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Most people diagnosed with invasive breast cancer will require some type of systemic therapy. There are various types of systemic therapies that are used for treating breast cancer, including:
Systemic therapies can be infused intravenously, given as injections or taken orally, and may be given after surgery, (adjuvant therapy), before surgery (neo-adjuvant or pre-operative therapy), or to treat advanced cancer.
Three tumor markers are assessed in every case of invasive breast cancer to determine the best treatment options. These markers are the estrogen receptor (ER), progesterone receptor (PR), and HER2. The results of these tumor marker tests play a major role in choice of systemic therapy:
Additional tests can be performed to look at how likely tumor is to recur. These prognostic genomic tests can also help guide treatment decisions. For some patients with advanced cancers, tumor testing can look for additional tumor markers to help guide the choice of targeted therapies. At the moment, this type of tumor testing for targeted therapy is mostly experimental and used within research studies.
Some early stage breast cancers and most advanced breast cancers eventually will require some type of chemotherapy. Common chemotherapy regimens include cytoxin, anthrocyclines, (such as adriamycin), taxanes, (such as paclitaxel), and platinums (such as carboplatin).
Certain chemotherapy drugs, including the platinum drugs carboplatin and cisplatin, may be more effective against cancers caused by an inherited mutation, because the drugs work by damaging the DNA in cancer cells. This process takes advantage of the inability of hereditary cancers to repair DNA, causing cancer cells to die from excessive DNA damage.
Currently, platinum therapies are used as a standard first-line treatment for ovarian cancer, and researchers are looking at whether these same treatments may be effective for newly diagnosed breast cancer patients with mutations in BRCA.
The Triple-Negative Breast Cancer Trial (TNT) compared the platinum-based drug carboplatin to the drug docetaxel as first line treatment in 376 patients with metastatic triple-negative breast cancer and/or with a mutation in BRCA1 or BRCA2. (Patients with BRCA mutations and ER/PR positive breast cancer also were included in this study.) When researchers compared the two drugs in all patients, the response rate was similar for the two chemotherapies. However, when they examined the results for the 43 patients who had mutations in either BRCA1 or BRCA2, they found that 68.0% of carriers responded to carboplatin as compared with 33.3% of carriers who received docetaxel. The results of this study show the benefit of BRCA testing patients with advanced triple negative breast cancer. Those who test positive for a BRCA mutation may benefit from carboplatin over docetaxel.
Lynparza and Talzenna are targeted therapies known as PARP inhibitors. Both agents have received FDA approval for treating metastatic breast cancer caused by a BRCA mutation. The National Comprehensive Cancer Network (NCCN) added Lynparza as a preferred single agent treatment for people with Her2-negative, metastatic breast cancer who carry a BRCA1 or BRCA2 mutation.
Immunotherapies are cancer treatments that boosts the body’s own immune system so that it works harder and smarter to attack and remove cancer cells. There are several different types of Immunotherapy. Certain types of immunotherapy have been approved for use in breast cancer while others are still under investigation. Herceptin and other treatments for Her2-positive breast cancers are a type of immunotherapy known as monoclonal antibodies. Other types of immunotherapy, including immune check point inhibitors and cancer vaccines are still in clinical trials for breast cancer treatment.