Advances in breast cancer treatment
There are quite a number of new advances in the past decade for breast cancer treatment, I will only highlight a few.
1. Sentinel lymph node biopsy
Local treatment of invasive breast cancer has swung from radical to more conservation therapy in the past decade. Not only does more and more breast conservation therapy being performed, but also less and less surgery done to remove the lymph node in the axilla. The status of the lymph node in the axilla is a very important parameter of metastasis for clincians. But the conventional surgery of removing the lower levels of axillary lymph nodes is associated with complications of swelling of the arm. Hence sentinel lymph node biopsy of removing only the nodes related to the cancer helps, as it is of lesser magnitude but provides the same important information on the nodal status as conventional therapy.
2. Targeted therapy
Targeted therapy aims to treat specifically cancer that expresses a particular gene. HER-2/neu gene is very well studied gene in breast cancer. Its expression is associated with a poor prognosis and higher chance of recurrence, There has not been much development on treating cancer that carries this gene, except perhaps to predict better efficacy of certain drugs such as anthracycline. However, with the development of anti-HER therapy, the scenario has changed dramatically. Trastuzumab, for example, has given significant survival advantages when given in association with chemotherapy both in the metastatic and adjuvant settings. The published results showed that trastuzumab given for one year after surgery and chemotherapy for primary breast cancer provides close to 50% of disease-free survival benefit.
Lately, another molecule, Tycerb, has attracted much attention. Evidence has shown that it gives a response rate of about 29% for refractory and Trastuzumab resistant breast cancer, 33% for Trastuzumab naïve patients and over 65% for inflammatory breast cancer. Its is an oral agent with relatively low toxicity. More studies are now being conducted to test its efficacy postoperatively.
We first started using Trastuzumab in the second half of the last decade. We have also participated in the multi-centre trials. Our findings are in line with that of the published results. We have also conducted studied on Tycerb. We found that this compound is also effective in HER-2/neu expressing cancer.