How is breast cancer treated?

Breast cancer treatment is one of the areas where innovation and knowledge has been the most in recent years.

Breast Cancer Treatment Options | treat Cancer 2022

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How is breast cancer treated?

Breast cancer treatment is one of the areas where innovation and knowledge has been the most in recent years. Until ten years ago, breast cancer was roughly classified into two groups as sensitive and insensitive to estrogen hormone, but today this information has changed and it has been revealed that breast cancer is in 4 main types and that it should be treated with different treatment strategies for the individual and the individual’s tumor.

A good treatment plan can be made by taking into account all known characteristics of the patient and the tumor.

1. Characteristics that are important to the patient

• personal medical history
  • Current illnesses and past illnesses,
  • Regularly used drugs
  • History of previous breast biopsy
  • History of previous radiotherapy
  • pregnancy status,
  • menopause status,
  • Family history of breast and other cancer
• Results of physical examination findings by the doctor
• blood tests

2. Characteristics of the tumor

• Stage of the disease (stage 1 to stage 4)
• Biological features (histological type and grade) according to biopsy results
• Hormone receptor status (Luminal A, B, Her2 positive, triple negative)
• Her2 receptor status
• Ki67

Breast cancers are divided into 4 different subgroups according to their hormone receptor status. One of the most important determinants of treatment decision is this hormone receptor status.

• Tumors sensitive to estrogen hormone (Luminal A)
• Tumors sensitive to estrogen hormone and also carrying Her2 receptor (algae) (Luminal B)
• Tumors carrying Her2 receptor insensitive to estrogen hormone (Her2 positive)
• Tumors lacking estrogen hormone and Her2 receptor (Triple negative breast cancer, also known as basal like)

The aim of the treatment to be applied after surgery in early stage breast cancer is to reduce the risk of recurrence of the disease. In the selection of treatment, preventive treatment is determined according to the age of the patient, concomitant diseases, the type and stage of the disease (1st stage, 2nd stage, 3rd stage).

Today, more than 90% of breast cancers are diagnosed at an early or regionally advanced stage.

Patients in these stages are mostly treated with surgery, however, pre-surgical reduction (neoadjuvant) or post-surgical preventive (adjuvant) chemotherapies and sometimes adjuvant radiotherapy may be required. Your oncologist will decide which treatments are necessary for you.

Adjuvant chemotherapy is a treatment method applied as a preventive measure and/or to kill possible cancer cells that persist after surgery. In tumors with large tumors or lymph node infestation, prophylactic chemotherapy is mostly preferred. The generally preferred number of applications for chemotherapy is 4-8 cycles every 21 days.

Most of the breast cancers, which have not spread to the lymph nodes and are sensitive to female hormones, do not need chemotherapy. In such tumors, special genetic tests that determine the risk of cancer recurrence (for example, Oncotype Dx test) can be performed to determine whether the patient really needs chemotherapy.

Treatment methods used in breast cancer are:

• Operation
• Radiotherapy
• hormonal therapy
• Chemotherapy
• Smart drugs (in HER2 positive patients)
• CDK 4/6 suppressive smart drugs (in hormone positive patients)
• Immunotherapy (in triple negative breast cancer)
• PARP inhibitors (in BRCA mutation positive patients)

Advanced breast cancer treatment basic principles and summary

The goals of systemic therapy for metastatic breast cancer (MMC) are to prolong life, alleviate symptoms and complaints, and maintain or improve quality of life.

• Hormone receptor status, human epidermal growth factor receptor 2 (HER2) overexpression, tumor burden, presence of inherited breast cancer susceptibility gene 1 or 2 (BRCA1 or BRCA2) mutations, and responses to previous treatments have predictive value for disease course and are important determinants in choosing appropriate therapy. .
• Hormone receptor and HER2 testing should be repeated in metastatic breast cancer when the treatment response is not as expected or there is a mismatch in expression between the primary site and metastases. Conversion to positive will significantly change treatment.
• For most patients with hormone-positive metastatic breast cancer, endocrine therapy with or without CDK 4/6 inhibitors is recommended instead of chemotherapy. However, for patients with rapidly progressive disease or visceral metastases with end-organ dysfunction, first-line therapy with chemotherapy is recommended.
• In general, sequential single-agent chemotherapy is preferred to combination chemotherapy in metastatic breast cancer; because single-agent chemotherapy is likely to reduce symptoms with fewer side effects, and no studies have demonstrated an overall benefit of combination chemotherapy over a long period of time. Combined chemotherapy may be preferred for selected patients with rapidly progressive disease, visceral crisis, or for whom rapid symptom control is desired.
• For patients with HER2-positive breast cancer, regardless of their hormone receptor status, HER2-directed therapy should be included in first-line therapies.
• For patients with metastatic, hormone-positive, HER2-negative breast cancer with germline BRCA mutations who have previously been treated with chemotherapy in the setting of neoadjuvant, adjuvant, or metastatic disease (and have also received at least one endocrine therapy if hormones are present), an oral poly(ADP-ribose) ) polymerase (PARP) inhibitor is recommended.
• Careful evaluation of the response to treatment will assist in making decisions regarding continuation of treatment and in the selection of subsequent treatments. Potentially useful tools for monitoring treatment response include history and physical examination, radiographic imaging (eg PET-CT), and/or assay of serum tumor markers. The role of circulating tumor cells continues to be actively investigated.
• The median survival for patients with metastatic breast cancer has increased significantly over time; this is a trend attributed to the availability of new, more effective agents, including taxanes, aromatase inhibitors and trastuzumab.

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