The race for knowledge about breast cancer

Oncology is constantly evolving, always in search of better diagnostic techniques, development of new drugs and knowledge of the mechanisms by which tumors develop resistance to treatment. In the area of ​​breast cancer, this constant race for advancement has shown an impressive evolution and benefit to all patients.

The incidence of this disease is quite high, one in eight women may develop breast cancer at some point in their lives, whether in young or older people.

First, you need to divide breast cancer into at least 3 different groups. The 1st, sensitive to the hormone and without expression of the protein called Her2; the 2nd corresponds to the Her2 positive tumor, which presents this overexpressed protein; and the 3rd, called triple negative, does not express any of the 3 receptors (estrogen, progesterone and Her2).

Fonte: Shutterstock

For hormone-sensitive tumors, some medications, such as the cyclin inhibitor class, have made robust gains for the treatment of advanced disease. We have three drugs approved for use in Brazil (palbociclib, ribociclib and abamaciclib), and their use combined with hormonal therapy doubles the time to control the disease, improves quality of life and delays the start of chemotherapy, in addition to increasing the time for lives of patients, who live longer and better after the incorporation of these drugs.

With all this positive impact and controllable toxicities, these medications continue to be studied in the initial or localized disease. There is still not enough data to say that these medications would also benefit in advanced disease. Specialists are working to gain more knowledge about treatments, but this takes time and, however much progress has been made, there is still a race for scientific evidence to better target treatment for each patient. This analysis is essential to be able to give the right medication to the right patient.

Breast cancerFonte: Shutterstock

Today, there is a lot of knowledge that allows the development not only of better treatments, but also the follow-up of patients. A common blood collection can detect, in the circulation, fragments of DNA from the tumor cell, the so-called liquid biopsy. This new method makes it possible to monitor the evolution of the tumor and the eventual development of the drug-resistance organism earlier, supporting the oncologist in their conduct.

In the field of new treatments, there is already a new class of drugs in Brazil, such as trastuzumab deruxtecan, specific for women with breast cancer who express the Her2 protein. This medication is composed of an antibody (trastuzumab) that is conjugated to the drug (deruxtecan). This allows the drug to enter only the tumor cell that has high levels of the Her2 protein, being a very specific delivery system, reducing the side effects of the treatment — once inside, an explosion is triggered that destroys the cell and those to around you. This has been shown to be highly effective in advanced disease in patients who have been previously treated with chemotherapy and other anti-Her2 antibodies.

The greater understanding of the disease, its biology and the molecular changes often related to the development of resistance to treatment has contributed to the creation of more intelligent, targeted and less toxic molecules, which has been transforming the advanced disease into a chronic one, whose treatment is lasting, but it is also responsible for the positive impact on cancer control, on the quality and length of life of patients, enabling them to live better.

This text was produced in partnership with the Dra. Fabiana Betoni, researcher at the Hospital Sírio-Libanês.

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