Are We Close to a Cure?

Dr. Larry Norton is head of the division of solid tumor oncology at Memorial Sloan-Kettering Cancer Center in New York, N.Y. An M.D. graduate of Columbia University College of Physicians and Surgeons, Dr. Norton is board certified in internal medicine and medical oncology, with clinical expertise in breast cancer.

We sat down for a Q & A session with Dr. Norton and asked him questions focusing on curing breast cancer. Dr. Norton’s candid responses and eternal optimism are trendsetting in the fight against breast cancer. His unending determination to eradicate breast cancer is infectious to say the least.

ABCG: Dr. Norton, you seem to be one of the most optimistic oncologists in America. You believe that many cancers, such as lymphomas, leukemias, and testicular, can and have been cured. How close do you feel the medical profession is to curing breast cancer?

Dr. Norton: The point that I make frequently is that most cases are cured right now. It’s a given fact that most Americans who develop breast cancer are cured of the disease. Mastectomies or lumpectomies with radiation and systemic gene therapies, such as hormone therapies or chemotherapies, have been proven to work. Most patients who are treated are cured and never relapse and never have a further problem with the disease. This was not the case in the nineteenth century, when everybody with breast cancer died of it. So already, we are curing most breast cancer. The next five to ten years is going to show us that breast cancer can be prevented in the majority of cases. In terms of metastatic breast cancer, that’s clearly going to be the hardest. But I think that’s going to prove possible as well. And again, I say this because I’ve seen it happen with a whole variety of diseases that were thought to be forever fatal and now we are seeing 90% cure rates. Now when’s it going to happen? No one knows that. I don’t think anyone can say it’ll happen this year or next year or in ten years. Where breast cancer is now, we’re on the verge of cure. I would be very shocked if we haven’t made very dramatic impacts in the next ten years.

ABCG: What do you feel is making breast cancer more difficult to attack as compared to some other cancers?

Dr. Norton: Most cancers that we have cured have had certain biological characteristics—the major one being that they have had a very high percentage of cells that are in cell division, like leukemias and lymphomas, or germ cell tumors. Whether that’s the reason they are particularly sensitive to the drugs we have or whether that indicates something else biologically that makes them sensitive no one knows.

The diseases that are harder to treat seem to be the ones where a fewer percentage of the cells are in cell division, like breast cancer or colon cancer or melanoma. So we need ways of being able to destroy cells that are not necessarily in a sensitive phase of their cell division cycle, and there are advancements in immunotherapy that are going to play a very significant role.

ABCG: The first breast cancer causing genes were discovered some 20 years ago. Now Her-ceptin—the first drug to target the underlying genetic defect that causes cancer–has been released.

Dr. Norton: Not quite. The first effective targeted therapy of breast cancer that we know of was Tamoxifen, which targets the estrogen-receptor.

ABCG: This twenty-year gap is pretty significant, and many people who are skeptical about a breast cancer cure use this to fuel their doubt. What do you say to these people?

Dr. Norton: If you look at testicular cancer or if you look at leukemia, you will notice that there were a lot of little improvements over a long period of time. The steady improvements were very slow and methodical and modest. Then, all of a sudden, there was a dramatic break in the curve and a high percentage of patients were being cured. There is a steady progression, and then there’s a certain break. And I think that’s what we’re seeing in breast cancer.

ABCG: Tell me a little about Herceptin/Taxol combination therapy.

Dr. Norton: It became obvious in the laboratory that Herceptin was killing breast cancer cells, but it wasn’t having a major impact. The concept came along of combining chemotherapy with drugs like Herceptin to try to augment the effect of both.

ABCG: Do you feel the competition between drug companies is counter-productive to your research and the research of other prominent oncologists?

Dr. Norton: I think the pharmaceutical industry works really well with academia and the National Cancer Institute. You just don’t know what would happen if you didn’t have the competition. I think you can certainly point to situations where you say ‘I wish these two companies would work together.’ They say that the reason they don’t is because of regulatory problems with the Food and Drug Administration. You have to admit that the American pharmaceutical industry is supplying most of the world with drugs and doing an extremely good job of it.

ABCG: What is the new trend regarding breast cancer research and development? Are there any new drugs on the horizon?

Dr. Norton: Yes, there are a bunch on them. How promising they turn out to be in the long run is going to depend very much on further research.
I’m particularly interested in the vaccine area. I think we have every reason to believe that with modern vaccine technology, we have a real chance at making a real difference. There have been very new ideas about how to develop vaccines, including those that can stimulate special cells—white cells and T-cells—to attack cancer tumors. I’m also very excited about some of the newer agents that can get into the machinery of the cells and fundamentally cause the cells to stop dividing.

ABCG: How can women become participants in clinical studies at Memorial Sloan-Kettering?

Dr. Norton: We are literally doing hundreds of clinical trials involving thousands of patients. We’re doing everything from vaccine trials to new combinations of existing drugs. We’re also doing much more work with Herceptin, and I’ve got a lot of interest in hormones. The National Cancer Institute’s number (1-800-4CANCER) is a very good source of information for people about what trials are open and what studies are suitable for these people. In the breast cancer area, NABCO—National Alliance of Breast Cancer Organizations—also provides a tremendous outreach effort. It is not hard to find out if you are a candidate for a clinical study.

ABCG: What advice do you have for women who have been diagnosed with breast cancer?

Dr. Norton: The first piece of advice that we always give is to just sit down for a minute, take a deep breath, and don’t rush into anything. Take some time to make a decision that is going to be the right decision for you. Every decision has two parts—it has the biology part and it has the other part, which is everything else. You’ve got to find out as much about the biology of your situation and also coordinate that information with all of the information that you know about your lifestyle, your quality of life, and your goals and aspirations. In other words, the patient has to be participatory in making the decision in how to proceed. And most of all, gather information.

ABCG: I recently interviewed Dr. Larry Norton from Memorial Sloan-Kettering, and one of the hot words he used was cure. Do you feel we have actually cured any cancers?

Fran Visco: I don’t think we know how to cure breast cancer—certainly not cure in the way that patient activists understand the word. To me, we know how to cure breast cancer when we can give each individual woman a treatment and tell her that her cancer will not return. We can’t do that for each individual woman. We really can’t tell anyone with any assurance that they are cured of breast cancer. Cure is a loaded word. I understand the need for the medical profession to believe that they are curing people. But, as activists, we understand that we don’t know how to cure breast cancer.

ABCG: I recently heard you say that you doubt very much there will be a cure for breast cancer in the next several years. How close or far away do you think we are to a cure?

Fran Visco: For the first time, I’m hopeful. But I don’t think it’s possible to put a time period on it. I don’t think we’re three years away. I’m unaware of any large-scale clinical trial right now that anybody thinks is a cure for breast cancer. It takes several years of a large-scale clinical trial to prove that we have a cure for something.

Fran Visco: If there were a large-scale clinical trial, I think we would know about it. It’s not there. That’s not to say that there is not something in the lab that might, in the next several years, find itself into a clinical trial addressing that question. As activists, we recognize that there is not going to be a single cure for breast cancer. There’s not going to be a magic bullet. It’s a much more complex disease than that.

ABCG: Do you share the excitement that many breast cancer patients and survivors have toward Herceptin?

Fran Visco: I’m very excited about Herceptin because of the proof principle. It’s one of the things that has given me a great deal of hope; not because of the effectiveness of Herceptin for women with breast cancer, but because it proves that monoclonal antibodies work. I think it opens up an entire new area of breast cancer research that I think holds much promise. Once we’ve shown that approach works, there will be more research and emphasis in that area.

ABCG: Do you feel breast cancer patients have easy access to the latest technologies and clinical trials?

Fran Visco: Only 3% of adult cancer patients in this country are in clinical trials. Women with breast cancer do not have easy access to clinical trials. That is something that as activists, we are working at on a daily basis to change. Access to standard of care therapy is mixed—it depends on whether you’re insured or not, what section of the country you live in, and whether there are cultural barriers to your care. There is a large number of women with breast cancer in this country who do not have access to the latest in care.

ABCG: Is enough research being conducted about preventative measures for breast cancer?

Fran Visco: No, not at all. We have not paid a lot of attention to preventive research in breast cancer or any type of cancer. That’s one of the things my organization is trying to do; we have been responsible for significantly increasing the funding for breast cancer research over the past several years, and we want to make certain that a sufficient amount of those resources are dedicated to finding the cause and preventing breast cancer.

ABCG: What advice do you have for recently diagnosed breast cancer victims?

Fran Visco: When women who are recently diagnosed with breast cancer call me, I always tell them that they are doing the right thing by calling an organization and finding out as much information as they can. Knowledge is power—it’s trite, but it’s true. When I was diagnosed with breast cancer, I felt powerless. But the more I found out about the disease, and the more I educated myself, the more I felt I had a voice in what happened to me. I always tell people, try and find out as much as you can and be involved in all of the decision making around your own care and treatment. You have a right to do this. You have a right to ask questions and make demands.

Call the American Cancer Society for more information on volunteer opportunities, cancer information, patient support, advocacy, and MAKING STRIDES AGAINST BREAST CANCER events at 1-800-ACS-2345, or visit on the web at www.cancer.org.