grow or too much HER2 protein. HER2-positive breast cancer, in particular, can grow very quickly. However, it is treatable with good outcomes for many patients! According to Dr. Ma, HER2-positive cancer that has not spread is considered “curable” and can have a 90% survival rate with a fairly straightforward treatment process.
The label “incurable” is used to describe metastatic breast cancer that has already spread beyond the breasts, into the regional lymph nodes and beyond. The most common places for breast cancer to metastasize are the bones, brain, lungs, and liver. Once there, surgery is used less often, but the treatment options are actually still plentiful. So, while the prognosis for incurable breast cancer is less predictable, there’s still much to be hopeful about, particularly with almost daily advancements in cancer treatment for HER2-targeted therapies.
In fact, when you listen to Dr. Ma talk about the latest breakthroughs in cancer treatments, her voice lights up with optimism. “The whole world of oncology is moving toward personalized treatment,” she says.
What is a Personalized Breast Cancer Treatment Plan?
While “personalized treatment” sounds fairly vague, the practice is actually highly scientific. It requires a biopsy to identify specific biological markers in a patient’s tumor. Oncologists, like Dr. Ma, can then employ a targeted treatment – or combination of treatments – for that specific cancer. These drugs have been proven effective at wiping out cancer – or preventing recurrence – and their use can often save patients the more uncomfortable side effects of the broad-spectrum chemotherapy historically used for cancer treatment. While most dominant in breast cancer treatment, “personalized,” targeted cancer treatment is being used more often to fight other types of cancer, as well.
The treatment planning process begins with the breast biopsy results. “Usually one biopsy can tell us a whole lot of info,” Dr. Ma explains how she targets her treatment for specific cancer markers. “You can always go back to archived tissue for another test. Sometimes I re-biopsy to see if there’s any change in biology during treatment, but I try to save patients the trauma of additional biopsies.”
Watch more videos and access more breast cancer education materials in our Education Center.
Balancing Breast Cancer Treatment with Quality of Life
Until relatively recently, cancer treatment was aggressive, systemic, and often devastating for the patient. “My philosophy for treating incurable cancer,” Dr. Ma says, “is first to prolong longevity and second, to improve quality of life during cancer treatment.” This includes tailoring treatment not only to the specific biological markers of the cancer but also to her patient’s individual desires, as well as any additional health complications they may have.
Personalized breast cancer treatment means that physicians like Dr. Ma won’t sacrifice the patient’s quality of life during treatment in pursuit of eradicating the cancer. The two priorities must be relatively balanced.
For example, certain agents might be contraindicated for a patient with heart disease or diabetes – or possibly with additional safety precautions in place. “It’s exciting to have these new agents but each one has unique properties so we have to monitor them carefully,” she says.
Some agents cause hair loss while others don’t, and the choice for treatment can be driven by very different patient priorities, according to Dr. Ma. She often works with patients to find treatments whose side effects are more tolerable to patients to support both physical and emotional well-being while fighting cancer.
Perjeta, Herceptin, Kadcyla, Tukysa, Nerlynx, Enhertu…the list of FDA-approved treatments for HER2-positive breast cancer can be baffling at first.
Choosing the Right Treatment Combination for Each Patient with Breast Cancer
Breast cancer doctors – as well as oncologists in a growing number of other treatment specialties – use a combination of therapies to create personalized cancer treatment. While traditional treatments like surgery, radiation, and broad-range chemotherapy are still frequently employed, breakthroughs in cancer drug trials allow precise, strategic treatment using targeted agents and antibody-drug conjugates.
When she talks about designing customized treatments or new discoveries in HER2 therapies, Dr. Ma speaks with the eagerness of an investigator solving a crime. “We were very frustrated for a long time about brain metastases in HER2-positive breast cancer patients,” she says. “Half of the patients with metastatic HER2-positive breast cancer get brain metastases. We were getting really good at killing the breast cancer, but then the cancer gets really sneaky and goes to the brain. And chemo and the older HER2-targeted agents can’t pass the blood-brain barrier. The newer agents are small molecules – small enough to go through the blood-brain barrier!”
“There’s lots going on in clinical trials,” Dr. Ma says. “We’re still learning, but there’s promising data in newer treatments.” Learn more about breast cancer clinical trials including those available through RMBS in Colorado.
Dr. Ma is continually reviewing the latest studies and drug trials and putting applicable discoveries into use to benefit her patients at RMBS. “As an oncologist, I feel it’s very important to follow the data and enact the new treatments in practice. It’s exciting. It’s interesting and very rewarding.”
Breast Cancer Specialists in Colorado
Our cancer centers treat more breast cancer patients than any other cancer center in Colorado. Dr. Ma sees patients at the RMBS location in Lakewood, Colorado. RMBS has additional breast specialists throughout Colorado from Longmont to Denver, as well as in Colorado Springs and Pueblo. Request an appointment for an initial consultation or a second opinion at a location that’s convenient for you.
Originally Published May 2021. Updated September 2024.
