Advanced Breast Cancer Treatments [video]

Video author: Streaming Well
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Video Transcript

Streaming Well

Choosing treatment for advanced breast cancer

There are many different treatment approaches for secondary breast cancer, Professor Rob Coleman - Honorary Consultant, Weston Park Hospital, because we have to face the reality that secondary breast cancer, although it's treatable and although you can live for years--maybe even 10 years--ultimately, it is a fatal disease.

So issues around quality of life become increasingly important when the cancer has spread. And then there's a really important dimension to this which is about what is acceptable to the patient, what are her expectations, what is the balance between benefit and side effects that she's prepared to accept.

For the patient, what she wants is a remission of her disease and a relief of symptoms and of course, where possible, to extend life.

Types of treatment

Breast cancer is more than one disease. We've learned that over recent years that you can subdivide breast cancer and, indeed, advanced or secondary breast cancer into different subtypes. Hormone sensitive, also known as hormone receptor or ER positive breast cancer, is stimulated to grow by the hormones estrogen or progesterone.

About 2 out of 3 breast cancers are hormone sensitive. In 20% to 25% of patients, the breast cancer cells have too many receptors for a protein called HER2. HER2 positive breast cancer tends to spread faster than other forms.

Around 10% to 17% of breast cancers are known as triple negative because they lack estrogen and progesterone receptors and do not overexpress the HER2 protein. These subtypes respond to drugs in different ways, so you will be put onto the treatment protocol for your type of cancer.

There are 3 main classes of drugs. Hormone therapy or sometimes called endocrine treatment are drugs that essentially affect the estrogen levels within the patient. Chemotherapy is a term given to drugs that are usually given by injection, although there are tablet forms. They may be given one at a time or in combination, and they are a much tougher form of treatment. They essentially poison the cancer cell by different means and therefore, although they may be good for the cancer, they will have some significant side effects for most patients.

And then the third area of treatment is what we call targeted therapy or biological treatments, and this is really where we're seeing
the explosion of new opportunities for patients because these drugs target what's fundamentally wrong with the cancer cell. Targeted drug therapies such as Herceptin can be really effective for the HER2 subtype that don't work with other cancers.

For patients who are offered chemotherapy, decisions sometimes have to be made about how aggressive the treatment should be. The most active drug in secondary breast cancer is docetaxel or Taxotere, but it's a tough treatment. It affects your hair. It makes you feel very tired and achy. You're very prone to infection. So it's not for everybody. But if you really want to get on top of the cancer, that's a good choice.

Then there are drugs that don't affect your hair. Capecitabine would be one of them; carboplatin would be another. We can often tailor treatment to the wishes and expectations of patients to match up benefit against side effects.

But the general rule is the better the treatment, the worse the side effects. So there's always a trade-off there. I've got a patient at the moment who unfortunately has got disease affecting her liver and her lungs, but she's a real dynamo. She wants to continue to work, she's trying to build a new house in Wales, and she wants to complete that project. And she will cope with anything that is thrown at her. She wants the best treatment, the toughest treatment, and the option that's going to let her live longest.

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