High Tumor Responses With Trastuzumab Deruxtecan
The DESTINY-Breast01 trial was not a randomized study, so all patients in the trial received trastuzumab deruxtecan.
Nearly all of the more than 180 women in the trial had at least some reduction in the size of their tumors, with 61% experiencing substantial reductions, Dr. Krop reported. Several patients had no evidence of cancer following treatment, known as a complete response. The median progression-free survival was more than 16 months.
Dr. Krop called the results compelling, noting that the tumor response rate is roughly double or triple what we typically see in other studies of this third- or later-line population.
Most of the treatment-related side effects seen in the trial were mild, Dr. Krop said. Even so, 15% of the participants stopped taking the drug because of side effects. Nearly all of these women were those who experienced ILD. Four of the women who developed ILD died as a result.
Why we have this particular risk is unclear, he said. And clearly we need to do more research to identify those patients who are at risk of getting the most severe cases of ILD and how to mitigate the risk.
For future studies of the drug, Dr. Krop said, clinicians will be advised to carefully monitor patients for any evidence or symptoms of ILD and, if they suspect it has developed, to immediately stop the drug and treat the patient with steroids.
We definitely have to be cautious, he continued. But I dont think is a major barrier to moving this drug forward.
Advanced Cancer That Progresses During Treatment
Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, a woman’s menopause status, general health, desire to continue getting treatment, and whether the hormone receptor status and HER2 status have changed on the cancer cells.
Drug Trial Offers New Hope For Those With Metastatic Breast Cancer
Scientists are studying whether talazoparib could help treat those with incurable breast cancer
Scientists have launched a new trial that could offer hope to those with incurable breast cancer.
They are studying whether an existing drug, talazoparib, also known by the brandname Talzenna, may offer a new treatment to people with incurable breast cancer that has spread to the brain.
Secondary breast cancer, also known as metastatic breast cancer, occurs when the cancer has spread from the breast to other parts of the body, where it becomes incurable. Last month, it claimed the life of Girls Aloud singer Sarah Harding.
The new trial, funded by the charity Breast Cancer Now, will see researchers assess whether talazoparib could help those with terminal breast cancer. The drug is a PARP inhibitor, which works by preventing cancer cells from repairing, forcing them to die.
Experts from RCSI University of Medicine and Health Sciences in Dublin will use tumours and breast cancer cells donated by patients to see in the lab whether talazoparib is effective in treating secondary breast cancer in the brain. Further tests will examine the drug in mice, as well as models that mimic the brains protective system.
Natalie Woodford, 57, from Surrey, who was diagnosed with secondary breast cancer in 2017, welcomed the launch of the research.
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Are We Close To A Cure
Every cancer is different, so finding a one-size-fits-all cure is unlikely anytime soon.
Research is targeting various methods, including gene editing, that have potential benefit for future treatments. Research is ongoing and new therapies are continually tested.
While living with metastatic breast cancer, there are ways to help improve your physical, emotional, and financial well-being.
In 2018, the released guidelines for improving the quality of life for people undergoing treatment.
The guidelines suggest the following steps:
- Talk with your healthcare professional about managing pain and side effects from your treatment, such as nausea or fatigue, as well as other potential issues, like sexual health and fertility.
- If youre experiencing depression or anxiety, check to see if a therapist or counselor is available at your cancer center, or join a breast cancer support group. Your healthcare team may have recommendations.
- For help covering the cost of your treatment, talk with a financial counselor about assistance programs.
Tucatinib Has Potential To Be First
Twenty percent of women with breast cancer have HER2-positive breast cancer, an aggressive disease fueling cancer growth through excess HER2 protein on tumor cells. If the cancer is not detected while still confined to the breast, up to 50 percent of these women develop cancer in their brains .
Since the late 1990s, drugs targeted to stop or slow the progression of HER2-positive breast cancer have continued to emerge. Tucatinib, which is taken by mouth, works in concert with two of these therapies by binding to the HER2 protein inside a cancer cell and prevents it from sending signals that promote cancer cell growth.
Dr. Jilani explains that the new drug regimen with tucatinib is designed to slow cancer progression and prolong a persons life, but not to cure the cancer. A patient continues to take the treatment as long as it is providing beneficial results.
Patients are living longer with metastatic breast cancer, she says. I am very hopeful this will be the new standard of care, the first-line treatment, in the near future for breast cancer patients with brain metastases.
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New Drug For Early Breast Cancer: First Advance In 20 Years
The drug, called abemaciclib â brand name Verzenio â is now approved for patients with the HR+, HER2-early breast cancer, which makes up 70% of all breast cancers.
The drug was already approved for advanced, or metastatic, breast cancer.
“This is the first time in more than 20 years that we have seen an advance in the adjuvant treatment of this form of breast cancer,” lead investigator Stephen Johnston, MD, from the Royal Marsden Hospital NHS Foundation Trust, London said at a recent meeting of the European Society of Medical Oncology..
The new drug will âchange practice,â said Giuseppe Curigliano, MD, head of the Division of Early Drug Development at the European Institute of Oncology, in Milan, Italy.
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New Treatments For Metastatic Breast Cancer
- The goals of treatment for metastatic breast cancer are to alleviate symptoms, slow the growth and spread of breast cancer cells, and add to life expectancy.
- New treatments for MBC are targeted and effective, especially in combination with traditional breast cancer treatments.
- There are more and better options to treat stage IV breast cancer than ever before.
- Working closely with your treatment team can help you receive the highest quality MBC treatment for your unique, personal circumstances.
As breast cancer cells replicate and spread , they are constantly changing and developing through genetic mutations. Metastatic breast cancer is a moving target. Treating MBC, also known as stage IV breast cancer, requires science and medicine to move quickly to find solutions.
There are many drugs used to treat MBC, and new treatments are found every year. These breakthrough therapies are often safer, more effective, and have fewer side effects. Sometimes, new therapies can replace older treatments like chemotherapy and Tamoxifen.
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Trastuzumab Deruxtecan Improves Progression
The DESTINY-Breast03 trial enrolled 524 people with HER2-positive breast cancer that could not be removed by surgery or had metastasized to other parts of the body, including the brain. Participants were randomly assigned to receive either T-DM1 or T-DXd. All had previously received treatment with trastuzumab and a taxane-based chemotherapy drug.
After 13.9 months of follow-up, the median time that people who received T-DM1 lived without their disease progressing was 6.8 months. In the T-DXd-treated group, the median time without disease progression had not yet been reached after 15.5 months.
Tumors shrank or disappeared completely on imaging tests in about 80% of patients who received T-DXd, compared with 34% who were treated with T-DM1.
The research team is continuing to follow participants to learn if there is a difference in how long people in the two treatment groups live overall. They will also compare participants quality of life in the two groups.
Serious treatment-related side effects occurred in about 45% of people in the T-DXd group and about 40% of those in the T-DM1 group, said Javier Cortés, M.D., Ph.D., of the International Breast Cancer Center in Barcelona, who presented the DESTINY-Breast03 findings at the ESMO meeting.
Almost 13% of people in the T-DXd group stopped treatment because of serious side effects, compared with 5% in the T-DM1 group. And more people in the T-DXd group than the T-DM1 group had the dose of the drug reduced due to side effects.
Explaining Differences Between Two Her2
Several differences between T-DXd and T-DM1 could explain why T-DXd is more effective, Dr. Cortés said.
The two drugs carry different types of chemotherapy payloads, and each molecule of T-DXd delivers about twice as much chemotherapy to HER2-positive cells as a molecule of T-DM1 does, Dr. Cortés explained.
Perhaps most important, studies in mice and lab-grown cells indicate that once the chemotherapy component of T-DXd has been released, it can enter and kill neighboring cells, including tumor cells that do not overproduce HER2.
In HER2-positive breast cancer, not all cells within a tumor overproduce HER2, Dr. Modi explained. So this bystander effect of T-DXd, which has not been seen with T-DM1, is particularly important for treating this form of breast cancer, she said.
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Targeted Therapies For Stage Iv Breast Cancer
Targeted therapies are also called personalized or precision medicine. Targeted therapies respond to specific molecular, biological, and genetic traits of different types of MBC. They can stop or slow the growth or spread of breast cancer cells by disrupting their biology, functionality, or other traits.
There are several new targeted therapies approved for stage IV breast cancer. New targeted therapies also present many possibilities for combination treatments. Combination treatments offer more options, improve quality of life, and extend survival rates for people living with stage IV breast cancer.
It’s Easy To Get The Care You Need
See a Premier Physician Network provider near you.
A new cancer drug called tucatinib recently was approved by the Food and Drug Administration to slow tumor progression and prolong life inwomen with metastatic HER2-positive breast cancer.
Oncologist Shamim Jilani, MD, from Dayton Physicians Network describes to Premier Health Now the potential impact of this new drug, saying, We previously had an unmet need for the group of patients with HER2-positive breast cancer who have brain metastatic disease . There is a substantial population who will benefit from this drug. If I have a patient who is appropriate, I wont hesitate to use it.
Dr. Jilani applauds cancer research efforts that continue even as the world battles the COVID-19 pandemic. The lives of people with advanced cancer may well depend on receiving new treatments without delay, she says.
The FDA approved tucatinib four months ahead of schedule, based on positive results from clinical trials.
The trial included patients who had already tried one or more other cancer treatments. They received either tucatinib or a placebo, in combination with chemotherapies trastuzumab and capecitabine .
The drug produced a very impressive, amazing result, Dr. Jilani says.
Dr. Jilani adds, In patients with brain metastases, there was a 52 percent lower risk of disease progression or death. For this subset of patients, this is very impressive data.
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Hormone Cell Receptor Type
Some types of breast cancer, called hormone receptor-positive cancers, are fuelled by hormones such as estrogen and progesterone. These breast cancer cells are further labeled as estrogen receptor-positive or progesterone receptor-positive depending on which hormones they respond to. Knowing the hormone receptor type of your MBC helps doctors determine whether hormone therapy would be an effective treatment.
Which Metastatic Breast Cancer Treatment Is Right For Me
According to the National Cancer Policy Forum, âa hallmark of high-quality cancer care is the delivery of the right treatment to the right patient at the right time.â The right MBC treatment is defined by your needs and the specifics of your cancer. Just as each personâs biology, medical history, and personal journey are unique, so is every case of breast cancer. No two treatment plans are the same. Your MBC treatment regimen may include many different classes of treatment at different times.
The right treatment for you may depend on many factors, including:
- Menopausal status
A personalized MBC treatment plan also depends heavily on the previous therapies that have been tried. You can also speak with your oncologist about clinical trials and whether they might be appropriate for your MBC treatment plan.
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Characteristics Of Breast Cancer Cells
Each case of breast cancer is diagnosed by type and by stage. Treatment plans for stage IV breast cancer are highly specific and unique to both the type of cancer and the person being treated. Identifying certain characteristics of cancer cells can help doctors know which treatments will be most effective.
Treatment Of Stage Iv Breast Cancer
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.
For women with stage IV breast cancer, systemic drug therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help some women live longer. These cancers are considered incurable.
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Different Drugs Same Target
Breast cancers that are HER2-positive tend to be aggressive, with the excess HER2 protein on tumor cells fueling the cancers growth. In the late 1990s, trastuzumab was among the first targeted cancer therapies to be approved by FDA, after trials showed it could improve survival in women with metastatic HER2-positive breast cancer.
Over time, other HER2-targeted therapies emerged, some with alternative mechanisms for disrupting HER2 activity in cancer cells. Drugs like trastuzumab and pertuzumab are monoclonal antibodies that bind to the HER2 protein above the cancer cells surface, preventing it from acting or enlisting the immune system to help destroy cells that produce it.
Tucatinib, on the other hand, is a member of a class of drugs known as tyrosine kinase inhibitors . These drugs work by binding to the part of the HER2 protein that is inside the cell and preventing it from sending signals that promote cell growth. Other HER2-targeted TKIs include neratinib and lapatinib .
Some TKIs have multiple targets. But, compared with other HER2-targeted drugs, tucatinib appears to be relatively selective for HER2that is, its less likely to bind to related proteins, explained Stanley Lipkowitz, M.D., Ph.D., chief of the Womens Malignancies Branch in NCIs Center for Cancer Research. That selectivity limits the risk of side effects seen with other HER2-targeted TKIs that inhibit other targets, Dr. Lipkowitz said.
Impact Of Exercise On Internal Organs
Proteomic analysis of the blood of the routinely active participants showed increased carbohydrate usage after exercise.
Data from the prospective study showed that exercise prior to developing cancer had a modest impact on diagnoses of slow-growing cancer.
However, exercise significantly reduced the likelihood of highly metastatic cancer, according to the researchers.
Among the participants studied, those who reported regular aerobic exercise at high intensity had 72% less metastatic cancer than sedentary participants.
In the mouse study, researchers found that mice subjected to exercise prior to being injected with cancer cells were significantly protected against metastases in distant organs.
Proteomic and ex vivo metabolic capacity analyses of the mice organs showed that exercise induces catabolic processes, glucose uptake, mitochondrial activity, and GLUT expression.
When researchers looked at the mice organs, they discovered that long-term physical activity changes muscles and changes organs.
We discovered that internal organs like lymph nodes, like lung, like liver, those organs that are usually hosting cancer changing when there is chronic physical activity, Levy told MNT.
They change in sense that they become super metabolic. And when I say super metabolic, I mean their demand for glucose and demand for their mitochondria is increasing their glucose uptake is increasing. Theyre becoming like superhero organs.
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Genetic Testing For Inherited Gene Mutations
The National Comprehensive Cancer Network recommends everyone diagnosed with metastatic breast cancer get genetic testing for BRCA1 and BRCA2 inherited gene mutations . If you have a mutation in one of these genes, a PARP inhibitor may be included in your treatment plan.
The NCCN has an animated video on genetic testing to guide metastatic breast cancer treatment.
Metastatic breast cancer can respond to many different drug therapies. This means the drugs can shrink the tumors.
However, over time, tumors can become resistant to drugs used to treat metastatic breast cancer.
Learn how your metastatic breast cancer will be monitored, including blood tests for tumor markers, and when drug therapies are likely to change. Also learn about scan anxiety .
Talk about quality of life issues with your health care providers and your family. This can help you decide what treatments are best for you.
Keep in mind how each treatment option fits in with your values and beliefs, your family situation, your finances and anything else that may be important to you at this stage of your life.
Joining a support group may also help you think through these issues.
The National Comprehensive Cancer Network has an animated video on how to talk with your doctor about metastatic breast cancer.