Drug could offer earliest option in breast cancer fight

The US Food and Drug Administration has issued a positive review of a breast cancer drug from Roche that may soon be the first pharmaceutical option approved for treating early- stage disease before surgery.

FDA scientists said women who received the drug Perjeta as initial treatment for breast cancer were more likely to be cancer-free at the time of surgery than women who received older drug combinations.

Although the results come from mid-stage trials of the drug, FDA scientists recommended accelerating approval of the drug.

Perjeta was first approved last summer to treat women with a subtype of breast cancer that has already spread to other parts of the body. But Roche’s Genentech unit is now seeking approval to use the drug at a much earlier stage of the disease: after diagnosis and before surgery to remove the tumour.

Surgery to remove tumours is the first step in treating virtually all forms of cancer. If approved, Perjeta would be the first cancer drug approved for use as a pre-surgical step. Using cancer drugs before surgery is still experimental, but doctors hope the approach could help shrink tumours to make them easier to remove. In some breast cancer cases, a tumour that is easier to operate on could allow women to keep their breasts, rather than having them surgically removed.

Today, the FDA will ask an outside panel of cancer specialists whether Perjeta’s benefits outweigh its risks for treating early-stage breast cancer. Among other questions, the experts will be asked is whether the preliminary results reported by Genentech are likely to result in longer overall survival for patients. The government agency isn’t required to follow the group’s advice, though it often does.

The panel will review a 417-woman study comparing Perjeta in different combinations against older breast cancer treatments. When Perjeta was combined with Herceptin, another Genentech drug, and standard chemotherapy, 39% of women saw their cancer reach undetectable levels. Only 21% of women experienced the same results from taking Herceptin and chemotherapy alone. After drug treatment all the women received standard breast surgery to remove any cancerous tumours. Genentech says this allowed researchers to confirm the presence or absence of cancer.

Last year, the FDA released guidelines for studying breast cancer drugs in the pre-surgical setting, with the aim of accelerating approval of promising therapies. Perjeta is the first drug to undergo FDA review since those recommendations were released.

“Despite advances in systemic therapy of breast cancer, there remains a need to expedite drug development and approval of highly effective therapies for patients with high-risk early-stage breast cancer,” the FDA states in its review.

Like Herceptin, Perjeta only works in a subset of about 20% of breast cancer patients who have tumours that overproduce a protein known as HER-2, which makes cancer cells rapidly divide and grow.

The FDA is to decide whether or not to approve Perjeta for early-stage breast cancer by Oct 31.