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Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer - Rilegato

 
9780679457022: Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer
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Provides a close-up look at Genentech's new cancer drug, Herceptin, a nontoxic therapy that deactivates the protein that makes breast cells turn malignant, and offers a detailed account of its creation, development, and promise as an effective treatment. 60,000 first printing. Tour.

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L'autore:
Robert Bazell is the chief science correspondent for NBC News. His reports, which appear on the NBC Nightly News, Today, and Dateline NBC, have won every major award in broadcasting. He has written for many publications, including The New Republic, The New York Times, and The New York Times Magazine. He lives in New York with his wife, Margot, and daughter, Stephanie.
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Discovering Cancer

One morning in the fall of 1978, Anne McNamara showered while her husband, Jeff, tended to Luke, their one-year-old son. As she soaped and scrubbed, she felt something unfamiliar in her left breast. "Uh-oh," she thought, a chill going down her spine. She had a history of fibrocystic disease. She tried to convince herself that all this could be was just another benign growth. Silently she recited the statistics: she was thirty-two; in premenopausal women, just one out of twelve tumors turns out to be cancerous. Fighting the impulse to panic, she sought comfort in the knowledge that there was no history of cancer in her family.

Anne McNamara brought uncommon understanding to her discovery. Having been a biology major and a chemistry minor in college, her first job had been in a laboratory of a scientist at Yale Medical School, who was carrying out medical research. She tested the effects of radiation and chemotherapy on cancer cells. Much as she wanted to believe that this lump, like many others she had previously had, would go away as she moved through her monthly hormonal cycle, she had a feeling that this one was different. In unguarded moments over the next couple of weeks, she probed the new growth. Had it changed? Did it feel different? Once you find a lump, she says, "You check it three times a day." After more than a month had passed without any change in the lump, she went to see her gynecologist, who said he thought it was just a cyst. Nonetheless, he sent her to a surgeon for a biopsy. Just to be sure.

A few days later, McNamara met with her doctor, James Finn, who offered her the choice that most women in her position then faced: he could do the biopsy and wait until McNamara came out of the anesthesia to give her the results, or they could agree ahead of time that he would remove her breast if the tumor turned out to be malignant. McNamara, typically matter-of-fact, chose the second option, the course of least emotional complication. As Jeff remembers it, "She did not fear the worst, but she prepared for the worst."

Anne's delicate appearance and honeyed Georgia accent belie her toughness. Her face settles naturally into a warm smile, and when she talks in her straightforward and low-key manner, her large green eyes and her high-arched eyebrows give the listener a clear window on her emotions. She's now a youthful fifty-two years old, with auburn hair flowing to her shoulders. Jeff, a muscular man with a neatly trimmed mustache and ice-blue eyes, had just returned from a four-year stint in the Air Force and was finishing up his business degree when they met. They lived in the same apartment building in New Haven; when Anne had totaled her motorcycle, and Jeff, an inveterate tinkerer, saw it crumpled in a corner of the garage, he asked her if he could take a crack at fixing it. They've been together ever since.

Anne's surgery was scheduled for the week after Thanksgiving. Jeff stayed home with the baby and awaited word from the hospital. In the operating room, the surgeon was stunned by the lump's size: five centimeters, the size of a lemon. Moments later, a pathologist confirmed that it was a tumor and it was indeed malignant. Dr. Jim (as the McNamaras called him) phoned Jeff from the operating room. "It's not good, Jeff." "How not good?" "Bad." Jeff paused to collect himself and then said, "Do what you've got to do. Take care of her the best way that you know how."

McNamara remembers slowly coming out of the anesthesia. "I was still extremely groggy, and I was trying to figure out if my breast was gone or not. I knew if it was, then it meant I had cancer. But I was so groggy that I clutched at my chest and I couldn't figure it out." As the anesthesia wore off, she realized that her torso was wrapped in a bandage. "I knew what that meant."

Her doctor was flabbergasted. "We were all flabbergasted," said McNamara. "Because it was cancer, and there I was, thirty-two years old, although now it's getting more and more common to happen in younger and younger women. But in 1978 it was still unusual enough that the doctor just couldn't believe it. Who knows where it came from? But it had probably been there seven or eight years by that time, they say, before you can feel anything."

In 1978, the initial treatment of breast cancer had not changed much since the end of the nineteenth century. Like Anne McNamara, most women undergoing surgical biopsy would drift off into the oblivion of anesthesia and grab at their chests when they awoke to learn whether they had lost a breast or not. When McNamara underwent surgery, enlightened doctors still considered the radical mastectomy, a decades-old procedure, the best choice for cases like hers.

McNamara's first question on learning that she had cancer was whether she needed chemotherapy. Even though she knew all about the side effects, like nausea and hair loss, she thought it might help keep the cancer at bay. But Dr. Jim tried to assure her that he had gotten all traces of the disease and recommended against it. McNamara felt relieved, but suspicious. "I remember thinking to myself, 'He doesn't really know that,' " she says. She spent enough time around cancer research to know that rogue cancer cells often escape to other parts of the body before surgery. Why not have chemotherapy as insurance against spread or recurrence? Dr. Jim argued that chemotherapy could actually spur cancer to recur and cited very preliminary Russian studies on premenopausal women that purported to show how chemotherapy could actually induce the spread of breast cancer. Those studies were soon discredited, but they illustrated a truth about medicine: state-of-the-art practices come and go as medical science proves and then discredits its latest thinking. Even the most immaculately reasoned advice can be faulty.

In fact, by the time Anne McNamara had her mastectomy, clinical trials were already under way that would prove the usefulness of chemotherapy immediately after breast-cancer surgery. McNamara did not care about trends in cancer treatment; she only wanted to take every precaution against her disease, and her instincts told her that chemotherapy would increase the chances of eradicating her cancer. While disheartened, she did not challenge Dr. Jim. As happens so often, the patient was protecting the caregiver. "He was trying to comfort me, and he was a friend." Thinking back on it now, McNamara wonders if chemotherapy might have saved her from the terror of recurring cancer. Then she dismisses the thought: "That was the accepted protocol at the time."

McNamara's instincts turned out to be better than her surgeon's. Ten years after her mastectomy, the National Cancer Institute issued an emergency clinical alert to physicians, recommending that chemotherapy follow soon after surgery for all but the least threatening breast-cancer cases. Clinical trials had demonstrated convincingly that chemotherapy administered right after cancer surgery--called adjuvant chemotherapy--could help prevent the disease from returning and could thus improve the patient's chances of survival. Nowadays, adjuvant therapy is the standard of care for most breast-cancer patients.

McNamara had good reason to be so cautious. Breast cancer in a thirty-two-year-old woman is extremely rare and especially frightening. For reasons no one clearly understands, when the disease occurs so early in life, it tends to grow aggressively. In the United States, the chance that a thirty-two-year-old woman will be diagnosed with breast cancer is less than one in four thousand. Only 6 percent of breast cancers in the United States strike women under the age of forty. The odds only grow worse as women age; the chance that an eighty-five-year-old woman will have developed breast cancer over the course of her lifetime is one in eight. In McNamara's case, the only relatively good news was that tests showed that the cancer had not yet spread to her lymph nodes, meaning that the chances of a recurrence were less than they would otherwise have been.

Though half of all women with breast cancer never suffer a recurrence after the initial treatment, they are still sentenced to a life of uncertainty, never sure if they will join the half that does have a recurrence; and when the cancer reappears, it is always deadlier than it was the first time around. For Anne and Jeff, breast cancer brought a particularly severe disappointment: Luke would have to be their only child. Female hormones can fuel the growth of breast-cancer cells, so a pregnancy, with its massive hormone surges, can greatly accelerate a recurrence, especially if diseased cells have managed to escape the surgeon's knife. Nowadays doctors will allow some breast-cancer survivors to risk a pregnancy, but when Anne was diagnosed it was out of the question. "That was a blow," says Anne. "We had waited for seven years after we got married to have Luke." With her hands folded calmly in her lap, she explains, "I knew it would be silly to have another infant if there was a chance I wouldn't be around to raise it. I didn't want to leave my husband with a new baby, and I didn't want to leave a new baby without a mother."

With her knowledge from the cancer lab, Anne could interpret the facts. Jeff had no similar understanding to temper his fear. He only knew that Anne might not always be there, and even twenty years later he is visibly upset at the thought, and he speaks freely about his confusion, fear, and frustration. His take-charge attitude had worked for him during his four years in the Air Force, and it had brought him success as a consultant to high-tech companies. But here was a problem that he couldn't solve. "If it had been a hole in the roof, I could have fixed it. But there wasn't anything I could do but be around to keep our life together. I just couldn't do much else."

"I mean, I was upset," he continues. ...

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  • EditoreRandom House Inc
  • Data di pubblicazione1998
  • ISBN 10 067945702X
  • ISBN 13 9780679457022
  • RilegaturaCopertina rigida
  • Numero edizione1
  • Numero di pagine214
  • Valutazione libreria

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