Transcript: Liang Yingxiu
(Kuala Lumpur News) Before discussing in depth new treatments for breast cancer, let us first review some common sense. What should be done if a lump is found in the breast? Of course, at this time, you should see a breast surgeon for a physical examination, a mammogram, and then a biopsy to confirm whether it is breast cancer; but whether it has metastasized to other places, sometimes a computed tomography scan is needed. and CT scan examination.
Early-stage breast cancer requires tumor removal to be cured. However, before surgical removal, it is first necessary to confirm which type of breast cancer it is. Because among breast cancers, triple-negative breast cancer and HER2-positive breast cancer have a higher risk of recurrence, chemotherapy is generally considered as a treatment option.
You can’t just remove breast tumors
Dr. He Guohuang, oncology consultant at the University of Malaya Medical Center, revealed that if the patient has triple-negative breast cancer or HER2-type breast cancer, he should consult an oncologist before surgery to confirm the treatment plan; because if it is triple-negative breast cancer or HER2-type breast cancer, Surgery for positive breast cancer can be divided into two categories: one is mastectomy; the other is tumor removal but preserving the breast.
“If the breast is saved, the remaining breast will need radiation therapy for 3 to 5 weeks; in addition, breast cancer surgery cannot only remove the breast tumor, but also must deal with the lymph nodes under the arm, because if not treated, it will continue to metastasize to the clavicle. Lymph nodes, so breast cancer surgery cannot just remove the breast tumor, but also must deal with the cancer cells in the lymph nodes to avoid recurrence.”
“If no enlarged lymph nodes are seen in the ultrasound examination before surgery, the patient can consider sentinel lymph node biopsy (sentinel LN biopsy). The advantage of sentinel lymph node biopsy is that there will be fewer sequelae of the surgery. For example, after the surgery, the patient There are problems such as difficulty in raising hands or hand edema, and patients who have undergone biopsy have fewer such problems.”
No more than 8 times of adjuvant chemotherapy
Next he will talk about the latest progress in adjuvant treatment of breast cancer.
After hormone-positive breast cancer surgery, patients should take anti-hormone drugs, such as Tamoxifen, which lasts for 10 years, or another hormonal drug called Aromatase Inhibitor (AI). , it will take 5 years.
Recently, new research shows that the third generation of hormonal drugs,
It’s called a selective estrogen receptor degrader.
(referred to as SERD), may have good curative effects.
However, he said he is still waiting for the report of this study.
Younger patients at higher risk may consider menopausal injections.
Injections are given once every month or three months for about 3 years.
There are also bone-strengthening needles for about 3 years, injected once every six months.
If the patient has undergone chemotherapy before surgery, but the tumor has not completely disappeared, he may consider taking the chemotherapy drug Capecitabine for 6 months after surgery.
For HER2-positive breast cancer, it is generally recommended to perform chemotherapy plus targeted therapy before surgery. If the risk of breast cancer is relatively high and the lymph nodes are affected, adding a second targeted therapy, trastuzumab, may be considered.
Adjuvant chemotherapy before or after surgery is usually 4, 6 or 8 times, and usually no more than 8 times. The highest goal of chemotherapy before surgery is to make the tumor completely disappear during surgery, but this cannot be achieved every time.
If HER2-positive breast cancer has been treated with chemotherapy plus trastuzumab before surgery, but the tumor does not completely disappear, the targeted therapy can be changed to a second drug, namely Trastuzumab Emtansine (Trastuzumab Emtansine), after surgery. T-DM1, also known as Kadcyla), lasts for one year.
It is relatively economical to take chemotherapy drugs for one year
He pointed out that there have been three developments in the adjuvant treatment of triple-negative breast cancer in recent years: 1. For high-risk triple-negative breast cancer, the immunotherapy drug Pembrolizumab can be added to chemotherapy, which will reduce recurrence. second, they found that some patients with triple-negative breast cancer carry this gene mutation called BRCA, so they should be tested for BRCA gene mutations; then if the patient has the mutation, after chemotherapy and surgery, they can take a drug called Austrian One year of olaparib can continue to reduce the risk of recurrence; third, research from China shows that patients with triple-negative breast cancer can continue to take oral medication if the risk remains after chemotherapy and surgery. The chemotherapy drug Capecitabine, for one year, continues to reduce the risk of recurrence.
Among the three new adjuvant treatment options for breast cancer mentioned above, namely the first immunotherapy pembrolizumab and the second targeted therapy olaparib, due to the The treatment prices are quite expensive; therefore, if patients cannot afford immunotherapy or targeted therapy, they can consider the third option, which is to take the chemotherapy drug Capecitabine for one year. This chemotherapy drug does not have many side effects, but may cause some skin problems. side effects, and the price is a few hundred dollars a month.
tumor metastasis to bone
Third generation hormonal drugs are effective
There is generally no cure for advanced breast cancer. However, it can improve quality of life and extend lifespan.
He Guohuang said, first of all, let’s talk about hormone-positive advanced breast cancer. The treatment of hormone-positive advanced breast cancer has changed significantly in the last four or five years. In the past, most patients were provided with chemotherapy and chemotherapy, but with targeted therapy, With the invention of CDK-4/6 inhibitors, the first-line treatment has now been changed to “hormone therapy plus targeted therapy.”
Stimulating hormones can lead to relapse
Since estrogen can stimulate the recurrence of hormone-positive breast cancer, young patients who have not yet experienced menopause need to use methods to reduce estrogen in the body, that is, menopausal injections or surgical removal of the ovaries, and then they can take hormonal drugs. Generally, AI, hormonal drugs such as Letrozole, Exemestane and Anastrozole, combined with a targeted therapy, will be CDK-4/6 inhibitors such as palbociclib ), ribociclib and abemaciclib have shown good efficacy.
If the patient’s tumor metastasizes to the bone, third-generation hormonal drugs, such as injectable Fulvestrant, also have good effects. Fulvestrant is a good third-generation hormonal drug, but it’s a monthly injection, so it’s not that convenient. Therefore, research in recent years has been developing oral third-generation hormonal drugs, such as camizestrant or giredestrant.
The University of Malaya is also conducting a study called Selena 4. That is, if patients take AI and then relapse, they can consider participating in Selena 4. The University of Malaya will provide targeted drugs such as camizestrant and palbociclib.
Research on new drugs is in full swing
Hormone-positive late-stage breast cancer patients sometimes have a recurrence of their disease after taking first-line hormone and targeted therapy drugs. At this time, they should be tested for a gene mutation called PIK3CA.
“If the species has a PIK3CA mutation, they can take another drug called alpelisib. In recent years, research on developing new breast cancer drugs has been in full swing, so if the patient has stage 4 breast cancer, especially triple negative People with breast cancer or hormone-positive breast cancer should consult their doctor to see if there are suitable studies to participate in.”
He said that the University of Malaya Hospital will launch three breast cancer research projects at the end of the year, which will be provided to patients with triple-negative breast cancer and hormone-positive breast cancer. Everyone is welcome to sign up.
“Patients with advanced triple-negative breast cancer who have not received more than two lines of chemotherapy can go to the Oncology Department of the University of Malaya Medical Center for consultation and participate in this research project; if they have a gene mutation called BRCA or HRD, they can try Talazoparib. Target therapeutic drugs.”
In addition, he also said that their study ACENT03 will provide Sacituzumab drug to first-line triple-negative breast cancer patients; as for HER2-positive patients, the latest drug is N HER2, which has not been registered yet and will probably wait until March next year. This medicine will not be available until around June.