This section discusses emerging areas of research in the treatment of early breast cancer, including some tools for tailoring treatment.
Learn about promising new treatments for metastatic breast cancer.
Research is ongoing to improve chemotherapy, hormone therapy and targeted therapy for breast cancer. New therapies are under study in clinical trials. The results of these studies will decide whether these therapies become part of standard care.
After discussing the benefits and risks with your health care provider, we encourage you to consider joining clinical trials of new therapies.
BreastCancerTrials.org in collaboration with Susan G. Komen offers a custom matching service that can help you find a clinical trial that fits your health needs.
Learn more about joining a clinical trial.
Every cell in your body has genes that contain the blueprints (genetic code) for your body. Similarly, every cell in a breast tumor has genes. These genes contain the blueprints for the tumor.
Tumor profiling (using gene expression profiling tools) gives information about the genes in cancer cells. These tests allow researchers to study hundreds of tumor genes at one time.
Tumor profiling tests take a sample of the tumor (removed during a biopsy or surgery) and look at a set of genes. Specific genes (or combinations of genes) may give useful information about prognosis and may help guide treatment decisions.
The gene profiles of some tumors may help predict whether the cancer is more likely to recur (when cancer comes back) and metastasize (when cancer spreads to other organs) .
Breast tumors with gene profiles showing a high risk of metastasis may be more likely to benefit from chemotherapy than tumors with gene profiles showing a low risk.
Tumor profiling is currently used to help make treatment decisions in some people with estrogen receptor-positive cancers. Two tumor profiling tests recommended by the American Society of Clinical Oncology (ASCO) are Oncotype DX® (looks at a set of 21 genes) and PAM50 (looks at a set of 50 genes) .
Learn more about Oncotype DX.
Learn more about PAM50.
MammaPrint® is a tumor-profiling test that looks at a set of 70 genes to give prognostic information for lymph node-negative breast cancers.
At this time, ASCO does not recommend the use of MammaPrint in making treatment decisions .
Breast Cancer Index® is a tumor profiling test that looks at a set of 6 genes to give prognostic information for estrogen receptor-positive, HER2-negative, lymph node-negative breast cancers .
In certain situations, Breast Cancer Index may be considered in making treatment decisions for these breast cancers .
Learn More | Current Article
Molecular and genetic differences in breast cancers may be useful in guiding the development of new targeted therapies.
Most studies divide breast cancer into 4 major molecular subtypes:
Although mainly used in research settings, these subtypes may be useful in tailoring treatment in the future.
Learn more about molecular subtypes of breast cancer.
Bisphosphonate drugs are used to help prevent bone loss (osteoporosis). They are also used as a bone-strengthening treatment for women with bone metastases (learn more).
Although individual study findings are mixed, some studies (including a pooled analysis) show bisphosphonates may lower the risk of breast cancer recurrence [50-51]. This topic is under study.
Bisphosphonate use increases the risk of osteonecrosis of the jaw, a serious jawbone disorder [52-53]. So, it is important to have a full dental exam before starting treatment and to talk with your oncologist before getting any dental procedure while on bisphosphonates .
Poly(ADP-ribose) polymerase (PARP) inhibitors are a class of drugs used in the treatment of ovarian cancer and under study for many other types of cancer, including breast cancer.
PARP is an enzyme involved in DNA repair. Some chemotherapy drugs damage DNA. Adding a PARP inhibitor to some chemotherapy plans may lower the chances that the cancer cells will become resistant to the chemotherapy. This is most often a problem for those with metastatic breast cancer.
PARP inhibitors are under study for the treatment of breast cancers related to BRCA1 and BRCA2 gene mutations .
At this time, data on PARP inhibitors and breast cancer are limited and are not conclusive. Although some results look promising, these drugs are in the early stages of study and are only available in clinical trials.
PI3 kinase is an enzyme important in cell growth. The PIK3CA gene helps control PI3 kinase enzyme activity.
Some breast cancers have a mutation in the PIK3CA gene (this mutation is in the genes of breast cancer, not the person). This mutation can affect PI3 kinase and cause the tumor to grow.
Researchers are studying whether PIK3CA mutations help predict benefit from breast cancer treatments, including trastuzumab (Herceptin) [55-56].
Tyrosine-kinase inhibitors are a class of drugs that target enzymes important for cell functions (called tyrosine-kinase enzymes).
These drugs can block tyrosine-kinase enzymes at many points along the cancer growth pathway.
Tyrosine-kinase inhibitors include lapatinib (Tykerb), which is FDA-approved for the treatment of HER2-positive metastatic breast cancer.
Neratinib is a tyrosine-kinase inhibitor under study for use in the treatment of HER2-positive early breast cancers.
Neratinib is not currently FDA-approved for breast cancer treatment.
Neratinib is under study as part of neoadjuvant therapy for HER2-positive, hormone receptor-negative early breast cancers.
One study found that neratinib added to standard neoadjuvant chemotherapy increased the response to neoadjuvant therapy better than neoadjuvant chemotherapy alone .
Neratinib is under study for the treatment of HER2-positive early breast cancers already treated with surgery, chemotherapy and trastuzumab (Herceptin).
One study found neratinib improved 1-year disease-free survival (survival with no local breast cancer recurrence, metastasis or death from any cause) better than a placebo .
CYP2D6 is an enzyme that affects how the body metabolizes (breaks down and uses) certain medications.
In the past, researchers were interested in whether certain forms of the gene related to CYP2D6 function affected the hormone therapy tamoxifen. However, large studies found no difference in the risk of breast cancer recurrence in women with genes related to low CYP2D6 function compared to risk in women with genes related to normal or high CYP2D6 function [57-58].
There is no role for routine testing of CYP2D6 in women taking tamoxifen.
Certain medications can interfere with CYP2D6 function and should be avoided while taking tamoxifen . For example, some antidepressants, such as fluoxetine (Prozac), buproprion (Wellbutrin) and paroxetine (Paxil), can interact with CYP2D6 and may affect how tamoxifen works in the body .
If tamoxifen is part of your treatment plan, talk with your health care provider about potential drug interactions.
Learn more about tamoxifen.
Some drugs contain biological products such as antibodies. A biosimilar drug is very similar to a brand name drug that contains biological products.
To be approved by the U.S. Food and Drug Administration (FDA), the biosimilar drug must work the same way as the brand name drug and it must have the same :
Biosimilar drugs cost less than brand name drugs.
Some biosimilar drugs for breast cancer are under study. However, today, none are FDA-approved.
A large study found a biosimilar form of trastuzumab is as safe and effective as trastuzumab in the treatment of HER2-positive metastatic breast cancer .
However, this biosimilar form of trastuzumab is not yet FDA-approved.
Immunotherapy is a promising new field of breast cancer treatment that uses the body's immune system to fight cancer. There are many types of immunotherapy under study, including the use of vaccines.
Like vaccines that protect against the flu or measles, cancer vaccines are designed to build up the body's immunity against disease. Cancer vaccines may be made up of cancer cells or parts of cancer cells. These cells stimulate the body's natural defenses, helping it to attack and kill cancer cells.
Still in early stages of development, cancer vaccines could one day be used to treat early breast cancer . Clinical trials of vaccines for breast cancer are underway.
After talking with your health care provider, we encourage you to consider joining a clinical trial of new therapies.
Learn more about clinical trials and find a list of resources to help you find a clinical trial.
Meet Bonnie Olson, a breast cancer survivor who participated in a clinical trial.
Komen PerspectivesRead our perspective on clinical trials (July 2012).*Learn More | Current Article
Our commitment to research
At Susan G. Komen©, we are committed to saving lives by meeting the most critical needs in our communities and investing in breakthrough research to prevent and cure breast cancer. Our Research Program is an essential driving force for achieving this mission. Since our inception in 1982, Komen has provided funding to support research grants that have greatly expanded our knowledge of breast cancer and helped us understand that breast cancer is not just a single disease but many diseases, unique to each individual. Going forward, our commitment to research will contribute significantly to our ability to achieve our bold goal of reducing the current number of breast cancer deaths in the U.S. by 50 percent by 2026.
To date, Komen has provided more than $920M to researchers in 48 states and 21 countries to support research that has resulted in a better understanding of breast cancer; earlier detection; personalized, less invasive treatments for what was once a “one-treatment-fits-all” disease; and improvements in both quality of life and survival rates.
Learn more about our continuing investment in research and the exciting research that we are funding, because nothing would make us happier than ending breast cancer forever.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.
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