Sitting down in front of three specialists could bring a sense of security and yet a feeling that the world is spinning out of control. “The pathology results arrived yesterday. You have HER2-positive breast cancer and a little portion of it is in your lymph node too,” is not something any woman wants to hear.
But this is how many women become warriors.
In 2018, approximately 266,120 women in the United States will be diagnosed with invasive breast cancer, and 63,960 with non-invasive or in-situ breast cancer. Breast cancer takes second place as the most diagnosed cancer in women after skin cancer.
Thanks to early detection methods and increased options for therapy, the risk of any woman dying from breast cancer dropped by 39% between the late 1980s and 2015.
Organizations like the American Cancer Society (ACS) make the fight of the “woman warrior” worth it every single day. With ACS, we unite, ignite, and we fight with every drop of blood and therapy.
OCTOBER: Breast Cancer Awareness Month
October is breast cancer awareness month. A time to shed light on the subject and to empower the women and families who have been through, are going through, or know someone who has been affected by breast cancer. We are only strong when we are united.
To elevate awareness efforts, I have written a very brief post here just to highlight current therapies, but more importantly to give you a call-to-action at the end of this post.
The number of breast cancer therapies are too many to highlight in just one article, but I will shed light on some of the popular therapies.
It is important to mention that before systemic treatment, i.e. treatment using substances that travel through the bloodstream, oncology doctors usually decide whether or not an individual needs surgery (lumpectomy or mastectomy) and/or radiation therapy. During surgery, some tissue will be removed to be tested in the lab.
What is the Systemic First-Line Treatment for Breast Cancer?
The first-line treatment is the medically accepted consensus of treatment that works for most patients right after diagnosis. There is no one-size-fits-all therapy. In fact, medical experts have guidelines for treating all kinds of breast cancer, including carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, and breast cancer during pregnancy.
First-line for HER2-Positive Breast Cancer
According to Dr. Sara Hurvitz, MD, “The standard of care to treat curable HER2-positive breast cancer has been to give chemotherapy with the HER2-targeted monoclonal antibody trastuzumab.”
Trastuzumab is popularly known as Herceptin, the brand name. Herceptin is approved for treating early-stage HER2-positive breast cancer that may or may not have spread to the lymph node, or any HER2-positive breast cancer that has not spread to the lymph node. Herceptin is a kind of ‘targeted treatment’ that targets a specific cancer cell. It’s different from traditional therapies that are not targeted, such as radiation therapy, chemotherapy, and hormonal therapy.
Many breast cancer survivors speak highly of Herceptin as being an integral part of their survival stories. For adjuvant breast cancer, Herceptin is used alongside other chemotherapy drugs (chemotherapy drugs doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel). For metastatic breast cancer, Herceptin is used either with paclitaxel or by itself.
Dr. Hurvitz also mentioned that over the last one year, two new HER2-targeted treatments have surfaced — neratinib and pertuzumab. Both drugs have interestingly been successful in some patients. Neratinib has reduced the risk of recurrence after 4 years by 3.5% and pertuzumab has shown improvement in disease-free survival at 4 years by 1.7%.
First-line for Hormone-Receptor-Positive Breast Cancer
For over 50 years, the standard hormone therapy for hormone-receptor-positive breast cancer has been tamoxifen (Brand Names: Nolvadex, Soltamox). Tamoxifen is one of the world’s bestselling breast cancer drugs for hormonal therapy.
Tamoxifen binds to estrogen hormone receptors and prevents these receptors from binding to estrogen. Since hormone-receptor-positive breast cancer cells NEED estrogen and/or progesterone to grow and thrive, blocking these receptors is the strategy from stopping the action of these hormones.
Tamoxifen significantly prevents recurrence of hormone-receptor-positive breast cancer. Physicians direct women at risk to take the necessary dose daily for 5-10 years. Research shows that taking it daily for 10 years reduces the risk of recurrence and death than just taking it for 5 years.
Does Immunotherapy Come into Play in Breast Cancer Treatment?
Immunotherapy is all the rage these days, and justifiably so. When doctors can specifically influence the body’s own immune system to do the fighting, it is often the successful path for some patients.
Without going into all the available traditional treatment options, let me shed some light on immunotherapy for breast cancer.
A very recent study revealed this October during the ESMO 2018 conference, that you can combine immunotherapy with chemotherapy and that this combination can improve the survival of women with metastatic triple-negative breast cancer (TNBC), the most aggressive type of breast cancer. The drug of choice in this study is atezolizumab.
Why is this good news? TNBC is not like HER2-positive or hormone-receptor-positive breast cancers. It does not have the HER2 protein, nor does it have any receptors for estrogen. So the only therapy that has been suited for TNBC has been chemotherapy, which individuals get resistance too within just a few months.
Adding atezolizumab to chemotherapy is the first trial of its kind for TNBC. It is exciting because we’ve seen successes in immunotherapy for other medical conditions. To see this being implemented in breast cancer therapy is a step in the right direction.
Takeaway Point: What Can You Do?
You can be part of the awareness movement. TAKE ACTION: Early Detection Can Save a Life
Over the years, the ACS has worked hard to demonstrate that women can be their own advocates. They created an infographic on recommendations for early detection of breast cancer. Please view the infographic below and follow the guidelines included.
This October, I am rooting for you and me, and for thousands of women who are the warriors in this pink fight. Here’s to HOPE and here’s to HEALING.