Herceptin Part I: What it Is

I've been thinking for a while that I want to have a "Herceptin Week" at The Big "C," but alas, there's been too much else to report on. Like foam rocket launches. Hair cuts. Other important matters.

So instead I'll have a "Herceptin Series," spaced here and there throughout my days.

To explain what Herceptin is, I have to explain what my cancer is.

Healthy cells have HER-2 proteins around them on the outside, and they send signals into the cell telling it to grow and divide.

My cancer cells--and 25% of breast cancers are like this--have an over-expression of this HER-2 protein. They've got too many of those HER-2 buggers and so the cancer cells grow and divide like crazy. This is what makes the cancer so aggressive. It grows fast. It chokes out nutrients to health cells and, if it had metastasized to any organs, it would interfere with very important cell function.

Herceptin is a "monoclonal antibody," or a targeted biological therapy that "is proposed to work" in two ways.

Isn't that language fascinating? "It is proposed to work. . ." as in, through laboratory science, they've seen the results of Herceptin's application to HER2+ cancer cells, and this is their hypothesis of what is happening. But they can't just say that this is what's happening. All their literature--oh, we'll get to the literature!--keeps it hypothetical.

1) Herceptin attaches to the HER2+ cell and "may stop" those many HER2's from telling the cell to grow and divide.

2) (This is the one I especially like) Herceptin "may flag" the cancer cell for destruction by the body's immune system. As in, the body doesn't recognize cancer as the enemy, so it doesn't fight it, but Herceptin calls attention to it, "Right here, girls! Come and get it!"

In 1998, Herceptin was approved by the FDA and was used immediately in the US to treat metastatic breast cancer. With startling results. The survival rate of those women treated with Herceptin jumped about 45%.

In 2006, following the clinical trials of Herceptin with adjuvant patients (e.g. those like me who had surgery and all the visible cancer was cut out), it became standard treatment as well. The survival rate went from just 23% to 83%.

I am deeply grateful and humbled by all the research that went before me. . .

But here's an interesting note. As I was poking around the internet to learn more about Herceptin, I came across the role of Herceptin in Australia.

They have national health care there.

The government didn't subsidize the use of Herceptin for anybody until 2006. Why? Because the treatment costs 70,000+ dollars per patient. There was an 8 year debate in their country over whether the effects warranted the cost.

Now, it's true that in 1998, the US didn't have a pile of clinical trials to point at and say, "This works." I asked Dr. Markus about all this on Monday, and he described the American medical mindset as, "If we think it would do some good, we go for it. And then years down the road, we see the evidence of of how much good it does. In a system like Australia's, they have the cost-benefit discussion first." He paused. "Not that I'm trying to enter the debate."

After the evidence of its benefit was 8 years in the making here in the US, the Australian government finally agreed it was worth subsidizing. During those 8 years, Australian women either had to come up with 70 grand, or walk the road with almost less than half the chance of survival as Americans.

It's worth noting, also, that uninsured women in the US have access to subsidies for this treatment through the company that makes it, as well as several other non-government organizations that support breast cancer patients.

I'm not trying to have a health care debate on this blog. I just happened to run across this example, and I'm counting it as a huge blessing that I'm an American living in the US, receiving a life-saving treatment that my excellent military insurance is paying for because my excellent husband has persevered in his career. It's the very definition of privilege, and I'm thankful for it.