Breast Cancer Latest Updates about treatments of different types

Latest Updates about Breast Cancers treatments

Dr. Mohanad Diab is a consultant Sub-Specialized in Breast Cancers. According to patients Dr Diab is the Best Oncologist in UAE/Abu Dhabi in treating Breast Cancers.

In general there are three types of Breast Cancers but recently some other types were added and they are treated in a different way than before. The previous three types are

Hormone receptor-positive, HER2-negative

fulvestrant is an endocrine therapy option, and elacestrant is an oral SERD option for ESR1-mutated cancers. For ESR1-mutated advanced disease after prior endocrine therapy, regulatory-approved options include elacestrant, imlunestrant, and vepdegestrant. For tumors with PI3K-pathway alterations, targeted options include capivasertib plus fulvestrant, and alpelisib plus fulvestrant.+3

HER2-positive

For de novo untreated HER2-positive metastatic breast cancer, a preferred approach is trastuzumab plus pertuzumab with a taxane such as docetaxel or paclitaxel, followed by maintenance trastuzumab and pertuzumab. Across lines of therapy, key HER2-directed agents include fam-trastuzumab deruxtecan, ado-trastuzumab emtansine, tucatinib (used with capecitabine and trastuzumab), lapatinib, neratinib, and margetuximab. fam-trastuzumab deruxtecan is suggested after progression on trastuzumab/pertuzumab/taxane, with monitoring for interstitial lung disease or pneumonitis.+3

HER2-positive with brain metastases

tucatinib plus capecitabine and trastuzumab improved progression-free and overall survival versus capecitabine and trastuzumab in previously treated HER2-positive metastatic breast cancer, including patients with brain metastases, and is FDA approved for this setting.

Triple-negative breast cancer

For PD-L1-positive metastatic TNBC with CPS ≥10, pembrolizumab is FDA approved in combination with either chemotherapy or sacituzumab govitecan, and pembrolizumab plus sacituzumab govitecan is suggested in the retrieved guidance. Chemotherapy partners used with pembrolizumab in KEYNOTE-355 included nabpaclitaxel, paclitaxel, or gemcitabine plus carboplatin. sacituzumab govitecan is also an appropriate later-line option for metastatic TNBC, with randomized trial evidence of improved overall survival versus clinician’s choice chemotherapy.+1

Additional clinically important categories

1. HER2-low or HER2-ultralow: tumors without HER2 amplification but with low HER2 expression that can be eligible for fam-trastuzumab deruxtecan in advanced disease.+1

2. BRCA-associated (germline BRCA1/2) HER2-negative cancers: a subset where PARP inhibitor therapy such as olaparib may be relevant in metastatic and selected high-risk early-stage settings.

Germline BRCA-associated, HER2-negative breast cancer

olaparib is approved for germline BRCA1/2 mutation carriers with metastatic HER2-negative breast cancer previously treated with chemotherapy, and is also suggested for pathogenic somatic BRCA1/2 mutations and germline PALB2 mutation after chemotherapy. For metastatic TNBC with germline BRCA mutations previously treated with chemotherapy, an oral PARP inhibitor is suggested over chemotherapy, and trial data support activity of olaparib and talazoparib versus single-agent chemotherapy comparators. In early-stage high-risk HER2-negative breast cancer with germline BRCA mutation after neoadjuvant or adjuvant chemotherapy, adjuvant olaparib has FDA approval.+2

HER2-low

fam-trastuzumab deruxtecan has an international regulatory approval for advanced HER2-low breast cancer after prior chemotherapy in the metastatic setting or recurrence during or within six months of completing adjuvant chemotherapy. In metastatic HER2-low disease after prior chemotherapy, fam-trastuzumab deruxtecan improved progression-free and overall survival versus clinician’s choice chemotherapy, with toxicities including neutropenia, anemia, nausea, and interstitial lung disease.