Breasts Don’t Come in ‘One Size Fits All’ — Neither Should Breast Cancer Care

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Breasts Don’t Come in ‘One Size Fits All’ — Neither Should Breast Cancer Care

Rocky Mountain Cancer Centers’ Dr. Ling Ma Focuses on Personalized Breast Cancer Treatment

If you know your basics about breast cancer, the phrase “HER2-positive breast cancer” probably conjures an ominous image. 

Ma-Ling-2-700x475Once considered a devastating diagnosis, progress in cancer research has made HER2-positive breast cancer highly treatable, and even curable. According to breast cancer doctor Ling Ma, an oncologist at Rocky Mountain Cancer Centers (RMCC), 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 and the regional lymph nodes. The most common places for breast cancer to metastasize are the bones, brain, lungs and liver. Once there, surgical removal is no longer effective, but the treatment options are actually still plentiful and much less formulaic. 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 enumerate the latest breakthroughs in cancer treatments, her voice lights up with optimism. “The whole world of oncology is moving toward personalized treatment,” she says.

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.

“Usually one biopsy can tell us a whole lot of info,” Dr. Ma explains of 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.”

shutterstock_1034344537-600x400Until 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 possible 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.

taking medicationsPerjeta, Herceptin, Kadcyla, Tukysa, Nerlynx, Enhertu…the list of FDA-approved treatments for HER2-positive breast cancer can be baffling at first. 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.” 

Dr. Ma is continually reviewing the latest studies and drug trials and putting applicable discoveries into use to benefit her patients at RMCC. “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.”

Dr. Ma sees patients at our RMCC location in Lakewood, Colorado. RMCC has additional breast specialists throughout the Front Range, from Longmont to Denver, as well as in Colorado Springs and Pueblo.

Do you or someone you know have HER2-positive breast cancer? If so, call the breast specialists at RMCC.

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