Evolution and development of diagnostic and treatment strategies for patients with breast cancer

The expert calls on the population to learn about this condition.

Dr. Luis Delgado, director of the Dr. Isaac González Martínez Oncology Hospital. Photo: Archive of the Journal of Medicine and Public Health.

In Puerto Rico the incidence of breast cancer in women it is estimated at about 29.7%. Among the cancers suffered by women on the island, this is the one with the highest incidence, according to official figures.

For this reason, the Dr. Luis Delgado, director of the Dr. Isaac González Martínez Oncology Hospitalexplained the importance of knowing the following process, once the disease has been diagnosed.

“It is important to evaluate various details or characteristics of the disease, including whether it is invasive or not, the possible extension of the disease to lymph nodes, or other organs. Establish the stage of the disease, TNM (T-size, N- involved nodules, M -metastasis to other organs),” he highlights.

The truth is that estrogen and progesterone may have a percentage of responsibility by stimulating the growth of malignant cells, which, when united, can attract some proteins known as receptors, he maintains.

“When this binding occurs, tumor growth can be stimulated. We call these tumors breast cancer with positive receptors, and tend to be less aggressive than those that do not have these proteins,” he explains.

The stage (TNM), the quality of the recipients and the general state of health of the patient are fundamental criteria to establish treatment recommendations for the breast cancer.

Each patient should be guided based on these characteristics and the result of each of the existing therapeutic alternatives, including the indications, risks and benefits of each of them so that the person has the necessary knowledge to choose between one and the other.

Until a few decades ago, the existing therapeutic alternatives had a significant impact on the lives of patients, not only because they involved more extensive radiotherapy, but also because the toxicity of some chemicals interfered with the health status of women, and the procedures they were radicals.

Fortunately, and as recognized by Dr. Delgado, with the scientific and technological advances of recent years, it has been possible to give patients an earlier and more accurate diagnosis.

“This is due to radiological equipment with higher resolution and reliability, less invasive or extensive diagnostic processes, such as directed biopsies, aspiration biopsies and/or mammography-guided stereostatic biopsies, in which a computer and a three-dimensional apparatus are used to identify and guide the procedure”.

Evolution of drugs to treat this condition

Cyclin (CDK4/6) inhibitors: There are several drugs in this class, including abemaciclib, palbociclib, and ribociclib. These drugs are used in patients with an advanced stage of the disease, whose hormone receptors are positive and whose Her 2 neu receptor is negative.

They are usually used in combination with hormonal blockade and have been shown to increase progression-free survival in these people. Although they may be associated with side effects such as diarrhea, and decreased white blood cell count.

Tucatinib, deruxtecan, perjetta, Neratinib, Kadcyla: These drugs are approved for the treatment of breast cancer whose Her 2 neu receptor is positive. They have shown benefits in terms of disease progression and survival.

Some are given in combination with chemotherapies, adjuvantly, or in patients with advanced disease.

PDL1 inhibitors: Studies in different types of cancer have shown that the expression of PDL1 is linked to the fact that cancer cells are not identified or destroyed by the immune system, so that they can spread to different organs.

“The development of new drugs that block the checkpoints that allow cancer cells to escape from T lymphocytes has been of great benefit in tumors such as malignant melanoma, lung cancer, kidney cancer, among others. During the past years, studies have been presented evaluating the efficacy and benefit of these immunotherapies in the treatment of breast cancer triple negative, achieving FDA approval,” he says.

Pembrolizumab has been approved for use concomitantly with chemotherapy, in patients with breast cancer triple negative, in early stages, with a high risk of recurrence, with tumors of 1 to 2 cm and in tumors larger than 2 cm; studies have shown a 37% reduction in the risk of disease progression, recurrence, or metastasis.

The combination of pembrolizumab and chemotherapy had already been approved on November 13, 2020, for the treatment of advanced or unresectable disease.

Sacituzumab (govitecan-hziy) has been approved for the treatment of breast cancer advanced triple negative, who has received at least two previous lines of treatment. This drug is a set of antibodies directed at TROP2 and a topoisomerase inhibitor.

It is an artificial antibody that causes the immune system to attack those malignant cells that express the TROP 2 protein; Studies have shown a reduction of at least 30% in the size of the lesions and the response lasted an average of 8 months.

Even with all these alternatives that he mentions, the expert assures that there is still a long way to go: “The breast cancer It has impacted many women in our population. We all must make a greater effort in education, early identification and in the modification of those risk factors that we can correct. The past few years have been very active and enthusiastic in cancer treatment, but much remains to be discovered,” concludes the expert.