Treatment
Standard of Care for Breast Cancer
The standard of care depends on the cancer type, stage, receptor status, and patient preferences. Treatment goals include curing early-stage disease, controlling locally advanced cancer, and managing symptoms in advanced stages.
1. Surgery
If the cancer is operable, the goal is to remove the tumour and sometimes surrounding lymph nodes, as well as establish the stage of cancer and guide further treatment.
Types of surgery
Breast-conserving surgery (lumpectomy): Removes the tumour and small margin of healthy tissue, preserving most of the breast.
Mastectomy: Removes the entire breast; recommended for large tumours or multiple tumours in one breast.
After surgery: Radiotherapy is often given to kill any remaining cancer cells and reduce recurrence risk. Further surgery (re-excision or mastectomy) may be required after breast conserving surgery if there is invasive cancer.
2. Chemotherapy
The goal is to destroy cancer cells, shrink tumours, and prevent recurrence or spread. It can be used before surgery (neoadjuvant therapy) to shrink the tumour, making surgery easier or breast-conserving. After surgery, chemotherapy (adjuvant therapy) is used to target any remaining microscopic disease and reduce recurrence. Chemotherapy is increasingly combined with immunotherapy (e.g., pembrolizumab) in early-stage triple-negative breast cancers expressing PD-L1, improving outcomes.
Common therapies used:
Anthracyclines: Doxorubicin, epirubicin (effective but with cardiac risks).
Taxanes: Paclitaxel, docetaxel (often combined with anthracyclines).
Alkylating agents: Cyclophosphamide.
Platinum agents: Carboplatin, especially in triple-negative breast cancer.
Capecitabine: An oral agent sometimes used in advanced disease.
3. Radiation Therapy
The goal is to target and kill remaining cancer cells in or near the breast post-surgery and is used following breast conserving surgery or mastectomy.
4. Hormonal (Endocrine) Therapy
The goal is to stop cancer growth in hormone receptor-positive cancers by blocking or lowering oestrogen. It is used following other treatments and for periods of 5–10 years, to reduce recurrence.
Common agents include Tamoxifen and Aromatase inhibitors
Tamoxifen often induces an immediate menopause in premenopausal women, which has significant side effects.
5. Palliative and Supportive Care
This is used to improve quality of life and address the practical needs of patients and their families throughout the illness journey, including advanced stages.
Treatments Include pain control, nutritional care, psychosocial and emotional support and practical assistance.
AB Health Solutions provides access to testing for targeted therapies.
Targeted Treatment
Personalised Medicine Targeting Tumours
These therapies are targeted to attack cancer cells with specific genetic mutations. More and more are being approved by the regulatory authorities, a selection of which are listed below:
Olaparib (Lynparza) and Talazoparib (Talzenna) are PARP inhibitors approved for use in patients with BRCA1 or BRCA2 gene mutations.
Alpelisib (Piqray): Approved for PIK3CA-mutated, HR-positive, HER2-negative advanced breast cancer.
Inavolisib (Itovebi): Recently approved (EU) for ER-positive, HER2-negative advanced breast cancer after recurrence, specifically with PIK3CA mutation.
Capivasertib (Truqap) is an AKT pathway inhibitor used when tumours have PIK3CA or AKT1 mutations. It is included as part of combination therapy with fulvestrant.
Everolimus (Afinitor) is an mTOR pathway inhibitor in patients that have for PI3K/AKT/mTOR Pathway Activation. It is included as part of a combination therapy with exemestane for HR-positive, HER2-negative breast cancers that have progressed on endocrine therapy.
Orserdu (elacestrant) is approved when tumours have ESR1 mutations in ER-positive advanced breast cancer in postmenopausal patients who have progressed after endocrine therapy.
Trastuzumab deruxtecan (Enhertu): Approved for HER2-low and HER2-positive breast cancers, including expanded indications in early and metastatic settings.
Tucatinib: Approved for HER2-positive breast cancer, especially for brain metastases, in combination therapies.
Palbociclib (Ibrance), Ribociclib, Abemaciclib (Verzenio) is used when there is suspicion of CDK4/6 Pathway Activation. It is used when tumours are HR+/HER2- in advanced breast cancer, independent of mutation status, but particularly effective in hormone receptor-driven cancers.
In order to get access to these therapies, testing for genetic mutations (BRCA, PIK3CA, AKT1, ESR1, HER2) is recommended in patients with advanced breast cancer to guide therapy selection and improve outcomes.