New Breast Cancer Treatments and Tech

September 23, 2020

A shorter version of the content below appears in A Guide to Caring For Yourself inside A Calendar to Live By 2021.

Photo by Testalize.me on Unsplash

THE NEWEST BREAST CANCER TREATMENTS AND TECHNOLOGY by VCU Massey Cancer Center

Treatments for breast cancer are always changing, thanks to the amazing efforts of scientists and researchers! If you feel like you can’t keep up with what’s out there when it comes to new, cutting-edge treatment options, you’re not alone! Advances are made seemingly daily, and doctors work diligently to learn what’s new and how to use the new tools and procedures effectively. Read on to learn about the newest options available to doctors when it comes to helping patients who have this disease, as well as their thoughts on what’s on the horizon – because it’s great to know what promising things may lie ahead!

Medicine/Chemo By Mary Helen Hackney, M.D., hematologist-oncologist, VCU Massey Cancer Center

Genomic tests, which analyze groups of genes in tumor samples, are becoming increasingly important in determining breast cancer treatment. Oncotype DX, MammaPrint and PAM50 are popular tests used to identify treatment strategies for early-stage estrogen-receptor-positive (ER+) breast cancer and those who might benefit from the addition of chemotherapy to hormonal therapy.

The current backbones of chemotherapy treatment for early-stage breast cancer include cyclophosphamide, doxorubicin, and paclitaxel or docetaxel in some combination. Hormonal therapy (treatment that adds, blocks, or removes hormones) remains a key component of care for women with ER+ breast cancer of all stages. Tamoxifen, the oldest  hormonal medication, is now joined by aromatase inhibitors, fulvestrant and ovarian ablation (treatment that reduces the amount of estrogen produced by the ovaries).

However, the future of breast cancer treatment will rely on testing for and hopefully having drugs to target specific genetic mutations. Alpelisib combined with fulvestrant is now approved for metastatic breast cancers expressing mutations in the PIK3CA gene. Atezolizumab combined with nab-paclitaxel is available for metastatic breast cancers expressing the PD-L1 gene. Olaparib and talazoparib have been approved for women with metastatic breast cancer and the BRCA mutation. Clinical trials are underway to see if these drugs may be useful in patients with earlier stage disease.

CDK4/6 inhibitors are drugs that target specific enzymes and have blazed onto the breast cancer treatment scene. Palbociclib, ribociclib and abemaciclib are approved to be used in combination with hormonal therapy to treat recurrent breast cancer, and they are being tested in clinical trials to determine if use in early-stage cancer is beneficial. This group of drugs is well tolerated and has provided excellent results.

The first drug approved to treat HER2-positive breast cancers, trastuzumab, has made remarkable differences in survival for all stages of disease. More recent drugs include pertuzumab, lapatinib and neratinib. The newest therapies showing promise for recurrent HER2-positive disease, including TDM-1 and fam-trastuzumab, combine trastuzumab with chemotherapy.

New treatments are found through research and clinical trials, and trial participants contribute not only to their health but to the health of future generations.

Surgery by Kandace McGuire, M.D., chief of breast surgery and surgical leader of the Breast Cancer Collaborative Care Clinic, VCU Massey Cancer Center

There are a number of promising technologies on the horizon in the field of breast cancer surgical oncology.

Targeted axillary dissection (TAD) is a procedure in which a surgeon performs a biopsy of a previously involved lymph node after chemotherapy to identify evidence of cancer and potentially spare the patient from removing additional lymph nodes under their arm. TAD leads to less extensive axillary surgery and less lymphedema (swelling in the arm caused by the removal of lymph nodes).

Axillary reverse mapping (ARM) is a novel strategy being tested in clinical trials that will attempt to use a colored dye to map out the lymphatic system in patients undergoing surgery to remove lymph nodes. ARM is intended to minimize the risks of lymphedema.

Breast seed localization is a procedure in which a tiny metal seed is placed in breast tissue to guide surgeons in locating and removing tumors. This technique makes surgery times more flexible and reduces the time a patient is in the hospital on the day of surgery.

Magtrace® is a non-radioactive liquid dye that points surgeons to lymph nodes in a patient to help determine if the cancer has spread. This approach increases flexibility in injection times and where patients can go for surgery and might help some early stage breast cancer patients avoid axillary surgery.

Radiation Todd Adams, M.D., medical director of the Department of Radiation Oncology at Stony Point, VCU Massey Cancer Center

For breast cancer patients experiencing recurrence after initial treatment with lumpectomy and whole-breast radiation, mastectomy has historically been the standard treatment. Recent findings from a multicenter clinical trial led by Douglas Arthur, M.D., showed that a second lumpectomy followed by partial breast irradiation was associated with a low rate of 5-year recurrence (5%), acceptable toxicity and a high rate of 5-year breast preservation (90%). Partial breast irradiation targets radiation to the area where the breast tumor was located and decreases radiation exposure of the surrounding tissue.

For patients with recurrent breast cancer initially treated with lumpectomy and whole-breast radiation, this study showed that a second lumpectomy plus partial breast irradiation may offer a practical alternative to mastectomy for many patients who hope to preserve their breast.

Detection/Diagnosis By Priti Shah, M.D., director of breast imaging, VCU Health

Every patient should determine a personalized breast cancer screening strategy that is based on a variety of individual risk factors and a discussion with their primary care provider. Mammograms continue to serve as the gold standard for all women at average risk aged 40 or older, regardless of breast density.

3D mammograms are becoming much more common at breast imaging centers around the country and can be particularly helpful for women with dense breast tissue. 3D mammograms have been shown to detect a greater number of breast tumors, and studies indicate they can also reduce the odds of being called back for follow-up imaging.

It is recommended that women at high risk of breast cancer (>20 % lifetime risk) undergo a yearly MRI in addition to their mammogram, typically starting around age 30. A breast MRI uses a magnetic field to generate images of the breast tissue that can show the presence of cancer sometimes not identified by other imaging tests.

Breast ultrasounds can be used as a supplemental screening method to mammograms for women at average risk of breast cancer with dense breast tissue. Ultrasounds are more effective than mammograms at determining if a mass is a cyst (benign and fluid-filled) or something more solid, which could require further testing.

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