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Advanced breast cancer: Understand how targeted therapy works in treatment

Advanced breast cancer: Understand how targeted therapy works in treatment

Breast cancer breast cancer is the type of cancer that affects women the world over - in Brazil alone, the Ministry of Health estimates more than 50,000 new cases a year. According to data from the Brazilian Society of Mastology, about one in 12 women will have a breast tumor until age 90.

As a rule, treatment for breast cancer includes surgery for removal of the tumor, which can be partial or total. However, cases considered advanced may not be indicated for surgery, leaving for other modalities. Breast cancer can be locally advanced, when there is involvement of neighboring structures, such as muscles, skin and lymph glands, or advanced with metastases, when the tumor has already reached other organs. According to the National Cancer Institute (INCA), about 75% of women are already diagnosed with advanced breast cancer.

Among the traditional treatments, such as chemotherapy, radiotherapy and hormone therapy, there is the target therapy. It is based on medications that specifically act on a group of tumors in which it is possible to identify a molecular alteration (altered protein or altered gene). "The drug acts at this 'target', inhibiting its action and reducing tumor growth," says oncologist Artur Malzyner of Clinonco in São Paulo. However, only people who have the molecular changes that can be affected by the drug benefit from target therapy.

These new therapeutic modalities aim to target treatment more specifically to diseased cells, sparing normal healthy cells, unlike

For advanced breast cancer, target therapy emerges as a hope of controlling the disease without exposing the patient to the more aggressive side effects of other treatments, since they affect the cells of the entire body, contributing to increase the life expectancy of these women. Know the different types of target therapy for breast cancer and which groups are indicated for each medication:

Everolimo

Patients with metastatic breast cancer, who express estrogen or progesterone receptors, and who have failed treatment with Non-steroidal aromatase inhibitors (anastrozole or letrozole) are indicated for treatment with everolimus.

These new therapeutic modalities aim to target treatment more specifically to diseased cells, sparing normal healthy cells, unlike what happens with chemotherapy, radiotherapy and hormone therapy.

In Brazil, everolimo was approved by Anvisa in 2013 for the treatment of postmenopausal women with advanced hormone receptor positive (RH +) and negative for growth factor receptor (HER2 -).

Tumors of the breast that present the estrogen receptor depend on the activation of this receptor to c to resent It is as if the estrogen receptor sends a warning to the breast cells, saying that they should continue to proliferate. In most patients, hormone therapy inhibits this signaling pathway, preventing tumor cells from multiplying.

However, in some cases the receptors are able to use "escape routes" to send these messages to cells. These are called alternative intracellular signaling pathways (mTOR pathway). "When this happens, tumor cell proliferation perpetuates and the tumor becomes resistant to hormone treatment," says clinical oncologist Vladmir Cordeiro de Lima of ACCamargo Cancer Center.

Everolimo inhibits mTOR, thereby preventing activation of the estrogen receptor and breaking the resistance of the tumor to the hormonal treatment. "In this way, treatment with everolimus associated with aromatase inhibitors is a partner in inhibiting tumor growth," says the expert. "The treatment provides the possibility of postponing the onset of chemotherapy, which clearly has more important side effects and a very similar response," explains the mastologist André Mattar of the Pérola Byington Hospital in São Paulo.woman taking medication - Photo: Getty Images

The medicine is given orally, usually once daily. Side effects can include diarrhea, fatigue, shortness of breath, mouth sores and coughing. Everolimus may also raise blood glucose and triglyceride levels, as well as increase the risk of infections. Although it is available for women with a health plan, everolimo is not yet available in the Unified Health System (SUS).

Trastuzumab

Produced from a protein in the immune system, trastuzumab is a type of medicine known as monoclonal antibody. The method can be used in women with tumors expressing the HER2 protein. Tumors of the breast that have this protein on its surface tend to spread more aggressively. "Trastuzumab works by binding to this HER2 protein, slowing that growth," says oncologist Vladmir. In addition, it stimulates the immune system to fight the disease more forcefully.

Trastuzumab is given intravenously once a week, usually in combination with chemotherapy. Side effects may occur in the first few doses, including fever, chills, weakness, nausea, vomiting, cough, diarrhea, and headache. Since 2013, trastuzumab is available in the SUS, and is also affordable for women with health insurance.

Pertuzumab

Pertuzumab is also a monoclonal antibody that binds to HER2 protein. However, the pertuzumab will act otherwise. "The drug prevents HER2 from associating with other proteins necessary for its functioning," explains the oncologist Vladmir. Thus, while trastuzumab inhibits the action of the protein, pertuzumab will prevent it from binding to other proteins necessary for tumor proliferation.

Pertuzumab is administered by intravenous infusion every three weeks. There may be side effects such as diarrhea, hair loss, nausea, fatigue, and decreased white blood cells, especially when associated with trastuzumab. The drug is approved in Brazil as the first-line treatment for HER2-positive metastatic tumors, and is available not only in the private network of hospitals but also in SUS.

Lapatinib

Exclusive to patients with advanced breast cancer, Lapatinib is also indicated for women with breast cancer who express HER2 protein, but does not respond to treatment with chemotherapy or trastuzumab.

Lapatinib inhibits functioning of the HER2 protein and thereby preventing tumor growth. It is administered orally and can cause side effects such as nausea, diarrhea, vomiting and rash.

There are ongoing studies to approve lapatinib as a treatment option for early stage breast cancer. "But, for now, it is only indicated for advanced cases after trastuzumab failure," explains the oncologist Vladmir. However, lapatinib is not available for SUS only for women with health insurance.

Bevacizumab

"Bevacizumab inhibits the formation of new blood vessels in the tumor," says Vladmir Cordeiro de Lima. This is necessary because every tumor needs to create new blood vessels to grow and grow. Bevacizumab inhibits vascular endothelial growth, preventing tumors from forming new blood vessels. Bevacizumab, given intravenously, is most often used in combination with chemotherapy. High blood pressure, tiredness, headaches, mouth sores and diarrhea are among the most common side effects. It is approved in Brazil as a first line treatment for any type of metastatic breast cancer. Bevacizumab is not yet available in the SUS for breast cancer treatment, but can be found in some health plans.

Ado-trastuzumab entansine

This target therapy is indicated for metastatic HER2 positive breast cancer after treatment failure with trastuzumab and / or pertuzumab. Unlike other target therapies, the ado-trastuzumab entansin necessarily requires the patient to be treated with conjugated DM1 chemotherapy. "This is because the drug connects to the chemotherapeutic, directly and specifically into the breast tumor cells that present the HER2 protein on the surface," explains the oncologist Vladmir.

Chemotherapy is a set of drugs that are infused by orally or directly into the bloodstream for the purpose of destroying, controlling or inhibiting the growth of diseased cells. Whether orally or intravenously, treatment is not done locally - that is, the drug will circulate throughout the body, including where the tumor is. This can cause the medication to affect other parts of the body, causing undesirable side effects such as nausea, hair loss and nail thinning.

When used in conjunction with ado-trastuzumab entansine, the chemotherapeutic is directed exactly to the cells prevent it from affecting other organs. It can bring side effects like fatigue, muscle and bone pain, headache, constipation and heart and lung problems. Recently approved by Anvisa, the drug is not yet available in the SUS.


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