As modern communications make passing on information easier than ever before, many have heard of breast cancer – but few have heard of “biologics”, the treatment that is providing great hope for people with certain cancers.

“The main advantage of biologic therapy lies in its ability to exert its effect only on the target,” says Dr Devan Moodley, an oncologist at Wits Donald Gordon Medical Centre in Johannesburg. “This is not always innocuous as many targets may not only be on the tumour, but also on other normal tissues, and therefore there may be side effects. It is not all a bed of roses, but it’s certainly nothing like conventional chemotherapy.”

Every October, the medical profession and breast cancer survivors raise understanding of the dreaded disease during Breast Cancer Awareness month, and now new hope may be on the horizon for many, as Eldré Strydom found out. Her story is one of tenacity and survival, which she tells in her own words:

Breast cancer at age 31 was something that I never planned on, so when I was diagnosed it turned my world on its head. I had so much life to live still. This couldn’t be the end already. So much I still wanted to do. Rohan and I were still relatively newlyweds; we had just bought a business and we hadn’t even started thinking about children yet. This just didn’t fit in with the plan I had for my life.

I always thought of myself as a strong, healthy boere meisie. I never spent a day in hospital, never broke a bone and felt that youthful immortality. When I felt a lump in my right breast one Saturday morning early in December 2004 I didn’t think much of it as the lump wasn’t painful and I didn’t feel sick. I made an appointment with my GP for the Monday morning, but wasn’t too worried because - as a friend of mine would say – you’d have had to shoot me to kill me.

My GP sent me for a sonar and needle biopsy. On Wednesday I waited for the surgeon to call and say everything was okay – but his secretary phoned late that morning and asked me to come in that evening.

I immediately knew something was wrong, but still had a small flicker of hope that it wouldn’t be the worst news. That evening Rohan and I sat waiting for the surgeon. After what felt like a lifetime, he confirmed my worst fear – I had cancer in my right breast. We decided I should go for a second opinion and had to make the difficult decision whether to have a mastectomy or a lumpectomy. After thorough discussions with my doctors and family I chose a lumpectomy.

On 30 December 2004, I had a lumpectomy and auxiliary dissection, removing all my lymph nodes, as the cancer had already spread to three of them. I had Stage 2 Breast Cancer and was ER+ and HER2 positive. My treatment started in January 2005 and after nine sessions of chemo and two months of radiation treatment, I thought I was done. Then my oncologist strongly suggested that I have HER2-targeted therapy for 12 months, as this would contribute greatly to my chances of survival.

I was exhausted from all the treatments, but knew I had to do everything possible to stay alive. The best thing about the IV targeted therapy was that it didn’t have any side effects and I could continue with my life while receiving the treatment every three weeks.

Looking back on that crazy year, I only now really absorb and deal with the enormous impact that one sentence, “you have cancer”, had on my life. The things I mostly remember were the physical battles. When I made the conscious decision to fight this unwelcome intruder in my body with everything I had, it turned into a mental and physical year-long battle.

My advice to someone newly diagnosed with cancer is to make educated and well-thought-through decisions. Get as much information as you can on your specific cancer and insist on all the tests - including genetic testing and the HER2 test. Then make the best decision for you, as you have to live with that decision.

What is HER-2 positive breast cancer?

HER2-positive breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. In about one of every five breast cancers, the cancer cells make an excess of HER2 due to a gene mutation. This gene mutation and the elevated levels of HER2 that it causes can occur in many types of cancer - not only breast cancer.

HER2-positive breast cancers tend to be more aggressive than other types of breast cancer. Medical science is, however, making great strides in the treatment of this cancer and others, with drugs known as “biologics”.

And biologics?

The essential difference between a biologic drug and other drugs is their size and complexity. Regular drugs (like antibiotics and painkillers) are small, simple molecules that can be manufactured in laboratories. Biologics, however, are so large and complex that scientists cannot manufacture them: They are “farmed” or grown from living organisms (such as yeast cells) which have been genetically modified to produce these complex substances.

These complex molecules are later “cleaned” to remove impurities, folded in a form that makes them work effectively and often modified with complex sugar molecules on their surfaces to make them more stable and efficient. This is why they’re called biologics - because they are produced through complex biological processes. Think of it this way: If a normal drug was a bicycle, a biologic drug would be an F1 fighter jet both in size and complexity.

“The main advantage of biologic therapy lies in its ability to exert its effect only on the target,” says Dr Moodley. “This is not always innocuous as many targets may not only be on the tumour, but also on other normal tissues, and therefore there may be side effects. It is not all a bed of roses, but it’s certainly nothing like conventional chemotherapy.”

The success rate in breast cancer treated with biologics is “variable”, says Dr Moodley, depending on which drug is used. However, with biologics proving to be quite remarkable in their function, South Africa’s Biologics Working Group (BWG) says that biologics often represent the latest biomedical research, and can therefore be the most effective means to treat a variety of illnesses when conventional treatment fails - and some offer solutions where previously no treatment was available.

According to the BWG, biologics are not a first-line treatment in South Africa and strict guidelines govern their use. However, this should not detract from the hope they provide. Says Kirti Narsai of the BWG: “Clinical experience has shown that in the early treatment of HER2positive breast cancer, the death rate from the disease is halved when patients are treated with a well known biologic.”

Pink ribbons may one day be a thing of the past, as long as medical science keeps researching and developing treatments like biologics.

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