Understanding Newer Classes Of Mbc Treatments
There has been substantial investment and progress in breast cancer research over the last 40 years. Advances in screening and treatment have led to a promising era for people living with stage IV breast cancer. Genetically and molecularly profiling tumors has uncovered gene mutations that have led to new drugs and better, more personalized MBC treatment options.
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.
Tucatinib Neratinib And Lapatinib
The tyrosine-kinase inhibitors FDA-approved for metastatic breast cancer treatment are:
Tyrosine-kinase inhibitors are a class of drugs that target enzymes important for cell functions . These drugs can block tyrosine-kinase enzymes at many points along the cancer growth pathway.
A tyrosine-kinase inhibitor in combination with trastuzumab and chemotherapy can be used to treat HER2-positive metastatic breast cancer. This combination may give women with HER2-positive metastatic breast cancer more time before the cancer spreads compared to treatment with trastuzumab and chemotherapy alone .
Adding the tyrosine-kinase inhibitor tucatinib to treatment with trastuzumab and chemotherapy may also increase overall survival in women with HER2-positive metastatic breast cancer who were treated with trastuzumab in the past .
Neratinib is also used to treat HER2-positive early breast cancer.
Tucatinib, neratinib and lapatinib are pills.
Learn about neratinib and treatment of early breast cancer.
Tucatinib, neratinib and lapatinib and brain metastases
Many drug therapies cannot pass through the blood to the brain . So, they cant treat breast cancer that has spread to the brain.
However, tucatinib, neratinib and lapatinib can pass through the blood-brain barrier and may be used to treat some metastatic breast cancers that have spread to the brain.
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Questions To Ask Your Doctor About Treating Metastatic Breast Cancer:
- How did you determine the hormone-receptor status and HER2 status of the cancer?
- Do I need a biopsy to find out whether the hormone-receptor or HER2 status has changed?
- Why are you recommending a particular treatment?
- What are the benefits of each possible treatment? What are the side effects?
- How will each treatment affect my quality of life?
- How will I know the treatment is working?
- What kinds of tests will I have?
- What happens if a treatment stops working?
- How do I know when to switch treatments?
- What happens if I decide to not have a treatment?
- Are there clinical trials that you think would be beneficial for me?
On the following pages, you can read about:
When Can Metastatic Breast Cancer Occur
Some people have metastatic breast cancer when they are first diagnosed with breast cancer . This is called de novo metastatic breast cancer.
Most often, metastatic breast cancer arises years after a person has completed treatment for early or locally advanced breast cancer. This may be called a distant recurrence.
A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.
Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but were dormant and could not be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.
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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.
Youve Been Diagnosed With Metastatic Breast Cancer Now What
If youve been diagnosed with metastatic breast cancer, you may be experiencing a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychology services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.
If you are experiencing symptoms that may indicate your breast cancer has spread, or if you have received a stage IV breast cancer diagnosis and would like a second opinion from a breast cancer specialist at Siteman, please call.
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What Is The Treatment For Metastatic Breast Cancer
Treatments include many of the same treatments as other stages of breast cancer:
- Radiation therapy
- Hormone therapy For patients diagnosed with Stage IV breast cancer that is hormone receptor positive, hormonal therapy may be the first line of defense against the disease. As long as the drugs are keeping the cancer from progressing, the patient may be kept on the medication for some time. If scans show the progression of the cancer, the medical oncologist may switch to another form of hormonal therapy or possibly stop this therapy and pursue a different line of systemic treatment, such as chemotherapy or biologic targeted therapy.
- Biologic targeted therapy
- Breast surgery It is controversial whether surgery should be done on the breast in the presence of known metastatic disease. In most cases, however, the knowledge of metastasis is discovered after the breast cancer surgery and other treatment has been performed. The cancer returns as a distant recurrence.
Treating Type : Triple
Immunotherapy is a hot topic in the cancer world: These medicines are designed to awaken the immune system to target it against the cancer, Dr. Mayer explains. But while theyve proven effective for other cancer types, theres been less data to support their use in breast cancer, she says. That said, the U.S. Food and Drug Administration has approved use of the immunotherapy drug Tecentriq plus chemotherapy for those with a certain type of advanced triple-negative breast cancer. Why? A 2019 clinical trial found the combo may help women live a median of seven months longer than with chemo alone.
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When Do People Get A Metastatic Breast Cancer Diagnosis
Metastatic breast cancer can occur at different points:
- De novo metastatic breast cancer: About 6% of women and 9% of men have metastatic breast cancer when theyre first diagnosed with breast cancer.
- Distant recurrence: Most commonly, metastatic breast cancer is diagnosed after the original breast cancer treatment. A recurrence refers to the cancer coming back and spreading to a different part of the body, which can happen even years after the original diagnosis and treatment.
Bone Metastasis And Pain Management
Breast cancer can spread to any area of the body. However, breast cancer most often metastasizes in the bones. Bone metastases affect more than half of women who develop stage IV breast cancer. The most common sites of bone metastasis are the ribs, spine, pelvis and long bones in the arms and legs.
Patients with bone metastases are at risk of bone fractures, spinal cord compression and bone pain. This pain tends to be constant. It may get worse with physical activity and usually doesnt go way with rest. As a result, sleeping can be difficult.
The good news is that there are drugs that can reduce these symptoms by strengthening and protecting your bones. There are many benefits to these drugs for those suffering from bone metastasis. These include:
- Reduced pain due to bone metastasis
- Lower risk of bone fractures
- Reduced need for surgery to repair bone fractures
- Reduced need for radiation to treat bone pain
- Blocked progression of bone metastasis
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Onclive: To Start With The Presentation You Gave During The Ipc Meeting On Early
Matro: T-DM1 is an antibody-drug conjugate , which means it is a chemotherapy drug. In this case, it is the payload emtansine linked to an antibody or trastuzumab . The trastuzumab part of the compound homes in on the HER2-expressing breast cancer cells so that the molecule gets internalized into the cancer cells and the linker between the payload and the trastuzumab gets dissolved to deliver the payload of chemotherapy directly into the cancer cell.
Afraid Of Your Metastatic Breast Cancer Diagnosis Youre Not Alone
If you or a loved one has recently been diagnosed with metastatic breast cancer, you may be feeling a great deal of fear. Common fears of stage IV breast cancer patients include:
- Fear of cancer progression
- Financial pressures
Your fears and concerns are surely valid. Still, it is important to remember that many metastatic breast cancer patients continue to live full and meaningful lives. Siteman breast cancer specialists are here to provide you with only the most exceptional care to give you the best possible chances for a positive outcome.
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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.
What Does It Mean When Breast Cancer Metastasizes To Bones
As mentioned earlier, metastatic breast cancer is when cancer has spread beyond the breast and the surrounding lymph nodes to other parts of the body. This can happen either because a cancer has come back after treatment or because a cancer did not respond to treatment or wasn’t treated in time, allowing it to spread. In the case of metastatic breast cancer in the bones, cancer cells take up residence in parts of a person’s bone, causing lesions that replace healthy tissue with cancer cells.
Modern science still doesn’t quite understand exactly how cancers metastasize, Nancy Lin, MD, a medical oncologist who specializes in breast cancer treatment at Dana-Farber Cancer Institute in Boston, Massachusetts, tells Health. “We know that at some point the cancer manages to find its way into the bloodstream and then through that is able to get to other parts of the body,” she says. Beyond that, it’s unclear why certain cancers tend to spread to specific spots in the body like the bones, but there are some theories.
Any part of your skeletal system can be impacted by metastatic cancer, but per the American Cancer Society , the spine is the most common site of bone metastasis. Other areas include the hip, femur, upper arm, ribs, and skull.
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During The Ipc Meeting Melanie A Sheen Md Of Ochsner Health Discussed Early
The big story there is really de-escalation. When should we apply neoadjuvant therapy? How do we give the least amount of cytotoxic therapy possible to achieve the same benefit ? Certainly, Sara M. Tolaney, MD, of Dana-Farber Cancer Institute, led that charge with her work looking at weekly paclitaxel plus trastuzumab in lower-risk patients with HER2-positive disease in the adjuvant setting. The WSG ADAPT-TP trial from Nadia Harbeck, MD, PhD, of the University of Munich, demonstrated outstanding results with limited chemotherapy in the neoadjuvant setting.
Several studies have now shown that dual-antibody therapy by itself a significant response rate. If we can pick out patients who might be able to get away with no chemotherapy at all, that would be a good thing. In the ADAPT trial, there were also patients who had antibody therapy alone who a pathologic complete response who never got chemotherapy. That is amazing that we could potentially chemotherapy-free treatment.
In the neoadjuvant studies with lapatinib and trastuzumab, patients also had pCRs with dual-HER2 inhibition as well.
In the early-stage and the advanced settings, one of the big unanswered questions is: Can we subgroup patients with HER2-positive disease above and beyond whether they are ER positive or negative? into other groups that might help us tailor therapy more specifically? There is a lot of interest in that, so we will be seeing some trials trying to get a handle on that soon.
How Are You Managing Patients With Small Her2
At this point, in patients with positive lymph nodes or larger tumors, it is well established that giving them neoadjuvant chemotherapy and allowing for individualized decision making is helpful. in the KATHERINE trial era where we know that if patients get full neoadjuvant chemotherapy and they have residual disease, they will benefit from adjuvant T-DM1 vs trastuzumab, which used to be the standard of care.
The controversy comes in with the smaller, lymph nodenegative tumors. Several studies have shown that those patients have good outcomes overall, but the question is: Should we be treating them with preoperative therapy? We know it is safe to de-escalate chemotherapy in the adjuvant setting, but we dont know at this point if it is OK to de-escalate chemotherapy in the neoadjuvant setting.
Ultimately, if we give somebody neoadjuvant chemotherapy, the goal is to get a pCR we want to set patients up for success so all they need in the adjuvant setting is 1 year of trastuzumab. However, if de-escalate chemotherapy or give single HER2-directed therapy vs dual , are we setting patients up to have residual disease and need 1 year of adjuvant T-DM1? We could be undertreating patients initially and then overtreating them in the adjuvant setting. Since we know patients do well with trastuzumab and paclitaxel in the adjuvant setting, if we give them more than that in the neoadjuvant setting: Are we overtreating them?
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What Are The Symptoms Of Bone Metastasis In Breast Cancer
All three doctors say that new, progressive pain in your bones or joints is the most common symptom of metastatic breast cancer in bones. “I always tell patients to inform me if there’s pain that’s not getting better,” says Dr. Tsarwhas. This can sometimes be confused with arthritis or other pre-existing chronic pain issues, he says, which is why it’s important for breast cancer patients to be proactive about any new pain they encounter.
New fractures or unexplained fractures can also be a sign of bone metastasis, Dr. Tsarwhas adds. Cancer can weaken bones and make them break more easily. “New lumps or bumps in the lymph node area…could be a sign of recurrent breast cancer as well,” he says.
A person with metastatic breast cancer in their bones may also experience more general cancer symptoms, such as fatigue, lack of appetite, and extreme, unexplained weight loss.
Comparing Two Targeted Treatments
In about 15%20% of people with breast cancer, tumors overproduce HER2, with the excess HER2 on tumor cells driving the cancers growth. Such HER2-positive tumors tend to grow faster and are more likely to spread elsewhere in the body, or metastasize, than those that do not overproduce HER2.
Trastuzumab and other drugs called monoclonal antibodies that target HER2 have been quite successful as treatments for HER2-positive breast cancer. As a result, researchers have been developing new drugs based on these antibodies.
Both T-DM1 and T-DXd, which are given by infusion into a vein, are drugs known as antibodydrug conjugates . Such drugs consist of a monoclonal antibody, in this case trastuzumab, chemically linked to a cell-killing chemotherapy drug.
The trastuzumab component of both T-DM1 and T-DXd acts as a homing device that helps the drug deliver its chemotherapy payload directly to tumor cells that overproduce HER2. The ADC is then ferried inside the cell, where the attached chemotherapy drug is released.
The new study, a large international clinical trial called DESTINY-Breast03, is the first to directly compare T-DXd with another treatment in people with breast cancer. The trial was funded by Daiichi Sankyo, Inc., and AstraZeneca, the developers of T-DXd.
We were waiting for T-DXd to be compared to another treatment in a large clinical trial like , Dr. Zimmer continued.
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Why Does Metastatic Breast Cancer Happen
Most often, metastatic cancer occurs because treatment didnt destroy all the cancer cells. Sometimes, a few cells remain dormant, or are hidden and undetectable. Then, for reasons providers dont fully understand, the cells begin to grow and spread again.
De novo metastatic breast cancer means that at the time of initial diagnosis, the breast cancer has already spread to other parts of the body. In the absence of treatment, the cancer spreads.
There is nothing you can do to keep breast cancer from metastasizing. And metastatic breast cancer doesnt happen because of something you did.