Types of Breast Cancer Therapeutics
Surgery
Surgery is often the first line of treatment for breast cancer. The main types of surgery for breast cancer are lumpectomy (partial or segmental mastectomy) and mastectomy (complete removal of the breast tissue). A lumpectomy removes only the tumor and surrounding tissue, while a mastectomy removes the entire breast including removal of lymph nodes under the arm. For early-stage breast cancers that have not spread, a lumpectomy along with radiation therapy after surgery is usually as effective as a mastectomy.
Chemotherapy
Chemotherapy uses powerful anti-cancer drugs that are administered through intravenous injections or orally in pill form to destroy cancer cells. The goal of chemotherapy in breast cancer treatment depends on the stage of cancer. For early-stage cancers, chemotherapy may be given after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. For later stage or metastatic breast cancers, chemotherapy seeks to slow cancer growth and spread. Common chemotherapy drugs used for breast cancer include doxorubicin, cyclophosphamide, paclitaxel and docetaxel. Chemotherapy is usually given in cycles with periods of treatment alternating with rest periods to allow the body to recover.
Hormonal therapy targets hormone-receptor-positive Breast Cancer Therapeutics that rely on hormones like estrogen or progesterone to grow. It involves the use of hormone-blocking drugs like tamoxifen or aromatase inhibitors to lower hormone levels or block their action on cancer cells. Hormonal therapy is commonly used as adjuvant therapy after initial treatment with surgery and chemotherapy to reduce the risk of recurrence in hormone-receptor-positive breast cancers. It is also used to treat advanced or metastatic hormone-receptor-positive breast cancers.
Targeted Therapy
Targeted therapies are precision drugs that target specific vulnerabilities within cancer cells. Two main types of targeted therapies used for certain types of breast cancer are HER2-targeted therapies and CDK4/6 inhibitors. HER2-targeted therapies such as trastuzumab (Herceptin), pertuzumab (Perjeta) and ado-trastuzumab emtansine (Kadcyla) interfere with the function of the HER2 protein, which promotes cancer growth. CDK4/6 inhibitors like palbociclib (Ibrance), ribociclib (Kisqali) and abemaciclib (Verzenio) block enzymes called cyclin-dependent kinases that cancer cells need to divide and grow. Both HER2-targeted drugs and CDK4/6 inhibitors are used along with other therapies like chemotherapy or hormonal therapy.
Radiation Breast Cancer Therapeutics
Radiation therapy uses high-energy rays to kill cancer cells and shrink tumors. It is primarily given after breast-conserving lumpectomy surgery to destroy any remaining cancer cells and reduce the risk of local recurrence in the breast or chest wall. Short-term radiation therapy is also given after mastectomy in women with large tumors or lymph node involvement. Newer forms of partial breast irradiation allow delivery of radiation to only the lumpectomy cavity plus a small margin of normal tissue rather than the whole breast. This reduces treatment time from several weeks to just a few days.
Recent Advances in Therapy
Immunotherapy
In recent years, immunotherapy has emerged as an exciting new type of treatment for breast cancer. Immunotherapy aims to help the immune system recognize and destroy cancer cells through drugs called checkpoint inhibitors. The first Food and Drug Administration approved immunotherapy drug for certain types of breast cancers is atezolizumab (Tecentriq), which is used for triple-negative breast cancers after chemotherapy. Other immunotherapy medications including pembrolizumab (Keytruda) and avelumab (Bavencio) are being studied in clinical trials for various breast cancer subtypes. By freeing up the brakes on immune cells, immunotherapy holds promise for improving responses and long-term outcomes, especially when combined with other therapies.
Polytherapy Approaches
As knowledge of breast cancer at the molecular level improves, treatment approaches are shifting towards more personalized, multi-modal polytherapy combinations tailored for each patient. For example, dual anti-HER2 blockade with trastuzumab and pertuzumab administered together with docetaxel chemotherapy has become a standard first-line treatment for HER2-positive metastatic breast cancer. Combining CDK4/6 inhibitors like palbociclib with letrozole as frontline hormonal therapy for HR+/HER2- advanced breast cancer has also shown significant benefit. Ongoing research aims to explore synergistic benefits of additional drug combinations involving newer classes of precision medicines along with standard therapies. The ultimate goal is long-term remission or even cure for a wider pool of patients with different breast cancer subtypes through optimized multi-drug regimens.
Side Effects and Survivorship Care
While newer treatments have improved survival rates, they may involve potential short-term and long-term side effects from therapy. Common side effects from chemotherapy include fatigue, hair loss, nausea, loss of appetite and risk of infection. Targeted therapies and hormonal therapies are generally better tolerated but can trigger side effects like diarrhea, skin rashes, joint pain, and hot flashes respectively. Radiation therapy may cause skin reactions, fatigue and lung damage with internal radiation. Improving supportive care through anti-nausea drugs, growth factor injections, skin care etc helps manage side effects. Long-term side effects involving heart problems, osteoporosis or second cancers also require careful monitoring. Comprehensive survivorship programs focus on surveillance follow ups as well as meeting psychological, vocational and quality of life needs of breast cancer survivors.
Significant progress has been made in breast cancer treatment through improvements in primary and adjuvant therapies, development of newer systemic therapies like immunotherapy, and multi-drug personalized regimens. While challenges remain in overcoming resistance and improving long-term outcomes, ongoing advances hold promise to benefit more patients with distinct breast cancer subtypes in the future.
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