Metastatic Breast Cancer: Personalized treatment with innovative drugs

It is estimated that 1 in 8 women will present it, while in Greece about 7,700 new cases are reported each year. Regular screening, early diagnosis and effective modern treatments have greatly increased the chance of women suffering from breast cancer being cured. However, some patients will develop metastatic disease.

“The developments in the treatment of metastatic breast cancer are stormy and this is due to the individualization of the treatment approach. Breast cancer is no longer treated as a disease with the same characteristics in all women, but we focus on its particular characteristics in each patient. Personalized treatment aims to choose the ideal treatment for the patient and is based on innovative drugs, which target specific molecules of cancer cells, involved in their proliferation and survival. In breast cancer, depending on the expression of the hormone receptors ER, PR and the oncoprotein Her-2, a corresponding targeted treatment is applied”, explains Dr. Eleni Galani,

Pathologist-Oncologist, 2nd Oncology Clinic Metropolitan Hospital.
For the treatment of metastatic hormone-sensitive breast cancer (ER, PR positive and Her-2 negative tumors) there is a new class of drugs, the cyclin inhibitors (CDK4/6 inhibitors), which give patients more years of quality life. A patient can now take an oral treatment, avoid chemotherapy for a long time and return to her life without hair loss and generally with minimal side effects. Three new drugs of this category are available today in our country.

New anti−Her-2 targeted therapies offer patients with Her-2 positive metastatic disease a significant survival benefit, turning a truly difficult disease into a chronic disease with a very good quality of life. In the last two years, the international oncology scientific community welcomed, with particular satisfaction, two new drugs for Her-2 positive metastatic breast cancer, which enriched and diversified the therapeutic algorithm of the disease. One is the new Trastuzumab-Deruxtecan complex molecule, which has shown extremely high efficacy in patients with metastatic Her-2 positive breast cancer who had failed previous treatments.

The other drug for which the announcement of its clinical trial results also generated excitement is Tucatinib, a highly effective small molecule selective Her-2 inhibitor, given orally in combination with oral chemotherapy and the monoclonal antibody Transtuzumab .

It should be noted that both of these drugs are also extremely effective in patients with Her-2 positive disease who have brain metastases, in fact Tucatinib is recommended for the treatment of patients with progressive brain localizations.

In addition, there are also very important developments for the difficult category of triple negative breast cancer.
Recent data show that patients with metastatic triple-negative disease have a significant clinical benefit if they receive a combination of immunotherapy and chemotherapy. This benefit concerns patients with expression of the PDL-1 marker. Also, very recently, a new complex molecule, Sagituzumb Govitecan, has been approved in Europe, which offers a significant extension of life for patients with advanced pretreated triple-negative breast cancer.

“In a small percentage (5%-10%) of patients breast cancer is hereditary. Today we know that hereditary breast and ovarian cancer are usually caused by pathological mutations in the BRCA1/2 genes. However, it must be emphasized that genetic testing must be done in a selected population that meets specific criteria.

Regarding patients with mutations in the BRCA1/2 genes, a new class of drugs in the form of pills, PARP inhibitors, which repair DNA damage, have opened new, important therapeutic avenues,” says the doctor.

It is worth noting that the above innovative treatments are approved by the European Medicines Agency and are available to Greek patients.

In conclusion, a new era of combination therapy appears to have arrived. Combinations of classical chemotherapy or hormone therapy with new innovative drugs, monoclonal antibodies or immunotherapy are now used, which have succeeded on the one hand in increasing cure rates, and on the other hand in transforming metastatic disease into a chronic disease.

The beneficial effect of the above drugs is enhanced by the significant assistance of the patient associations, who with their continuous and substantial presence support breast cancer patients at every level (informative, psychological and/or financial) throughout the entire course of the treatment. course of their treatment.

In addition, the “Women in Oncology” network, which consists of female oncologists, in addition to the continuous information and awareness activities it undertakes, has created the online platform w4life.gr with the aim of reliable and responsible information.

“Finally, let’s keep in mind that ‘prevention’ is what we want, i.e. ‘better than cure’, when avoiding the habits associated with increasing the risk of cancer and adopting a lifestyle are added to the recommended preventive medical examinations which is related to the reduction of the same risk”, points out Dr. Galani, who analyzes the steps that patients should follow to prevent breast cancer:
• Avoiding smoking, obesity, which is the first and second biggest risk factor for cancer, and even moderate alcohol consumption, which increases the risk of breast cancer
• Healthy diet and exercise, which are a shield of protection against cancer
• Sex, age and history appropriate screening tests.
“It is this path that we have an obligation, both to ourselves and to those we love, to follow”, concludes the doctor.

She writes:

Dr. Eleni Galani, Pathologist-Oncologist, 2nd Oncology Clinic Metropolitan Hospital

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