Treatment For Advanced Breast Cancer

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Although treatable, advanced breast cancer is a fatal disease.  There are many different treatment approaches for advanced (secondary) breast cancer with quality of life becoming increasingly important when the cancer has spread.

Breast cancer is more than one disease. It can be divided into different subtypes:

• Hormone sensitive, also known as hormone receptor or ER-positive breast cancer – This type of breast cancer is stimulated to grow by the hormones oestrogen or progesterone. Approximately two out of three breast cancers are hormone sensitive.

• HER2-positive – The cancer cells have too many receptors for the HER2 protein. This type of breast cancer tends to spread faster than other forms and occurs in 20-25% of patients.

• Triple negative – A group of breast cancers that lack oestrogen and progesterone receptors and do not over-express the HER2 protein. Around 10-17% of cancers are triple negative.
Each subtype responds to drugs in different ways and has different treatment protocols.

Types of advanced breast cancer treatment

There are three main classes of drugs used to treat advanced and secondary breast cancer:

• Hormone therapy, also called endocrine treatment – Drugs that affect the oestrogen levels within the patient

• Chemotherapy – A term given to drugs that essentially poison the cancer cells. They are usually given by injection although there are tablet forms. Chemotherapy drugs may be given one at a time or in combination. They are considered a more aggressive form of treatment and whilst they are good at treating the cancer, they will have some significant side effects for most patients
 
• Targeted therapies, also called biological treatments – Drugs that target specific cancer cells. Most new treatments becoming available are in this class of drugs.

The questions that need to be asked before deciding upon the best treatment programme for advanced breast cancer are:

• What is acceptable for the patient?
• What are her expectations?
• What is the balance between benefit and side effects that she is prepared to accept?

This information can be used to select the most appropriate treatment for each patient.

For those who are offered chemotherapy there is often a decision to be made as to how aggressive the treatment should be, as explained by Professor of Medical Oncology, Rob Coleman:  “The general rule is that the better the treatment, the worse the side effects. The most active drug in secondary breast cancer is docetaxel (Taxotere®). It is an aggressive treatment affecting a patient’s hair. It can make the patient very tired, achy, and prone to infection. For this reason it is not for everybody, but if you really want to get on top of the cancer it is a good choice.

Then there are drugs that do not affect the patient’s hair like capecitabine (Xeloda®) or carboplatin (Paraplatin®). It is possible to tailor treatment to the wishes and expectations of the patient and match up benefit against side effects.”

Professor Rob Coleman continues: “I’ve got a patient at the moment that unfortunately has the disease affecting her liver and lungs, but she is a real dynamo. She wants to continue to work, she is trying to build a new house and she wants to complete that project. She will cope with anything that is thrown at her and wants the most aggressive treatment and the option that is going to let her live the longest.

Professor Rob Coleman, MBBS, MD, FRCP (London & Edinburgh)
Honorary Consultant, Weston Park Hospital
Professor of Medical Oncology, Weston Park Hospital, Sheffiled

 

10013 October 2011

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