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What Is Targeted Therapy For Breast Cancer

What Is It Treatment And More

Do I Need Targeted Therapy to Treat my Breast Cancer?

Breast cancer isnt a single disease. Its actually a group of diseases.

When diagnosing breast cancer, one of the first steps doctors take is identifying the type of breast cancer. The type provides key information about how the cancer may behave.

About 13 percent of women in the United States will develop invasive breast cancer. Anyone can develop HER2-positive breast cancer, regardless of their sex.

However, its more likely to affect younger women. Around 20 percent of all breast cancers are HER2-positive.

Continue reading to learn more about HER2-positive breast cancer and what you can expect.

When you have a breast biopsy, the tissue is tested for hormone receptors . Its also tested for something called human epidermal growth factor receptor 2 . Each can be involved in the development of breast cancer.

In some pathology reports, HER2 is referred to as HER2/neu or ERBB2 . Hormone receptors are identified as estrogen and progesterone .

The HER2 gene creates HER2 proteins, or receptors. These receptors help control the growth and repair of breast cells. An overexpression of HER2 protein causes out of control reproduction of breast cells.

HER2-positive breast cancers tend to be more aggressive than HER2-negative breast cancers. Along with tumor grade and cancer stage, HR and HER2 status help determine your treatment options.

In the United States, its estimated that more than 42,000 women will die from breast cancer in 2020.

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Side Effects Of Herceptin

Your medical team will monitor you for side effects. These are usually caused by the chemotherapy. This means that once chemotherapy finishes and you are continuing with Herceptin alone, most side effects ease. For example, hair grows back, there is no nausea or vomiting, and you no longer need regular blood tests.

Although side effects from Herceptin itself are uncommon, they can include headache, fever and diarrhoea. In some people, Herceptin can affect how the heart works, so you will have tests to check your heart function before and during treatment.

A number of new drugs have been developed and tested as additional treatments after Herceptin for people with HER2 positive breast cancer. Talk to your doctor about whether these are appropriate for you.

How Are Targeted Therapies Developed

Once a candidate target has been identified, the next step is to develop a therapy that affects the target in a way that interferes with its ability to promote cancer cell growth or survival. For example, a targeted therapy could reduce the activity of the target or prevent it from binding to a receptor that it normally activates, among other possible mechanisms.

Most targeted therapies are either small molecules or monoclonal antibodies. Small-molecule compounds are typically developed for targets that are located inside the cell because such agents are able to enter cells relatively easily. Monoclonal antibodies are relatively large and generally cannot enter cells, so they are used only for targets that are outside cells or on the cell surface.

Candidate small molecules are usually identified in what are known as “high-throughput screens,” in which the effects of thousands of test compounds on a specific target protein are examined. Compounds that affect the target are then chemically modified to produce numerous closely related versions of the lead compound. These related compounds are then tested to determine which are most effective and have the fewest effects on nontarget molecules.

Monoclonal antibodies are developed by injecting animals with purified target proteins, causing the animals to make many different types of antibodies against the target. These antibodies are then tested to find the ones that bind best to the target without binding to nontarget proteins.

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Types Of Targeted Therapy Used For Breast Cancer

There are two main types of targeted therapy:

  • Monoclonal antibodies – which block a specific target on the outside of cancer cells
  • Small-molecule drugs – which can block the process that helps cancer cells multiply and spread.
  • Drugs used in targeted therapy have been developed to target specific cell changes. Therefore, the drugs given to patients are usually based on their specific hormone status and the type of their breast cancer. Below is an explanation of the various types of targeted therapies that an oncologist may choose to use if one has been identified as a good fit for the type of breast cancer.

    Breast Cancer: Types Of Treatment

    Targeted Therapy

    Have questions about breast cancer? Ask here.

    ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.

    This section explains the types of treatments that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are strongly encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less treatment than what is usually done as the standard of care. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

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    The Following Therapies Target Specific Receptors That Control The Growth Of Cancer Cells

    Whereas chemotherapy targets all rapidly dividing cells, targeted therapies are less likely to harm healthy cells, because of their specificity.

    Biological therapies, one type of targeted therapy, use laboratory-manufactured proteins to harness the bodys immune system to help destroy cancer cells. These treatments target molecules on the surface of cancer cells. Other targeted therapies use drugs containing small molecules that enter the cells and block the signals that the cancer relies on for growth.

    Reducing Breast Cancer Risk

    Researchers continue to look for medicines that might help lower breast cancer risk, especially women who are at high risk.

    • Estrogen blocking drugs are typically used to help treat breast cancer, but some might also help prevent it. Tamoxifen and raloxifene have been used for many years to prevent breast cancer. More recent studies with another class of drugs called aromatase inhibitors have shown that these drugs are also very effective in preventing breast cancer
    • Other clinical trials are looking at non-hormonal drugs for breast cancer reduction. Drugs of interest include drugs for diabetes like metformin, drugs used to treat blood or bone marrow disorders, like ruxolitinib, and bexarotene, a drug that treats a specific type of T-cell lymphoma.

    This type of research takes many years. It might be some time before meaningful results on any of these compounds are available.

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    What Are The Side Effects Of Targeted Cancer Therapies

    Scientists had expected that targeted cancer therapies would be less toxic than traditional chemotherapy drugs because cancer cells are more dependent on the targets than are normal cells. However, targeted cancer therapies can have substantial side effects.

    The most common side effects seen with targeted therapies are diarrhea and liver problems, such as hepatitis and elevated liver enzymes. Other side effects seen with targeted therapies include:

    • Skin problems
    • Problems with blood clotting and wound healing
    • High blood pressure
    • Gastrointestinal perforation

    Certain side effects of some targeted therapies have been linked to better patient outcomes. For example, patients who develop acneiform rash while being treated with the signal transduction inhibitorserlotinib or gefitinib , both of which target the epidermal growth factor receptor, have tended to respond better to these drugs than patients who do not develop the rash . Similarly, patients who develop high blood pressure while being treated with the angiogenesis inhibitorbevacizumab generally have had better outcomes .

    The few targeted therapies that are approved for use in children can have different side effects in children than in adults, including immunosuppression and impaired sperm production .

    Can Targeted Therapy Work For Your Form Of Cancer

    Targeted Therapy for Breast Cancer – MedStar Health Cancer Network

    Youre probably wondering if targeted therapy can work for your type of cancer

    I have good news for you chances are, yes!

    Regardless of what stage your cancer has reached and, even if youve been told youre already getting the best, or perhaps the only, option you have the reality is:

    There is very likely a targeted therapy that your oncologist will prescribe for you, that will give you a longer life and fewer treatment side-effects.

    You just have to help your oncologist find it for you.

    And before you get overwhelmed about how to do that, dont worry!

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    Inherited Brca Mutations And Breast Cancer Types

    Certain types of breast cancer are commonly found in women with BRCA gene mutations.

    • Estrogen receptor-positive, HER2-negative cancer: Women with a BRCA2 mutation usually develop ER+/HER2- breast cancer that is, cancer cells that are fueled by the hormone estrogen but not by a protein known as HER2 .
    • Triple negative breast cancer: Women with a BRCA1 mutation tend to develop triple negative breast cancer that is, cancer cells that arent fueled by the hormones estrogen and progesterone, or by HER2.

    Knowing what encourages different types of breast cancer to grow helps scientists develop new treatments, and helps doctors choose available treatments to slow or stop tumor growth. Often this involves a combination of treatments.

    Inhibitors Of Apoptosis Proteins

    Negative regulators called ‘inhibitors of apoptosis proteins’ prevent uncontrolled and excessive cell death in the final course of apoptotic signalling. An important member of this group is survivin, which can be detected in approximately 90% of breast tumours. Increased survivin levels are significantly associated with high nuclear grade, negative hormone receptor status, HER2 over-expression, VEGF expression, and high urokinase-type plasminogen activator and plasminogen activator inhibitor-1 levels. Therefore, patients with elevated levels of survivin have significantly worse disease-free survival and overall survival than do patients with lower levels of survivin. In a multivariate analysis the prognostic value of survivin in terms of disease-free and overall survival was found to be independent of both TNM stage and molecular parameters.

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    P: A Target For Gene Therapy

    The p53 gene acts as a regulator of cell growth and DNA repair in normal cells inactivation of the gene appears to lead to cancer. It is the most frequently mutated gene in human cancers 35% of breast tumours have p53 mutations, of which 88% are located within exons 5 to 8 . Mutations in the p53 gene occur more frequently in ER-negative, basal-like and HER2-amplified tumours than in luminal, ER-positive breast tumours . p53 mutations occur in 24.5% of the axillary node-negative breast carcinomas and more frequently in cancers with HER2 amplification . Elevated risks for disease recurrence and mortality were identified in patients with both p53 mutation and HER2 amplification .

    How Is Targeted Therapy Different From Chemotherapy

    Figure 1 from Targeted therapy for breast cancer ...

    Targeted therapy drugs, like other drugs used to treat cancer, are technically considered chemotherapy. But targeted therapy drugs dont work the same way as traditional or standard chemotherapy drugs. Targeted drugs zero in on some of the changes that make cancer cells different from normal cells. This makes them work differently from chemotherapy in two key ways:

    • Because of their targeted action, these drugs have an effect on the cancer cells and mostly leave normal, healthy cells alone. Traditional chemotherapy is cytotoxic to most cells, meaning it can damage normal, healthy cells in addition to damaging and killing cancer cells.
    • Targeted drugs often work by blocking cancer cells from copying themselves. This means they can help stop a cancer cell from dividing and making new cancer cells. Traditional chemotherapy, however, kills cancer cells that have already been made.

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    Targeted Therapies In Breast Cancer: New Challenges To Fight Against Resistance

    Correspondence to: Gilles Pagès, PhD, Director of Research INSERM, University Nice Sophia Antipolis, Institute for Research on Cancer and Aging of Nice CNRS UMR7284/INSERM U 1081, Centre Antoine Lacassagne 33 Avenue de Valombrose, 06189 Nice, France.

    Telephone: +33-4-92031231 Fax: +33-4-92031235

    Targeted Therapy For Her2

    In about 1 in 5 women with breast cancer, the cancer cells make too much of a growth-promoting protein known as HER2 . These cancers, known as HER2-positive breastcancers, tend to grow and spread more aggressively than HER2-negative breast cancers. Different types of drugs have been developed that target the HER2 protein.

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    Targeted Therapies And Immunotherapies For Metastatic Breast Cancer

    Targeted therapies are treatments that target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells. Some targeted therapies are antibodies that work like the antibodies made naturally by our immune systems. Because of this, they are sometimes called immune targeted therapies.

    Immunotherapy medicines use the power of your bodys immune system to attack cancer cells.

    There are a number of targeted therapies doctors use to treat metastatic breast cancer:

    Afinitor is used in combination with Aromasin to treat advanced-stage, hormone-receptor-positive, HER2-negative breast cancer in postmenopausal women that has already been treated with Femara or Arimidex . Afinitor is a pill taken by mouth.

    Avastin is given intravenously in combination with the chemotherapy medicine Taxol to treat people diagnosed with metastatic, HER2-negative breast cancer who haven’t yet received chemotherapy for metastatic breast cancer. In 2011, the U.S. Food and Drug Administration removed the breast cancer approval from Avastin because the drug has not been shown to be safe and effective for that use. Avastin has not been removed from the market, though, and doctors can choose to use Avastin to treat metastatic breast cancer whether or not that particular use is officially approved by the FDA.

    Cell Cycle Inhibition And Cyclin

    Hormonal and HER2-Targeted Therapy in Early Breast Cancer

    Interactions of cyclins with CDKs play an important role in regulating the cell cycle. CDKs promote phosphorylation of their target proteins, initiating progression of the cell cycle. Because cells begin to undergo cell division through mitogenic stimuli, there is induction of synthesis of cyclin D1, which is associated with the kinases CDK4 as well as CDK6. Cyclin D1 is essential for HER2-induced cell growth and is induced by growth factors through Ras-dependent and Ras-independent signalling pathways.

    In a preclinical study , the CDK inhibitor flavopiridol was combined with several transduction inhibitors . In two breast cancer cell lines, one HER2 low expressing and another HER2 high expressing , enhanced growth inhibition was observed predominantly in the high HER2 expressing cell line. These data suggest that combinations of flavopiridol and signal transduction inhibitors warrant further studies as treatments for breast tumours, and that HER2 expression may influence the choice of inhibitor to combine with flavopiridol.

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    What Types Of Targeted Therapies Are Available

    Many different targeted therapies have been approved for use in cancer treatment. These therapies include hormone therapies, signal transduction inhibitors, gene expression modulators, apoptosis inducers, angiogenesis inhibitors, immunotherapies, and toxin delivery molecules.

    Cancer vaccines and gene therapy are sometimes considered targeted therapies because they interfere with the growth of specific cancer cells. Information about cancer vaccines can be found in NCI’s Cancer Treatment Vaccines page.

    How Does Targeted Therapy Work

    There are many types of cells that make up every tissue in your body. For example, there are blood cells, brain cells, and skin cells. Each type has its own job. Cancer starts when certain genes in healthy cells change and become abnormal over time. This change is called a genetic mutation.

    Genes tell cells how to make proteins to keep the cell working. If the genes mutate, these proteins change, too. This can make cells divide too much or too quickly and allow the cells to live much longer than they normally would. When this happens, the cells grow out of control and form a tumor. Learn more about the genetics of cancer.

    To develop targeted therapies, researchers first identify the genetic changes that help a tumor grow and change. A potential target for this therapy would be a protein that is present in cancer cells but not healthy cells. This can be caused by a mutation. Once researchers have identified a mutation, they develop a treatment that targets that specific mutation.

    Targeted therapies can do different things to the cancer cells they target:

    • Block or turn off signals that tell cancer cells to grow and divide

    • Prevent the cells from living longer than normal

    • Destroy cancer cells

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    Who Gets Targeted Therapy

    Some types of cancer, like CML, almost always have a target that treatment can focus on. But sometimes, your doctor will need to test your tumor to see if it has any targets. Sometimes they’ll do a biopsy — take a small sample from the tumor and check it in a lab.

    Even if you have the same type of cancer as someone else, you might not have the same target. Not all breast cancers are HER2-positive. Targeted colon cancer medicines like cetuximab won’t work if you have the KRAS gene mutation.

    Before your doctor recommends a targeted therapy, you might have to try other treatments first. Targeted therapy is often given along with other treatments.

    When You Might Have Targeted Treatment

    Figure 2 from Targeted therapy for breast cancer ...

    Targeted cancer drugs are used in different situations to treat breast cancer. You might have this treatment :

    • before surgery – to shrink a cancer
    • after surgery – to reduce the risk of the cancer coming back

    You might also have this treatment if your cancer comes back or if you have breast cancer that has spread to another part of the body . You may have it on its own, with other targeted drugs, or with other treatments such as chemotherapy.

    There are many different types of targeted drugs. We describe some of the drugs used for breast cancer below.

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