The German Society for Senology (DGS) has been advocating for women’s breast health for a good four decades. The special feature of the professional society is its interdisciplinarity. To ensure the best possible care for those affected, the experts exchanged views on prevention, early detection and individual treatment approaches.
Under the motto “Together against breast cancer: optimal treatment for every patient”, breast carcinoma was once again the focus of attention. Breast cancer is now the most common cancer worldwide. Treatment options in early and advanced stages are varied. Interdisciplinary cooperation is essential for the success of therapy, as is commitment to prevention and early detection.
In recent years, the treatment of breast carcinoma has continued to improve. New targeted therapies have been developed and introduced into clinical practice for patients with metastatic breast cancer. Some of these therapies have been developed for subgroups of patients, such as the CDK4/6 inhibitors or the anti-HER2 antibodies pertuzumab and T-DM1. Other drugs require more detailed testing of genetic alterations in the tumor, such as the PI3K inhibitor Alpelisib, or in the germline, such as the PARP inhibitors, for indication. Finally, immunotherapy with checkpoint antibodies is now also established in triple negative breast carcinoma. Immunotherapy with second-generation antibody-drug conjugates show high potential of this group of drugs.
Advanced HER2 positive breast carcinoma.
The treatment of patients with HER2-positive advanced breast carcinoma, is characterized by the use of targeted anti-HER2 drugs. With the antibodies trastuzumab, pertuzumab and the antibody-drug conjugate T-DM1, very effective anti-HER2 drugs are already in use for the treatment of HER2-positive breast cancer. The fixed-dose combination of pertuzumab and trastuzumab also facilitated treatment. Thus, double antibody blockade can be used to treat a particularly aggressive form of breast cancer and significantly prolong the lives of affected women.
Advanced HER2 negative breast carcinoma
The immune checkpoint antibodies have now also found their way into the therapy guidelines for triple negative breast carcinoma. Following the approval of the immune checkpoint antibody atezolizumab in combination with nab-paclitaxel in the first line of therapy for patients with metastatic breast cancer, data are now available with the antibody pembrolizumab in the first line of therapy. In tumors with a high immune score, the addition of pembrolizumab to chemotherapy prolonged progression-free survival.
In HER2-negative hormone receptor-positive breast carcinoma, therapy with the three CDK4/6 inhibitors palbociclib, ribociclib, and abemaciclib has become the new standard of care. This therapy has proven efficacy in combination with both aromatase inhibitors and fulvestrant, improving progression-free, and in some studies overall, survival to over 60 months in some cases.
Detect early stages of disease
Treatment of patients with early breast cancer has always been characterized by escalation through new therapies and de-escalation through identification of better therapeutic regimens or introduction of better tools to assess prognosis. The results of the large de-escalation studies using multi-gene testing show that this approach can spare many patients with hormone receptor-positive breast cancer from chemotherapy. Several large-scale studies investigating the role of CDK4/6 inhibitors in adjuvant therapy are now available. The MONARCHE trial demonstrated that combining anti-endocrine therapy with abemaciclib improved outcomes for high-risk patients with hormone receptor positive tumors. Further progress has been made in patients with BRCA1/2 germline mutations, where the PARP inhibitor olaparib has significantly improved treatment outcomes. In triple-negative breast carcinoma, the addition of the immune checkpoint antibody pembrolizumab to chemotherapy significantly increased progression-free survival.
Personalization in radiotherapy
Personalization in radiotherapy has long been a reality. Depending on age, tissue characteristics of the tumor, prognosis and treatment goal (curative vs. palliative), the total radiation dose and the exact procedure are individually planned by computer. Modern precision radiation techniques often allow higher/higher doses of radiation to be applied in a few sessions without causing too much stress to the tissue surrounding the tumor. Since most recurrences occur in the so-called tumor bed, surgical breast-conserving removal of the tumor is followed by radiation therapy to reduce the risk of local recurrences.
Congress: 41st Annual Meeting of the German Society of Senology
InFo ONCOLOGY & HEMATOLOGY 2022; 10(4): 24.
