Pembrolizumab Plus Chemotherapy Improves Progression
The KEYNOTE-355 trial showed that the immunotherapy pembrolizumab, in combination with chemotherapy, increased progression-free survival for anyone with metastatic triple-negative breast cancer whose tumors express the protein PD-L1.
What Patients Need to Know
The combination of pembrolizumab and chemotherapy was given as a front-line treatment. The improvement in progression-free survival was demonstrated regardless of the type of chemotherapy given.
Antibody drug conjugate approved for treatment of triple-negative breast cancer Results from the phase lll ASCENT trial showed that the antibody drug conjugate sacituzumab govitecan, given as a third-line treatment, can benefit those with metastatic triple-negative breast cancer in both progression-free survival and overall survival. Antibody drug conjugates work by combining a chemotherapy with a monoclonal antibody.
What Patients Need to Know
Sacituzumab govitecan was approved by the FDA in April 2020 for the treatment of those with metastatic triple-negative breast cancer who had received at least two prior therapies.
Ductal Carcinoma In Situ
Ductal carcinoma in situ is a non-invasive breast cancer where abnormal cells have been contained in the lining of the breast milk duct. Although it isnt considered life-threatening, DCIS can increase the risk of developing an invasive breast cancer later on. Most recurrences happen within 5-10 years after initial diagnosis.;;
What Are The Stages Of Her2 Breast Cancer
All breast cancers are staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. Grade one is low grade cancer and three is high grade which grows and spreads rapidly.
The four stages of breast cancer are:
- Stage I: The tumor is relatively small and localized to the original site with possible spread to the sentinel lymph node, which is the first node the cancer is likely to spread to.
- Stage II: The tumor has grown and spread to a few nearby lymph nodes.
- Stage III: The tumor has grown into many lymph nodes and other breast tissue.
- Stage IV: The cancer has spread to distant parts of the body.
Another classification system is the TMN breast cancer classification, based on Tumor size , lymph Node status and distant Metastasis . It has many detailed classifications for breast cancers.
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How Can Hormone Receptors Be Used To Slow Cancer Growth
Blocking the action of estrogen and/or progesterone could possibly stop the cancer from growing. There are a few ways in which this can happen:
- Blocking the hormone receptor with another compound prevents the estrogen or progesterone from being able to attach to the receptor and activate the cell.
- Prevent the body from making the hormone: This can be done with medication to block the production of the hormone, or with surgery to remove the organ that makes it. For example, estrogen production can be significantly decreased by surgically removing the ovaries.
- Eliminate the hormone receptors on cells or change their shape: This makes it impossible for the hormone to attach itself to the cell receptor and to activate it, essentially making the hormone unable to function.
Hormone Receptor Status And Prognosis
Hormone receptor status is;related to the risk of breast cancer recurrence.
Hormone receptor-positive tumors have a slightly lower risk of breast cancer recurrence than hormone receptor-negative tumors in the first;5 years after diagnosis .
After;5 years, this difference begins to decrease and over time, goes away .
For a summary of research studies on hormone receptor status and survival,;visit the Breast Cancer Research Studies section.;;
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Hormone Receptor Positive Breast Cancer
Your breast cancer may be hormone receptor-positive or HR+.;Some breast cancers have receptors on them that attach to the hormones, estrogen, and progesterone, as they circulate in your body. These hormones feed the cell and help it grow.
- If your tumor has hormone receptors, it is called hormone receptor-positive or HR+. If your tumor is HR+, the tumor needs estrogen and/or progesterone to grow.;
- About 80% of breast cancers are HR+.
- If your tumor does not have hormone receptors, it is hormone receptor-negative or HR-.;
What Is The Life Expectancy For Each Cancer Stage
Your outlook depends on the stage of your cancer when its discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning and stage 4 is the last stage, also called the metastatic stage because its when cancer has spread to other areas in the body.
Each number reflects different characteristics of your breast cancer. These include the size of the tumor and whether cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.
The cancer subtype doesnt play a role in staging, only in treatment decisions.
Survival statistics of women with the major subtypes of breast cancer such as ER-positive, HER2-positive, and triple-negative are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a normal life span.
Survival rates are based on how many people are still alive years after they were first diagnosed. Five-year and 10-year survival are commonly reported.
According to the American Cancer Society, 5-year survival rates are:
- stage 0 100 percent
- stage 3 72 percent
- stage 4 22 percent
One thing to note is that these statistics also included women with the more aggressive HER2-positive and triple-negative cancers. And it takes five years to get to a five-year statistical survival rate, so newer therapies are not included in these numbers.
Its likely that a woman with ER-positive breast cancer diagnosed today may have a higher chance of survival.
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How Are Breast Tumors Tested For Her2
Women newly diagnosed with invasive breast cancers should be tested for HER2.;
A biopsy or surgery sample of the cancer is usually tested with either immunohistochemical stains or Fluorescent in situ hybridization .
See Testing Biopsy and Cytology Specimens for Cancer and Understanding Your Pathology Report: Breast Cancerto get more details about these tests. ;
The Present: Addressing Hormone Resistance Via Molecular Therapies
Since their FDA approval in the latter 20th century, modern hormonal therapies have demonstrated significant PFS for ER+ mBC patients . However, post-diagnosis approximately 30-50% ER+ breast cancer patients on these hormonal therapies acquire resistance, requiring additional or substitutive treatment for the further clinical benefit . Recent research suggests this resistance to occur via the PI3K-AKT-mTOR, CCND1-CDK4/6-RB, BCL2-p53-MDM2, ESR1 and other cell-signaling pathways, demonstrating the potential efficacy of molecular-based therapies in advanced breast cancer.
Despite early successes in molecular targeting of the PI3K-AKT-mTOR pathway, others pursued the molecular targeting of other frequently deregulated pathways in ER+ mBC. The CCND1-CDK4/6-RB pathway, innately vital to cell cycle control, regulates whether a cell advances or arrests at the G1-S phase of the cell cycle. Furthermore, it was estimated that 35% HR+ breast cancers demonstrated amplification in the CCND1, the gene that encodes cyclin-D1, and 16% demonstrated amplification in the gene encoding CDK4, suggesting the theoretical utility of their inhibitors in ER+ mBC therapeutics .
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Immune Checkpoints And Immunotherapy Trials In Hr+ Breast Cancer
Despite the limited number of TILs, low PD-L1 expression and low mutational burden in HR+ breast cancer , there has been an effort to determine if ICB has a role in HR+ disease . While, to date, clinical trials testing ICB in HR+ breast cancer have not yet translated to FDA approval, there is opportunity to learn from both past and ongoing trials to identify the ideal therapeutic sequencing, combination strategies and patient population to extract value in this immunologically cold subtype of breast cancer, as reviewed below.
Table 2 Clinical trials in HR+ breast cancer assessing the safety and efficacy of ICB as monotherapy or in combination with chemotherapy and other treatment modalities.
What Are The Symptoms Of Her2 Breast Cancer
The most common symptom of most breast cancers, including HER2 breast cancer is a lump in the breast. A painless, hard mass with irregular edges is most likely cancer, but breast cancers can also have a lump that is soft and tender to the touch. Other possible symptoms in the first three stages of breast cancer include:
- Change in the size and shape of the breast
- Jaundice and stomach swelling
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Cancercares Free Support Services And Programs
It can be very difficult to receive a diagnosis of breast cancer, and adjusting to the necessary changes in your life can be challenging.
CancerCare can help. We are a national nonprofit organization providing free, professional services to anyone affected by cancer. Our licensed oncology social workers can provide support and education, help in navigating the complicated health care system, and provide information on support groups and other resources.
To learn more about how CancerCare helps, call us at 800-813-HOPE or visit www.cancercare.org.
You will likely also build your own personal support network, composed of family and friends. In doing so, its best to take some time to think about the people in your life and how they are best suited to help. Match the task to their strengthsask a family member who loves to shop to pick up something for you at the store; ask a friend whos a good listener to come over for a chat.
Treatment recommendations are individualized, taking into consideration the biology of the cancer, its stage and the overall health of the individual.
Treatment for cancer usually includes a combination of surgery, radiation and drug therapy. Surgery and radiation focus on the disease in the breast and lymph nodes, and are referred to as locoregional therapies.
Why Is Knowing Hormone Receptor Status Important
Knowing the hormone receptor status of your cancer helps doctors decide how to treat it. If your cancer has one or both of these hormone receptors, hormone therapy drugs can be used to either lower estrogen levels or stop estrogen from acting on breast cancer cells. This kind of treatment is helpful for hormone receptor-positive breast cancers, but it doesnt work on tumors that are hormone receptor-negative .
All invasive breast cancers should be tested for both of these hormone receptors either on the biopsy sample or when the tumor is removed with surgery. About 2 of 3 breast cancers have at least one of these receptors. This percentage is higher in older women than in younger women. DCIS should be checked for hormone receptors, too.
Communicating With Your Health Care Team
As you manage your cancer, its important to remember that you are a consumer of health care. The best way to make decisions about health care is to educate yourself about your diagnosis and get to know the members of your health care team, including doctors, nurses, dietitians, social workers and patient navigators.
In addition to creating a treatment summary, here are some tips for improving communication with your health care team:
*Start a health care journal. * Having a health care journal or notebook will allow you to keep all of your health information in one place. You may want to write down the names and contact information of the members of your health care team, as well as any questions for your doctor. Keep a diary of your daily experiences with symptoms related to your illness or treatment. You can separate your journal or notebook into different sections to help keep it organized.
Prepare a list of questions. Before your next medical appointment, write down your questions and concerns. Because your doctor may have limited time, you should ask your most important questions first and be as specific and brief as possible.
Write down your doctors answers. Taking notes will help you remember your doctors responses, advice and instructions. If you cannot write down the answers, ask the person who accompanies you to do that for you. If you have a mobile device, ask if you can use it to take notes. Writing notes will help you review the information later.
Breast Cancer Hormone Receptor Status
Breast cancer cells taken out during a biopsy or surgery will be tested to see if they have certain proteins that are estrogen or progesterone receptors. When the hormones estrogen and progesterone attach to these receptors, they fuel the cancer growth. Cancers are called hormone receptor-positive or hormone receptor-negative based on whether or not they have these receptors . Knowing the hormone receptor status is important in deciding treatment options. ;Ask your doctor about your hormone receptor status and what it means for you.
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What This Means For You
The results of this study support current North American standard-of-care treatment guidelines after lumpectomy for early-stage hormone-receptor-positive, HER2-negative breast cancer.
If youâve been diagnosed with early-stage hormone-receptor-positive, HER2-negative breast cancer and are deciding on treatments after lumpectomy, itâs likely that your doctor will recommend hormonal therapy and radiation therapy. If your doctor recommends hormonal therapy alone, you may want to ask why and talk about the results of this study.
Together, you and your doctor will figure out the best treatment plan for you and your unique situation.
For more information on radiation therapy and how it is given, visit the Breastcancer.org Radiation Therapy pages.
To talk with others about radiation therapy, join the Breastcancer.org Discussion Board forum Radiation Therapy – Before, During, and After.
Lisa Newman Md Mph Facs Fasco Fsso
Chief, Division of Breast Surgery Director, Interdisciplinary Breast Program Medical Director and Founder, International Center for the Study of Breast Cancer Subtypes Weill Cornell Medicine/New York Presbyterian Hospital Network 2nd Vice President, American College of Surgeons
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How Your Breast Cancer Type Will Affect Your Treatment
Because breast cancer is not a one-size-fits-all disease, neither is treatment. Typically, your breast cancer treatment plan will be personalized and based on your specific stage and type of breast cancer. However, it is critical to determine which hormones, if any, are involved in the growth of your breast cancer.;
Your RMCC oncologist will run some tests that indicate the hormone receptor status and HER2/neu status of your breast cancer tumor. These results will play a large role in the type of breast cancer treatment that we recommend for you.;
Breast Cancer And Its Classification
Breast cancer is a malignant clonal proliferation of benign breast tissue that continues to pose a significant threat to women across the globe. As of 2013, American women run a 1 in the 8-lifetime risk of breast cancer, up from 1 in 11 during the 1970s . Fortunately, however, we have seen several advancements in the screening, prevention, and treatment of breast cancer throughout the last half-century due to an immense multi-disciplinary effort encompassing the disciplines of researchers, clinicians, pharmaceutical companies, technology, and many others. Of these advancements, breast cancer treatment has debatably seen the most innovation and is a direct consequence of our greater understanding of breast cancers pathophysiological foundations.
At the time of diagnosis, approximately 90% of breast cancers are not metastatic ; however, in addition to the 10% metastatic at diagnosis, approximately 10-60% of localized breast cancers develop systemic relapse . Furthermore, the prognosis for ER+ mBC is a median five-year survival rate of 27%, suggesting the need for new therapies that significantly impact progression-free and overall survival in this population . In this article, we aim to briefly describe the history of ER+ mBC treatment, current translational research in development and suggest a theoretically promising molecular therapy combination for future clinical study in ER+ mBC.
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Options For Luminal Breast Cancer
with luminal or other types of HR-positive breast cancer receive hormone therapy. Some people call this endocrine therapy.
Because triple-negative breast cancer is HR-negative, it does not respond to hormone therapy.
The four different types of anti-estrogen therapy are:
- selective estrogen-receptor response modulators, such as Tamoxifen
- aromatase inhibitors
- estrogen-receptor downregulators, such as fulvestrant
- luteinizing hormone releasing agents, including goserelin and leuprolide , prevent the ovaries from producing estrogen
The type of anti-estrogen therapy a person receives depends on various factors, including:
- the stage of the breast cancer
- whether the person has any other medical conditions
- whether the person has been through menopause
A person usually continues hormone therapy for at least 5 years.
Other hormone therapies
In some cases, HR-positive breast cancer may not respond to the above treatments. If this is the case, a doctor may recommend one of the following hormone therapies for more advanced cancer:
- progestin medications, such as megestrol
- an anabolic steroid, such as fluoxymesterone
Should I Enroll In A Clinical Trial
Clinical trials are definitely worth considering, according to the Susan G. Komen organization. They offer the chance to try and possibly benefit from new treatments. The best time to join a trial is before starting treatment or, if your provider is considering changing treatments, before you switch to a new treatment. Ask your doctor if there are any trials that would suit your circumstances. You can also search the clinical trial database at ClinicalTrials.gov or use the Susan G. Komen Metastatic Trial Search, a personalized tool to match you with clinical trials.
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Hormone Receptor Positive Breast Tumor
A hormone-receptor-positive tumor is a tumor which consists of cells that express receptors for certain hormones. The term most commonly refers to estrogen receptor positive tumors , but can also include progesterone receptor positive tumors. Estrogen-receptor-positive tumors depend on the presence of estrogen for ongoing proliferation.