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.
This is an exciting time in breast cancer research. New drugs are becoming available and treatment for early breast cancer is improving.
New chemotherapy, hormone therapy and targeted therapy drugs are under study in clinical trials. The results of these studies will decide whether these new therapies become part of standard care.
After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.
If you or a loved one needs information or resources about clinical trials, call our Clinical Trial Information Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email at firstname.lastname@example.org.
Learn more about clinical trials.
Capecitabine is a chemotherapy drug used to treat metastatic breast cancer. It’s now under study for use in treating early breast cancer.
A randomized clinical trial studied women with HER2-negative early breast cancer who got neoadjuvant (before surgery) chemotherapy, but still had some tumor left when they had surgery. Standard treatment after surgery included radiation therapy and/or hormone therapy .
Women who got capecitabine after neoadjuvant chemotherapy had a lower risk of breast cancer recurrence and better overall survival at 5 years compared to women who got standard treatment alone .
Trastuzumab emtansine (T-DM1, Kadcyla) is a type of targeted therapy used to treat HER2-positive metastatic breast cancers.
T-DM1 consists of trastuzumab linked to a chemotherapy called DM1. Combining these into one drug allows the targeted delivery of chemotherapy to HER2-positive cancer cells.
A randomized clinical trial studied women with HER2-positive early breast cancer who had cancer remaining in their breast or lymph nodes after neoadjuvant (before surgery) chemotherapy. After surgery, women got trastuzumab (standard treatment) or T-DM1. The risk of breast cancer recurrence or breast cancer death was 50 percent lower in the women who got T-DM1 .
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 neratinib (Nerlynx), which is FDA-approved for the treatment of HER2-positive early breast cancer, and lapatinib (Tykerb), which is FDA-approved for the treatment of HER2-positive metastatic breast cancer.
Other tyrosine-kinase inhibitors are under study.
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 may help predict benefit from breast cancer treatments, including trastuzumab (Herceptin) [57-58].
Poly(ADP-ribose) polymerase (PARP) inhibitors are a class of drugs under study for many 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 the cancer cells will become resistant to the chemotherapy. This is most often a problem for those with metastatic breast cancer.PARP inhibitors appear to hold the most promise for people who have a BRCA1 or BRCA2 gene mutation .The PARP inhibitor olaparib (Lynparza) is FDA-approved for the treatment of HER2-negative metastatic breast cancer in people who have a BRCA1 or BRCA2 gene mutation.PARP inhibitors, such as velaparib, are under study for early breast cancer treatment. Velaparib in combination with neoadjuvant chemotherapy is under study for the treatment of triple negative breast cancer .
Androgens are hormones in the body important for sexual development. Some breast cancers may need androgens to grow. Some cancer cells have special proteins inside, called androgen receptors.
When androgens attach to androgen receptors, the cancer cells with these receptors may grow. Drugs designed to block this pathway are called androgen receptor inhibitors (AR inhibitors).
AR inhibitors may help slow or stop the growth of breast cancers that express (have a lot of) androgen receptors (androgen receptor-positive (AR-positive) breast cancers).
AR inhibitors are under study as a possible targeted therapy for AR-positive triple negative breast cancers. (At this time, there are no targeted therapies for triple negative breast cancers. They are treated with chemotherapy.)
For example, the AR inhibitor drug enzalutamide is under study for the treatment of locally advanced and metastatic AR-positive triple negative breast cancers .
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 may cost less than brand name drugs.
The drug trastuzumab-dkst (Ogivri) is a biosimilar form of trastuzumab (Herceptin) and can be used to treat HER2-positive breast cancer. It's the only FDA-approved biosimilar drug for breast cancer treatment at this time.
Other biosimilar drugs for breast cancer are under study.
Immunotherapy uses the body's immune system to fight cancer. There are many types of immunotherapy under study, including 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 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.
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 a 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 (come back) and metastasize (spread to other organs) .
People with breast tumors that have gene profiles showing a high risk of metastasis may be more likely to benefit from chemotherapy than those with tumors that have gene profiles showing a low risk.
Tumor profiling is currently used to help make treatment decisions in some people with estrogen receptor-positive cancer.
At this time, the 3 tumor profiling tests recommended by the American Society of Clinical Oncology (ASCO) are Oncotype DX® (looks at a set of 21 genes), PAM50 (Prosigna®, looks at a set of 50 genes) and MammaPrint® (looks at a set of 70 genes) [62-63].
Other tumor profiling tests are under study.
Breast Cancer Index® is a tumor profiling test that looks at a set of 11 genes to give prognostic information for some breast cancers.
Breast Cancer Index may be considered in making treatment decisions for some estrogen receptor-positive, HER2-negative, lymph node-negative breast cancers .
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.
Circulating tumor cell levels may help predict recurrence and survival in people with early breast cancer [216-218].
Some studies have found women with more circulating tumor cells had a worse prognosis than women who had few or no circulating tumor cells [216-218].
At this time, circulating tumor cell tests (sometimes called liquid biopsies) should not be used to guide treatment.
Circulating tumor cell levels may also help predict survival for people with metastatic breast cancer [54-55].
These topics are under study.
Some types of anti-depressants called selective serotonin reuptake inhibitors (SSRIs) can interfere with the metabolism of tamoxifen (how tamoxifen works in the body) .
Whether these SSRIs may impact the effectiveness of tamoxifen is under study.
Some SSRIs (such as fluoxetine (Prozac), buproprion (Wellbutrin), paroxetine (Paxil) and sertraline (Zoloft)) may interfere with tamoxifen. However, it’s not known whether this might affect tamoxifen treatment for breast cancer.
If tamoxifen is part of your treatment plan, talk with your health care provider about potential drug interactions.
Learn about SSRI anti-depressants for the treatment of menopausal symptoms.
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 drug tamoxifen.
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 [65-66].
There is no role for routine testing of CYP2D6 in women taking tamoxifen.
After talking with your health care provider, we encourage you to consider joining a clinical trial.
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service to help you find a clinical trial that fits your needs.
Susan G. Komen® Breast Cancer Clinical Trial Information Helpline
If you or a loved one needs information or resources about clinical trials, call our Clinical Trial Information Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email email@example.com.
The Helpline offers breast cancer clinical trial education and support, such as:
Learn more about clinical trials and find a list of resources to help you find a clinical trial.
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 $988M to researchers in 47 states, the District of Columbia and 22 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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