Trastuzumab Emtansine And Trastuzumab Deruxtecan
Another important development was the production of trastuzumab emtansine . This is a conjugate of trastuzumab with the drug emtansine , combining the anti-HER-2 effect of trastuzumab with cytotoxic effect of emtansine, being delivered in a targeted fashion to cancer cells expressing HER-2 . The EMILIA phase III trial compared trastuzumab emtansine versus lapatinib plus capecitabine in patients with advanced HER-2 positive BC who had undergone prior treatment with trastuzumab and a taxane . Median PFS was 9.6 months with trastuzumab emtansine versus 6.4 months with lapatinib plus capecitabine . Also, OS was 30.9 months with trastuzumab emtansine versus 25.1 months lapatinib plus capecitabine , and the objective response rate was 43.6% with trastuzumab emtansine versus 30.8% with lapatinib plus capecitabine . The common toxicities associated with trastuzumab emtansine were thrombocytopenia and transaminitis.
The TH3RESA trial was another phase III trial that also recruited patients with HER-2 positive mBC and compared trastuzumab emtansine against the physicians choices of treatment. The trial demonstrated comparable improvements in PFS and OS in the trastuzumab emtansine group with lower rates of grade 3 or worse adverse events . Based on the results of these trials, trastuzumab emtansine is now recommended in patients with HER-2 positive mBC as second-line therapy or beyond.
Detecting Cancer Types With Better Screening
New screening scans and biopsies are contributing to more favorable outcomes, says Erica Mayer, MD, director of breast cancer clinical research at Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School in Boston.
Since newer medications are only effective when targeting certain cancers, getting tumors checked by a biopsy to look for unique aspects of the tumor is critical.
A good proportion of patients are found to have a tumor type for which appropriate medications can be available for them, Dr. Mayer explains. In addition, she says that without this kind of testing, doctors may wind up treating a cancer with the wrong medication.
Metastatic Breast Cancer Facts
According to the Metastatic Breast Cancer Network , breastcancer that has spread outside of the breast to other organs such as bones, liver, lung or brain has metastasized it is still breast cancer, and the misunderstanding around that is probably the biggest misconception around MBC, says Comen.
Itâs the misconception that metastatic disease is liver cancer or bone cancer when, in fact, metastatic breast cancer is breast cancer cells living in a new location,â Comen explains. âEven when asking about a patients family history, Ill hear, âMy mom had breast cancer in her 40s and then later had bone cancer,â but almost always it was metastatic breast cancer. So its important to understand family history, but also because it really informs a patients awareness of how we will treat the disease. And the way we treat liver or bone cancer is very different from how we treat metastatic breast cancer.â
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Of the 3.5 million people living with a history of breast cancer in the U.S., an estimated 155,000 are stage IV.
There are approximately 40,000 breast cancer deaths each year, with men representing 1%. Itâs a number that has remained essentially unchanged for 20 years, notes MBCN, adding, âAll deaths from breast cancer are caused by metastatic breast cancer.â
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How Tech Is Revolutionizing Breast Cancer Diagnosis And Treatment In Saudi Arabia
- Breast cancer diagnoses have increased fivefold over 17 years owing to improved screening
- Breakthroughs in detection using artificial intelligence could help further improve cancer care
JEDDAH: Technological advancements in the early detection and treatment of breast cancer are radically improving the chances of survival, recovery, and quality of life for women in Saudi Arabia, according to health experts.
Breast cancer is among the biggest challenges facing health systems worldwide. Studies have shown that a girl born today has a one-in-eight chance of developing breast cancer during the course of her lifetime.
Circulating Tumor Cells And Circulating Tumor Dna
Circulating tumor cell levels can help predict survival for people with metastatic breast cancer .
The more circulating tumor cells in the blood, the more advanced the metastatic breast cancer tends to be.
Having more circulating tumor cells may also predict a lack of response to treatment.
Circulating tumor DNA is also under study for use in monitoring metastatic breast cancer and predicting treatment response .
Circulating tumor cell and circulating tumor DNA tests are not used today to guide treatment. This is because they havenât been shown to offer benefit .
However, these methods are under study.
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Advances In Breast Cancer Diagnosis And Treatment
Breast cancer remains one of the two most-common types of cancer in the world, according to the World Health Organization. Its the fifth-leading cause of cancer-related deaths annually. And more than 265,000 people will be diagnosed with it in the United States alone, during any given year.
But there is reason for hope. Research has yielded a number of exciting developments in breast cancer diagnosis and treatment that will improve the lives of breast cancer patients for years to come. We spoke with our Senthil Damodaran, M.D., Ph.D.,Jennifer Litton, M.D., and Anthony Lucci, M.D., to learn more.
1. Node preservationreduces lymphedema cases
Axillary lymph nodes used to be removed from the armpit routinely during breast cancer surgery to test for metastasis. This caused chronic pain, numbness and lymphedema in about 1 in 5 patients. But studies have shown that many of those nodes can be preserved without compromising long-term survival rates.
Sentinel node mapping lets surgeons identify which lymph nodes are most likely to be affected by a tumor. Targeted axillary dissection allows surgeons to potentially preserve nodes that once tested positive for cancer, but reverted to negative status after chemotherapy or another treatment. In both cases, if tests come back negative for cancer on the first few nodes taken out, the remaining nodes can be left alone. That means fewer complications, and fewer side effects for our breast cancer patients.
Innovation Meets Empathy And Personal Services
When a whole team of doctors specializes in exactly what you have, your care improves. Thats what you get at MedStar Health.
Our tumor boarda group of health care providers, from plastic and general surgeons to medical and radiation oncologistsdiscusses every MedStar Washington Hospital Center patient who is diagnosed with breast cancer.
We also work closely with our:
- Cancer rehabilitation team from the MedStar National Rehabilitation Network, who screens patients for risks such as lymphedema or low blood sugar that may result in cancer patients who have diabetes and receive chemotherapy
- Clinical research office, who screens every new patient for potential clinical trial participation
- Social workers, who screen for barriers to care, such as other health conditions and financial or transportation challenges
MedStar Health also recently partnered with the Georgetown University Law Center to create a program that helps our patients manage legal challenges. In the last year weve helped more than 100 patients, sometimes with multiple legal problems, and will add more resources to provide employment and medical disability law assistance.
Our patients overall well-being is truly our top focus. Well continue to discover and provide the best treatments possible to improve breast cancer patients quality of life.
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Entering The Next Wave Of Research: Breast Cancer And The Brain
When cancer spreads into other parts of the body, such as the bones, liver, or lungs, treatment can stop the progression for long periods of time. But sometimes it appears in the brain because most of the treatments we provide cannot cross into the brain it has a very protective barrier.
This is one of the biggest unmet needs for breast cancer patients, and new drugs are starting to fill the gap. A recent study showed that a combination of the drugs tucatinib, trastuzumab, and capecitabine resulted in better progression-free survival in HER2-positive breast cancer patients whose cancer had spread to their brain.
This specific drug combination received FDA approval in 2020 and is available at MedStar Health. We also have two ongoing studies to further understand the benefits of this approach.
Darah Signs Publishing House Deals To Globalize Saudi Literature
- Darah signed three agreements with prestigious Netherlands-based Koninklijke Brill
- Agreement with Dar Tashkeel Publishing and Distribution Company to print, publish, distribute and translate the works of the Our History is a Story program also signed
RIYADH: Saudi Arabia has signed a number of deals with international publishing houses to nurture literary culture in the Kingdom and promote Saudi works worldwide.
The agreements were signed on the sidelines of the 2022 Riyadh International Book Fair.
CEO of the King Abdulaziz Foundation for Research and Archives Turki Al-Showair signed the deals with several printing, publishing and distribution agencies to expand the reach of the foundations publications.
Darah signed three agreements with prestigious Netherlands-based Koninklijke Brill , an international academic publishing house established in 1683.
They were signed by KB senior publishing director Dr. Moritz H. Van den Bogert and Al-Showair, in the presence of Darah Secretary-General Dr. Fahad Al-Samari.
Darah granted the Dutch publisher an exclusive license to digitally display and sell the foundations publications including a dictionary of literature and writers in the Kingdom in Arabic and English around the world.
A third agreement included a limited and non-exclusive license from Darah to KB, to publish, market and distribute Darahs magazine globally on digital platforms.
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Gene Tests To Decide On Treatment
We know that two people with breast cancer may have differences in their cancer cells. The differences mean that the cancers will respond to different types of treatment. If your cancer doesnt have a particular cell change, the medicine that targets that change wont work.
Clinical trials are looking at the genetic makeup of breast cancer cells before or during treatment. Researchers want to know if particular genes affect how well treatment works. And they want to know whether genetic testing can help doctors decide who should have particular types of treatment after surgery.
Radiation: A Larger Dose Means Fewer Trips To The Clinic
Now, many patients can receive just one, larger dose of radiation during their lumpectomy. This treatment is called intraoperative radiation therapy and is best suited for patients with early breast cancer and low risk factors for cancer recurrence.
IORT delivers incredible time-saving benefits by eliminating the need to continually drive to the clinic to receive small doses of radiation. This has been especially helpful for patients who dont receive paid time off from work or are single parents.
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What Tests Are Used To Determine If A Patient Can Benefit From Chemo
Genomic profiling tests can help determine if a cancer is likely to return and whether or not some patients with small, early cancers will or will not benefit from chemotherapy.
There are many of these tests, and the two most common ones are Oncotype DX and MammaPrint, Dr. Lustberg says, adding that both are FDA-approved. The tests analyze a sample of a cancer tumortaken from a biopsy or a surgical specimenlooking for the activity of certain genes that can affect the likelihood that a patients cancer will grow or spread.
The following patients may be eligible for the Oncotype DX test:
- Youve recently been diagnosed with Stage I, Stage II, or Stage IIIa invasive breast cancer
- The cancer is estrogen-receptor-positive
Patients With Germline Brca Mutationsparp Inhibitors
Polyadenosine diphosphate-ribose polymerase inhibitors have shown efficacy in patients with metastatic HER2-negative BC and germline BC susceptibility gene mutations. PARP inhibitors work by inducing cell death. In a normal cell cycle repair pathway, PARP 1 and 2 proteins help repair single-stranded breaks in DNA. When these breaks go unrepaired, double-stranded breaks can form during DNA replication. BRCA1 and BRCA2 are proteins that are involved in DNA repair of DSB by homologous recombinant repair pathway . Notably, when BRCA1 and BRCA2 genes are mutated, cells become deficient in HR repair and DNA is repaired with non-homologous end joining which gives rise to additional DNA alterations and deletions leading to increased cancer risk. PARP inhibitors work by causing persistent SSB in some cases leading to DSB by trapping PARP proteins on DNA in addition to blocking their catalytic activity, thus causing cytotoxic effects in the cell .
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Exploring Why Some Cancers Grow And Spread And Others Dont
For years, doctors and researchers have noted that not all cancers are alike. Some patients tumors grow quite slowly and never spread beyond the site where they first formed. But for other patients, their tumors grow rapidly and spread like wildfire.
In the early 1980s, after the discovery that a mutated gene called HER2 could stimulate excessive cell growth and division, many scientists wondered if certain genes might make cancers grow and spread rapidly. Researchers around the world began searching for genes that spur cancer growth.
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.
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Drug Delivers Chemotherapy Payload To Tumor Cells
T-DXd, which is given by infusion into a vein, is a type of drug known as an antibodydrug conjugate. Such drugs consist of a monoclonal antibody, in this case trastuzumab, chemically linked to a cell-killing chemotherapy drugin this case, deruxtecan.
The trastuzumab component of T-DXd acts as a homing device that helps the drug deliver its chemotherapy payload directly to tumor cells that have HER2 on their surface. The antibodydrug conjugate is then ferried inside the cell, where the attached chemotherapy drug is released and kills the cell.
Once its released, the chemotherapy portion of T-DXd can also enter and kill nearby tumor cellseven those that have little or no HER2. This unique bystander effect of T-DXd is thought to be a key reason that the drug is effective against HER2-low tumors whereas other drugs that target HER2 are not, Dr. Modi said.
T-DXd is already approved for the treatment of adults with advanced or metastatic HER2-positive breast cancer who have previously been treated with other HER2-targeted therapies, based on results of the earlier DESTINY-Breast03 clinical trial.
Other HER2-targeted antibodydrug conjugates in development are showing promise in early-phase studies, Dr. Modi noted.
Saudi Foreign Minister Discusses Relations With Counterparts From Mata El Salvador
RIYADH: Saudi Arabias Foreign Minister Prince Faisal bin Farhan on Sunday received his Maltese counterpart Ian Borg in the capital, Riyadh, the Kingdoms foreign ministry said.During the meeting, they reviewed bilateral relations and ways to enhance and develop them in all areas of cooperation, in addition to discussing aspects of joint work and coordination in many regional and international issues.Meanwhile, Prince Faisal also met with his El Salvadorian counterpart, Alexandra Hill Tinoco, where they also reviewed relations between the Kingdom and El Salvador, and opportunities to develop cooperation between the two countries in all fields, and discussing a number of issues of common interest, and discussed the most prominent regional and international developments.
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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.
Can Receiving Less Chemotherapy Result Ultimately In Better Outcomes
Chemotherapy can shrink cancer and slow its growth, which is why it has been used to treat breast cancer in conjunction with surgery for so many years. But the side effects can be difficult.
In the short term, these side effects can include such problems as nausea, fatigue, and hair loss, which can sometimes last far beyond treatment. We know that, after a course of chemotherapy, a number of women, up to several years out, don’t regain their full vitality, Dr. Winer says.
But even more concerning are the long-term effects, which can include rare, but difficult, complications such as heart problems, neuropathy, and leukemia, which can ultimatelyand indirectlyaffect outcomes.
These potentially debilitating side effects are why personalizing chemotherapy treatment has become so important. If a patient can do just as well with fewer medical treatments, it’s almost always a better thing, says Dr. Winer. Less chemotherapy can mean fewer side effects, less anxiety, improved quality of life, and possibly even a longer life, he adds.
Also, when side effects are truly debilitating, treatment delivery may be impaired, Dr. Lustberg says. If we can enhance how patients are feeling during treatment, they may actually tolerate treatment better, stay on it longer, not need dose reductions or modifications, and have better disease outcomes. It’s all interrelated.
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