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Using Subtypes to Guide Treatment of Advanced Breast Cancer
Cancer

Date

For patients with breast cancer, knowing whether the diagnosis is early stage or advanced is needed to help treat the disease.

Vice-President and Chief Medical Officer for Georgia Cancer Specialists, Cheryl Jones, MD, has experience in treating patients with advanced breast cancer, an incurable but treatable disease, which comprises metastatic (stage IV) and locally advanced (stage III) breast cancer.

Metastatic breast cancer occurs when the cancer spreads to other parts of the body and is treated differently than earlier stages of the disease. Dr. Jones explains the importance of understanding tumor subtypes to help patients become more involved in treatment discussions.

Here she addresses questions about the different subtypes, which include human epidermal growth factor receptor-2 positive (HER2+) and hormone receptor-positive (HR+).

Q: How do HR and HER2 status help determine a treatment plan?

Dr. Jones: Each tumor’s genetic makeup helps oncologists identify the best approach to the treatment of advanced breast cancer.

HR+ tumors, which occur in approximately 70 percent of cases, are fueled by hormones like estrogen and progesterone. Therefore, postmenopausal patients may benefit from hormonal therapy, such as an aromatase inhibitor, which blocks the production of estrogen from helping the cancer grow.

If the breast cancer is HR-, accounting for about 15-20 percent of cases in the US, then we treat with drugs other than hormonal therapy, such as chemotherapy.

If the tumor overexpresses the HER2 gene it is known as HER2+ and requires aggressive treatment such as with drugs that target the HER2 protein. This occurs in about one in five breast cancers.

Q: What are the biggest considerations when treating advanced breast cancer subtypes?

Dr. Jones: For advanced HR+/HER2- breast cancer, we consider how this type can outsmart hormonal therapy over time and become resistant, resulting in tumor progression7.

Treatments exist that may extend the benefits of hormonal therapy. For example, Afinitor (everolimus) is a prescription medicine used to treat advanced HR+/HER2- breast cancer, along with the medicine exemestane (an aromatase inhibitor), in postmenopausal women who have already received certain other medicines for their cancer. Afinitor can cause serious side effects, including lung or breathing problems, infections and kidney failure which can lead to death

Even though HER2+ tumors tend to be more aggressive, HER2 targeted treatments also exist.

Tumors that are both HER2- and HR-, known as triple negative breast cancer, cannot be treated with HER2 targeted or hormonal therapies, so we will commonly use a combination of surgery, radiation and chemotherapy.

Afinitor is a prescription medicine used to treat advanced hormone receptor-positive, HER2-negative breast cancer, along with the medicine exemestane, in postmenopausal women who have already received certain other medicines for their cancer
Important Safety Information

Patients should not take Afinitor if they are allergic to Afinitor or to any of its ingredients. Patients should tell their health care provider before taking Afinitor if they are allergic to sirolimus (Rapamune) or temsirolimus (Torisel). Afinitor can cause serious side effects, including lung or breathing problems, infections, and kidney failure, which can even lead to death. If patients experience these side effects, they may need to stop taking Afinitor for a while or use a lower dose. Patients should follow their health care provider’s instructions.

In some patients, lung or breathing problems may be severe and can even lead to death. Patients should tell their health care provider right away if they have any of these symptoms: new or worsening cough, shortness of breath, chest pain, difficulty breathing, or wheezing.

Afinitor may make patients more likely to develop an infection, such as pneumonia, or a bacterial, fungal, or viral infection. Viral infections may include reactivation of hepatitis B in people who have had hepatitis B in the past. In some people these infections may be severe and can even lead to death. Patients may need to be treated as soon as possible. Patients should tell their health care provider right away if they have a temperature of 100.5?F or above, chills, or do not feel well. Symptoms of hepatitis B or infection may include the following: fever, chills, skin rash, joint pain and inflammation, tiredness, loss of appetite, nausea, pale stools or dark urine, yellowing of the skin, or pain in the upper right side of the stomach.

Afinitor may cause kidney failure. In some people this may be severe and can even lead to death. Patients should have tests to check their kidney function before and during their treatment with Afinitor.

Afinitor can cause incisions to heal slowly or not heal well. Patients should tell their health care provider if their incision is red, warm, or painful; if they have blood, fluid, or pus in their incision; or if their incision opens up or is swollen.

Common side effects include mouth ulcers. Afinitor can cause mouth ulcers and sores. Other common side effects include infections, feeling weak or tired, nausea and vomiting, skin problems, headache, weight loss, loss of appetite, cough, diarrhea, fever, swelling of the hands, arms, legs, feet, face, or other parts of the body, joint pain, abnormal taste, stomach-area (abdomen) pain, nose bleeds, increased blood cholesterol and sugar levels, decreased blood phosphate levels, low red and white blood cells, and the absence of menstrual periods (menstruation).

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