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Breast cancer is the most common cancer in women, but men also suffer from it. About 20 new cases are reported annually in Poland, writes Joanna Streb, MD, PhD, a provincial consultant in the field of clinical oncology in Małopolska.
Breast cancer – there are four types
Ductal carcinomas are the most common type of breast cancer, with lobular carcinomas in second place, and other types, for example epithelial, are less common. However, if we take into account the HER receptors (human epidermal growth factor receptor) located in the cell membrane, as well as estrogen and progesterone receptors located in the cell nucleus and in the cytoplasm, we can distinguish 4 types of breast cancer.
Luminal A subtype is more sensitive to hormone therapy and less sensitive to chemotherapy because it has estrogen and progesterone receptors; there are no HER receptors. It can be in the ductal or lobular form. The prognosis is better here compared to luminal type B because its Ki-67 index, which indicates the rate of cell division, is quite low.
The luminal B subtype includes HER positive or HER negative tumors. Here, too, there are progesterone and estrogen receptors. This type of cancer can be treated with chemotherapy if it is HER positive – because we use monoclonal antibodies later. In HER-negative cancer, the Ki-67 index is higher, which means that the cancer is progressing faster, which means a worse prognosis.
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The third subtype is HER positive, non-estrogenic, and non-progesterone cancer. The prognostic and predictive factor here is the HER receptor located in the cell membrane. This cancer can progress faster, but here we have the option of treating the so-called double lock.
The fourth subtype is triple negative breast cancer. There are no receptors – neither HER, nor estrogen and progesterone. It occurs more often in young women and is associated with the BRCA1 and BRCA2 mutations. The prognosis for it is worse.
Cykliby – a chance for life
In the arsenal of modern drugs used in the treatment of breast cancer, which give the chance to extend life and its good quality during and after treatment, there are drugs from the group of CDK4 / 6 inhibitors, the so-called cycles. These are drugs that break hormone resistance. In Poland, these drugs have been available for several years. They are reimbursed under drug programs – initially only palbociclib and ribociclib, while in September 2020 abemaciclib appeared on the reimbursement list, with the indication for the XNUMXst or XNUMXnd line of treatment in combination with an aromatase inhibitor or fulvestrant.
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All three cycles mentioned are indicated in advanced breast cancer that is HER-negative, estrogen positive, may be primary disseminated, or the patients may have previously received treatment based on an aromatase inhibitor.
The introduction of cyclib has helped to extend overall survival and the time to disease progression. Their advantage is lower toxicity compared to cytostatics, and in the case of HER2-negative cancer, they also enable very good results of the therapy.
Triple Negative Breast Cancer – There Is Hope
Clinicians and patients are primarily waiting for the introduction of new therapies in triple negative breast cancer. Although this cancer accounts for only 10-15% of all breast cancers, its prognosis is worse than in other subtypes. The first monotherapy drug for patients with triple negative breast cancer with BRCA mutations spread beyond the original site has recently emerged. It’s talazoparib – it has already obtained a marketing authorization from the European Medical Agency (EMA) in the European Union. This drug is of great hope for patients with triple negative breast cancer, because for this group there has been no treatment other than chemotherapy. Unfortunately, it causes a number of serious side effects. Modern drugs do not cause such severe adverse reactions.
The article comes from the educational campaign “W trosce o women” prepared by Warsaw Press and whose media partner is medTvoiLokony. All materials can be found on http://www.warsawpress.com/
See also:
- The most common symptoms of cancer in children. How not to miss them?
- Not only Kadcyla. Oncologist: Cancer drugs have quietly disappeared from the list
- Preventive mastectomy. What do you need to know about a treatment that celebrities decide?