Living Well: Doctor's bold step paid off for his patients

During the summer there was advance word about the promising clinical trials for a breast cancer drug called Herceptin. The results of those three major studies were published in the New England Journal of Medicine earlier this month, making it front-page news in the P-I.

And rightfully so. Herceptin appears to be a direct and effective match for many women with tumors that churn out too much of a protein called HER2. About 20 percent of breast cancer patients are HER2-related cases.

Herceptin previously was used and approved as a drug for women whose HER2 cancer had recurred. Research showed it could extend survival of advanced-stage patients for months and, in some cases, years. This month's breakthrough suggests Herceptin can be lifesaving for women with early-stage breast cancer.

The drug doesn't help every single HER2 patient -- common among medications -- but that didn't stop early buzz about the Herceptin trials in July when Catherine Daniels participated in a three-day, 60-mile walk for breast cancer.

"Everyone was talking about it," said Daniels, 58, a breast cancer survivor. "Every day."

Daniels got a chance to tell her story to fellow walkers. She was diagnosed with breast cancer in May 2000. She talked to a surgeon who suggested chemotherapy and then a mastectomy. While browsing the Internet, she found out about Seattle Cancer Treatment and Wellness Center, known for its integrative medicine approach. She called to make an appointment with its medical director, Dr. Ben Chue, because chemotherapy scared her.

As it turns out, Chue also recommended chemotherapy. But his approach was different. He prescribed smaller, more frequent doses of chemotherapy (known as "fractionated") for three months before surgery and that Daniels concurrently go on Herceptin. One reason was Chue had tested Daniels to find she was HER2-positive and another was the aggressive nature of the tumor.

"I said I needed some literature and Dr. Chue said, 'Wait one moment,' " said Daniels. "Then he got right up, went to the copier and came back to hand me the material himself. When's the last time your doctor did that?"

Chue's unconventional ways didn't set so well with the physician that Daniels saw to get a second opinion about the fractionated chemo and Herceptin treatment plan before undergoing a double mastectomy.

"I've never told Dr. Chue this but the second-opinion doctor rolled his eyes and stopped just short of saying Dr. Chue was planning to put a bone through my nose or pour radishes on my head," said Daniels.

There are some risk factors associated with Herceptin, most particularly the potential for heart failure. Chue said using the fractionated doses would reduce the chances, plus he ordered regular cardiovascular scans for Daniels. For her part, she was convinced from her own research that too many women with HER2 cancer were nonetheless "still dying" after standard chemotherapy and no Herceptin.

The breast cancer walkers were impressed.

"They were telling me, wow, that my doctor was really smart," said Daniels.

Chue himself got a chillier reception earlier this fall during a regional meeting of oncologists or cancer doctors. When advance word about Herceptin trials were discussed, Chue spoke up about how he had been using the medication for six years with HER2 patients. There was mostly a hush in response. Later, one oncologist told Chue he was lucky. A common response was how could Chue have decided to use Herceptin before clinical trials were complete? You wonder if that question is skewed toward worries about malpractice.

"It's funny how things have turned around," said Chue, who trained as a medical resident at the University of Washington and the Fred Hutchinson Cancer Research Center and as a fellow at Virginia Mason Hospital. "Before these findings you stood the chance of getting sued for using Herceptin (in early stage breast cancer patients). Now, after the findings you might get sued for not using Herceptin."

Despite "people around me saying not to do it" Chue just wouldn't accept the statistic that 70 percent of women with HER2 breast cancer would face a recurrence -- and only then were they prescribed Herceptin.

"We knew it lengthened life," said Chue. "It wasn't that far off to use it earlier."

For his part, Chue emphasized he was "not throwing away science" by using the Herceptin or fractionated chemotherapy, which has been validated in recent research findings. Early patients like Daniels inspired both Chue and subsequent patients.

Correctly, Chue pointed out that lots of physicians go "off-label" with certain medications that have been approved by the Food and Drug Administration for one condition but seem to work effectively on others.

"Aspirin is an example," said Chue. "We use it for pain all of the time but no trial has ever been done (associating aspirin and pain relief).

Chue's training does have some insights not experienced by all MDs. He grew up in San Francisco's Chinatown, accustomed to herbal tonics as first-line remedies for all sorts of illnesses, including colds, flu and headaches. He always remembered his family's medicine as he studied at schools like Yale and the University of California-San Francisco medical school.

"I was in Hong Kong with my parents on a trip in May when I got the first e-mail about the Herceptin trials," recalled Chue last week during a quiet moment at his clinic. "There was a big meeting of the American Society of Clinical Oncology in Florida. The researcher presenting the Herceptin data received a standing ovation. That's unheard at an oncology meeting."

Chue paused. One can imagine his thoughts were with dozens of patients who took Herceptin before this year under his direction. They were alive, following dreams like Daniels, who moved up to Conway, south of Mount Vernon, to start an animal rescue shelter.

"I was jumping for joy," said Chue. "My parents didn't quite understand it but they knew I was happy."

Bob Condor writes every Monday about health and quality of life. He is editor of the Seattle-based Evergreen Monthly, which covers health, environment, food, social good, spirituality and personal growth (visit www.evergreenmonthly.com). Send e-mails to bobcondor@aol.com with any questions or ideas for the Living Well column.

Add P-I health headlines to