Breast cancer is the most common type of cancer in women in the Western world. Mortality from the disease has decreased significantly in recent years. It is estimated that from 1989 to 2015 mortality has decreased by 40%.

The fact is attributed to the following factors:

• in raising women’s awareness.
• in the diagnosis of the disease at an earlier stage (early diagnosis).
• to better knowledge of the biology of breast cancer.
• in the most effective strategies to deal with it, in the initial stages.
• In pharmaceutical progress to treat the disease.

The awareness of women has taken on great dimensions in recent years mainly by the M.M.E., the state, agencies, doctors. Cases of breast cancer are sporadic. However, there are 5% of genetic breast cancers that carry BRCA1 and BRCA2 oncogene mutations.

Genetic testing for BRCA1 and BRCA2 oncogene mutations, which predispose to the hereditary breast and ovarian cancer syndrome, is already in practice. A number of other mutations have been implicated in breast cancer, but some of them are very rare and for others their role in the risk of developing the disease has not been clarified.

In breast cancer, given that there is no primary prevention (e.g. vaccines), efforts are being made by the medical world to identify high-risk women with the aim of early diagnosis of the disease.

Breast cancer is now diagnosed at very early stages and at younger ages, which makes the disease curable. The development of diagnostic methods is continuous. The scientific training of doctors, the abundance of specialized doctors, the diagnostic tools (digital mammography, breast ultrasound, automated breast ultrasound ABUS and magnetic mammography) have led to the early diagnosis of the disease almost 100%.

The treatment requires the cooperation of various specialties: radiologist, pathologist, surgeon, pathologist-oncologist, radiation therapist and others (plastic surgeon, psychologist, geneticist).

Information from the pathological examination of breast tumors results in the classification of breast cancer into molecular subtypes that contribute to the revolutionary new strategy for treating the disease. Today knowing the opponent directly determines the strategy of the full response.

The rule for choosing the treatment is the molecular classification of the neoplasm and the presence of BRCA1/BRCA2 gene mutation.

The majority (about 72%) of breast cancers are hormone sensitive, (Luminal A, Luminal B) i.e. they express hormone receptors (HR+/HER2-).
The second most common subtype (at about 13%) is triple negative breast cancer (TNBC, or HR – /HER2-). Hormone-sensitive HER2-positive breast cancer (HR+/HER2+) (Luminal B) accounts for approximately 10%, and hormone-negative HR-/HER2-positive breast cancer occurs in 5%.

The majority of hormone-dependent neoplasms can be taken directly to surgery.

Induction therapy, as preoperative therapy is called, is mainly used in locally advanced breast cancer, in large tumors with the aim of reducing the burden of the disease and the best surgical result. It can also be used in specific histological subtypes. It has been shown in clinical studies that in these patients with systematic preoperative treatment complete remission and a better outcome of the disease is achieved in the majority of patients. These subtypes are HER2 positive and triple negative breast cancer (TNBC).

Systemic therapy – new drugs

The postoperative treatment is determined by the results of the surgery and additionally by the results of specialized tests that give us the genetic signature of the tumor (Oncotype DX, Mammaprint, etc.).

New drugs

Hormone-dependent (HR) positive breast cancer

Postoperative treatment of hormone-positive breast cancer includes hormone therapy, either as monotherapy or in combination with other targeted therapies.

For metastatic disease, combinations of hormone therapy with CDK4/6 cyclin-dependent kinase inhibitors, as well as mTOR inhibitors, are used.

Studies show that the combinations are quite effective with a manageable toxicity profile. Some of the CDK4/6 inhibitors have received approval and are also given in early breast cancer.

Another target in hormone-positive metastatic breast cancer is the PIK3CA mutation for which there is a targeted drug Alpelisib, which in clinical trials has shown that it can significantly benefit patients who carry the mutation.

HER2 positive breast cancer

In recent years the success of trastuzumab (Herseptin), pertuzumab (Perjeta) and Ado – ​​trastuzumab emtastine (Kadcyla) in patients with HER2 positive (+++) breast cancer has sparked interest in the HER2 oncogene as a therapeutic target. New drugs such as margetuximab (Margenza) as well as trastuzumab deruxtecan (Enhertu) which appear to be effective in selected patients, as in clinical trials they have been shown to be safe and effective when used in previously treated patients with metastatic+ HER2 positive breast cancer.

Recent studies show that using the latter drug (Enhertu) in patients with low Her2 load (low) (1+) has great therapeutic results in metastatic disease.

Likewise tyrosine kinase inhibitors (TKIs). Oral drugs such as tucatinib (Tukysa), lapatinib (Tyverb), neratinib (Nerlynx) appear to benefit patients with brain metastases and play an important role in the treatment of metastatic HER2-positive breast cancer.

Triple negative breast cancer (TNBC)

Recently the interest in triple negative breast cancer has turned to combinations of classical chemotherapy with immunotherapy. Agents instead of PD-1/PD-L1 (Pembrolizumab, Atezolizumab) are being tested in clinical studies in metastatic as well as early breast cancer with encouraging results so far. A newer drug with a comparative study for triple negative breast cancer is Sacituzumab govitecan with excellent results in metastatic disease.

Finally, PARP inhibitors have been identified as therapeutic targets in patients carrying mutations such as BRCA1/2 and PALB2, especially in the treatment of metastatic as well as early TNBC breast cancer.

October is Breast Cancer Awareness Month and a reminder that prevention and early screening save lives. HYGEIA and MITERA, with their new campaign, try to remind every woman how important breast screening is in the prevention of the disease, asking the simple question: “Have you been checked?”. So let’s make prevention our ally!
Discover more here https://www.hygeia.gr/oktovrios-minas-kata-toy-karkinoy-toy-mastoy/