Breast cancer is a disease in which cells in the breast grow unmanageable and disorderly. There are different types of breast cancer. The type/nature of breast cancer typically depends on which cells in the breast turn into cancer.
Once, someone is diagnosed with this cancer, health specialists will try to figure out if it has progressed, and if so, how distant. This process is known as staging. The cancer stage describes how much cancer is developed in the body. It helps ensure how severe the cancer is and how best it can be treated. Health specialists also use the breast cancer stages when specifying survival statistics.
Targeted drug therapy is designed to target proteins on the cells of breast cancer that help them progress, replicate and live longer. Targeted drugs act to kill cancer cells or resist their growth. They have adverse reactions different from chemotherapy and can be given as IV, as an injection under the skin, or as a pill.
Certain targeted therapy drugs, for instance, monoclonal antibodies, act in more than single way to manage cancer cells and may also be considered immunotherapy as they are capable of boosting the immune system.
Like chemo, targeted drugs enter the bloodstream and reach all the possible areas of the body, which makes them effective against cancers that have progressed to different parts of the body. It is believed that targeted drugs sometimes work even when chemotherapy drugs do not. Certain targeted medicines can help make other types of treatment useful.
There are several types of FDA-approved targeted drugs for Breast Cancer that can be considered at the global level by health professionals.
- Targeted Therapy for HER2 +Ve Breast Cancer
- Targeted Therapy for HR +Ve Breast Cancer
- Targeted Therapy for Women with BRCA Gene Mutations
- Targeted Therapy for Triple -Ve Breast Cance
TARGETED THERAPY FOR HER2-POSITIVE BREAST CANCER
Estimated in 15- 20% of breast cancers, the cancer cells make excess HER2: a growth-promoting protein. These cancers, called HER2-positive breast cancers. HER2+ breast cancer progressed a bit more aggressively than HER2-negative. There are different types of medicines that have been approved by the FDA that target the HER2 protein.
Monoclonal antibodies are man-made antibodies that are designed to attach to a precise target. In this case, they attach to the protein named HER2 on cancer cells, which can help inhibit the cell’s progression.
Trastuzumab (Herceptin): Trastuzumab is FDA-approved and can be considered to combat early-stage as well as advanced breast cancer. It is often used with chemotherapy, but it might also be prescribed alone (in case chemotherapy alone has previously been used).
In case of neoadjuvant or adjuvant surgery to treat early breast cancer, Trastuzumab is usually prescribed for 6 to 12 months. To treat advanced breast cancer, this drug is often recommended for as long as it is effective. The drug Trastuzumab can be administered into a vein (IV) or as an injection under the skin (subcutaneous).
Trastuzumab is suppled under the original brand name Herceptin, but several biosimilars are now available as well, including Herzuma, Ogivri, Ontruzant, Trazimera, and Kanjinti.
Pertuzumab (Perjeta): This HER2 monoclonal antibody is used with trastuzumab and chemotherapy, either prior to or following surgery to tackle early-stage breast cancer, or to combat advanced breast cancer. This medicinal product is administered into a vein (IV).
Trastuzumab/Pertuzumab/Hyaluronidase (Phesgo): This is a combination of 3 medicines given as a subcutaneous (under the skin) shot over a few minutes.
Margetuximab (Margenza): It is a HER2 monoclonal antibody, used together with chemotherapy to combat advanced breast cancer, typically after minimum two other medicines that target HER2 have been used. This medicinal product is administered into a vein (IV).
Antibody-Drug Conjugates (ADC)
An ADC is a monoclonal antibody linked to a chemo drug. In this scenario, the anti-HER2 antibody works like a homing signal by attaching to the protein named HER2 on cancerous cells, bringing the chemotherapy directly to them.
Fam-trastuzumab deruxtecan (Enhertu): The trastuzumab deruxtecan is an ADC, that connects the HER2 antibody to a chemotherapy drug deruxtecan which is identical to irinotecan. It can be considered by itself to treat breast cancer that is hard to be removed with the help of surgery or has progressed to other organs of the body, usually after at least use of one other anti-HER2 targeted medicine. This medicinal product is given in a vein (IV).
This medicine can also be prescribed to combat HER2-low breast cancers that can’t be eliminsted with the help of surgery or that has progressed to other part of the body, typically after the use of chemotherapy.
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HER2 is a kind of protein named kinase, which is a protein in cells that typically relay signals (such as telling the cell to progress). Medicines that are designed to block kinases are know as kinase inhibitors.
Lapatinib (Tykerb): This medicinal product is supplied in the form of pill for oral administration. Lapatinib is widely used to combat advanced breast cancer. It is used along with medicine trastuzumab and the chemotherapy drug named capecitabine.
Tucatinib (Tukysa): Tucatinib is a kinase inhibitor, which is availabile to take as a pill, typically twice daily. It is used to combat advanced breast cancer, when one anti-HER2 targeted medicine has been used. It is used with medicine trastuzumab and the chemotherapy drug capecitabine.
Neratinib (Nerlynx): Neratinib is a kinase inhibitor and is supplied as a pill for oral administration. It is used to treat early-stage breast cancer when a patient has been treated with medicine trastuzumab for 12 months, and it is usually prescribed for 12 months.
TARGETED THERAPY FOR HORMONE RECEPTOR-POSITIVE BREAST CANCER
Estimated 3 of 4 breast cancers are hormone (estrogen or progesterone) receptor +Ve. For those with these cancers, hormone therapy is often effective. There are certsin targeted therapy drugs that make this therapy even more effective.
Ribociclib (Kisqali), Palbociclib (Ibrance), and abemaciclib (Verzenio) are medicines that inhibit proteins in the cell known as cyclin-dependent kinases (CDKs), specifically CDK4 & CDK6. Inhibiting these proteins in HR +Ve breast cancer cells helps halts the cells from dividing. This can resist the growth of cancer.
These medicines are approved for those with advanced HR-positive, HER2-negative breast cancer and are taken in the form of pills, usually once or twice daily.
For those with early-stage breast cancer that is HR-positive, HER2-negative, and has progressed to the lymph nodes, and has a high probability of coming back, abemaciclib can be used after surgery together with tamoxifen. It is prescribed for two years in the form of pills twice daily.
Everolimus (Afinitor): Everolimus supplied under the brand name Afinitor is known to inhibit mTOR, a protein in cells that helps them progress and divide. Everolimus also halt tumors from preparing new blood vessels, which limits their growth. In order to treat breast cancer, it seems to work better. It is availabile as a pill that is taken once daily.
Everolimus (Afinitor) is used for those who have gone through menopause and have advanced HR-positive, HER2-negative breast cancer. It is used along with the drug exemestane (Aromasin) for those whose cancers have progressed while being treated with medications either letrozole or anastrozole. It might also be prescribed with a hormone therapy drug named fulvestrant.
Alpelisib (Piqray): Alpelisib supplied under the brand name Piqray. It inhibits PI3K protein in cancer cells, which can help them stop progressing. This medicinal product is widely available as a pill that should be taken once daily.
Alpelisib can be used together with fulvestrant to treat postmenopausal women with advanced HR-positive, HER2-negative breast cancer with a gene mutation named PIK3CA that has grown during or after therapy with an aromatase inhibitor.
TARGETED THERAPY FOR THOSE WITH GENE MUTATIONS NAMED BRCA
Olaparib (Brand Name: Lynparza) and talazoparib (Brand Name: Talzenna) are medicines named PARP inhibitors. The proteins PARP generally help repair damaged DNA inside cells. The BRCA1/BRCA2 gene also help repair DNA, but mutations in one of those genes can inhibit this from happening. PARP inhibitors are designed to act by inhibiting the PARP proteins. These medicines supplied in the form of pills and are taken once or twice daily. They can be considereed in different ways for treating breast cancer.
TARGETED THERAPY FOR TRIPLE-NEGATIVE BREAST CANCER
In TNBC, which is also known as triple-negative breast cancer, the cancer cells typically don’t have estrogen or progesterone receptors and they form tiny or none of the protein named HER2.
Antibody-Drug Conjugate (ADC)
An ADC or antibody-drug conjugate is a monoclonal antibody joined to a chemotherapy medicine.
Sacituzumab Govitecan (Trodelvy): This antibody-drug conjugate (ADC) can be widely used by itself for treating advanced triple-negative breast cancer (TNBC), after at least two other chemotherapy regimens have been used. This medicinal product is administered in to a vein (IV) weekly for 14 days, followed by 7 days off, then restarted.