HER2: The Dawn of Precision Medicine
From Oncogenes To Genetic Targeting
In the early 1950s, Danish physicist Niels Henrik Arley floated the idea of the existence of oncogenes, genes that could drive cancer mutations. His contemporaries laughed at him, so the term oncogene went dormant until 1970, when National Cancer Institute scientists George Todaro and Robert Heubner reintroduced the term, and UC Berkeley researcher Dr. G. Steve Martin started studying a chicken retrovirus that turned out to have the oncogene SRC embedded within it. A few years later, the oncogene Human Epidermal Growth Factor Receptor 2 (HER2) was discovered to be a driving force in a significant minority of breast cancer diagnoses, and the era of genetic targeting in cancer treatment was born.
Precision Medicine, Patient Activism, And Herceptin
“Slash and burn”—surgery and radiation—as the sole approach to cancer treatment shifted as chemotherapy protocols started to emerge in the 1940s, and were added to the standard of care in the 1960s. Then, with the discovery of oncogenes, and the identification of HER2 as a driver of 15% to 30% of invasive breast cancers, the race was on to see if there were targeted therapy opportunities for cancers caused by oncogenes.
Genentech was the first biotech company to bring a drug to market: trastuzamab, most commonly known as Herceptin. The clinical trials that led to that drug’s release started in 1992, with Phase I, moved to Phase II in 1993, and then in December of 1994 made headlines when breast cancer patients with HER2 positive breast cancer literally stormed Genentech’s headquarters building, demanding access to the drug, spurred by the activism of Marti Nelson Erwin, an obstetrician-gynecologist who had fought unsuccessfully for access to the drug, and who died of breast cancer the month before.
Genentech set up meetings with breast cancer patient activists to discuss the idea of early access “compassionate use” for HER2+ patients. Breast Cancer Action and ACT UP Golden Gate had been working together since 1990 to make the case for early access to new drugs emerging from genetic research for patients with HER2+ breast cancer, creating an alliance between patient communities that’s a model for patient activists and advocates today, including the Cure Forward Precision Medicine Advocates, who build bridges connecting all cancer communities to emerging precision medicine.
DNA Cures for DNA Driven Cancers
The discovery of HER2 as a cancer trigger, and the development of trastuzamab, marked the first use of monoclonal antibodies to successfully treat cancer. In addition to breast cancer, HER2 is a factor in esophageal, stomach, small bowel, and oral cancer, as well as some ovarian cancers. Trastuzamab is a treatment option for those cancers, too, making genomic profiling of cancer tumors an important part of developing a cancer treatment plan.
A century ago, cancer was seen as one disease that could appear in any human organ. Now, cancer is known to be thousands of diseases, driven by gene-level triggers, making genomics the pathway to discovering the key to remission and cure in each patient.
Every body is different, even with the same DNA double helix that makes each of us human. That’s why, when you’re confronted with a cancer diagnosis, one of your first questions should be, “when will we do a molecular profile on my tumor?”
No matter what triggered your cancer, the answer to it is in your DNA.
|Casey Quinlan covered her share of medical stories as a TV news field producer, then got a breast cancer diagnosis five days before Christmas in 2007. She used her research, communication, and comedy skills to navigate treatment, and wrote “Cancer for Christmas: Making the Most of a Daunting Gift” about managing medical care, and the importance of health literate self-advocacy.Her speaking calendar for 2016 includes Academy Health’s National Health Policy Conference, the 7th Patient Engagement, Education and Adherence Summit, the ePharma Summit, the Genetic Alliance’s Building Trustworthiness in PCORnet meeting, and Health Datapalooza.|