Breast cancer is a complex form of cancer that could present differently in each individual. The biological composition of the tumor, such as its hormone receptors and mutations, might be considered when deciding on how to treat it. Progress in precision medicine makes it possible to shift from a general approach towards choosing medications based on the molecular aspects of cancer. In regard to the group of therapies for patients with advanced breast cancer who are hormone receptor-positive and HER2-negative, Alpelisib, Palbociclib, and Fulvestrant act via various mechanisms.
What Is Breast Cancer?
The condition of breast cancer arises from the proliferation of abnormal breast cells. The cells tend to develop into a mass and have the potential to penetrate the surrounding tissues or spread throughout the body. Breast cancer is not biologically similar in all cases since the approach to treating the condition goes beyond the location or the size of the tumor. Testing the breast cancer tissue for its reaction to hormones and certain molecular changes will assist in the diagnosis of the tumor. This helps to identify whether the treatment should be hormonal, targeted, chemotherapeutic, or all of the above.
What Are the Common Symptoms of Breast Cancer?
Symptoms of breast cancer differ from individual to individual, and some may not experience symptoms during the early stages of the disease. Symptoms could be related to the appearance of the breast, the nipple, or even the skin around the breast. Some of the symptoms are as follows:
- New lump or thickening in the breast or armpit
- Breast size or shape change
- Changes in the skin appearance (dimpling)
- Inverted nipple or an unusual change in appearance
- Discharge from the nipple which does not have an obvious cause
- Breast or nipple pain
- Redness or swelling of the breast or nipple which does not go away
What Are the Different Types of Breast Cancer?
Breast cancer can be grouped depending on the presence of specific markers in the malignant cells:
- HR-positive (hormone receptor-positive): These are cancers that have estrogen receptors, progesterone receptors, or both and might be responsive to hormonal therapy.
- HER2-positive: These are cancers that have an excess number of HER2 protein or amplified gene and are treatable using targeted drugs against HER2.
- Triple negative breast cancer: These cancers do not have any estrogen receptors, progesterone receptors, or HER2 expression and hence are treatable in a different way.
- HR-positive, HER2-negative, PIK3CA mutation: These are cancers that have the PIK3CA gene alteration which activates PI3K pathway.
How DoesPrecision Medicine Influence Breast Cancer Treatment?
In precision medicine, data on the molecular properties of the tumor is used in determining the treatment modality. Treatment is not limited to organ-specific approaches only but allows for the consideration of biomarkers that suggest certain pathways being involved in disease progression. In case of advanced breast cancer, there are tests available to determine the presence of estrogen and progesterone receptors, HER2 status and genetic mutations. In that way, targeted drugs may be included in the treatment regimen.
Which Medicines Can Be Used for Modern Breast Cancer Treatment?
Modern-day treatment of breast cancer may comprise of various drugs depending upon the receptors and genes present in the tumor. The following medications can be used for modern breast cancer treatment:
1.Alpelisib
It is a targeted therapy that is given orally in the treatment of some forms of advanced or metastatic breast cancer. Alpelisib belongs to a group of classes called PI3K inhibitors. However, medicine works by targeting particular changes within the body that contribute to the growth of cancer cells. The administration of this drug is determined by the biological properties of cancer in each patient.
Brands
Some of the brands of the tablet include:
- PIQRAY 150 mg
- ALPESIB 150 mg
The presence and form of a certain brand may differ from one country to another. Patients must take the therapy according to the prescription of the doctor.
Potential benefits of the medicine
The tablet offers an approach for those patients who have a relevant mutation in the PIK3CA gene. The targeted nature of the therapy makes it possible to use treatment to target a pathway which helps to slow tumor growth. Advantages of treatment include:
- Targeting the PI3Kα pathway.
- An alternative for PIK3CA mutated tumors.
- Treatment of the disease along with Fulvestrant.
- Targeted therapy after progression under endocrine therapy.
Possible Side effects caused by the medicine
There are several adverse reactions caused by the tablet, which should be monitored throughout treatment, including:
- Hyperglycemia
- Diarrhea
- Rash
- Nausea
- Decrease in appetite
- Weight loss
- Fatigue
2. Palbociclib
It is a targeted therapy that is taken orally and prescribed for certain forms of advanced/metastatic breast cancer. It is one of the medication that belong to a group of CDK4/6 inhibitors.
Brands
Names of Palbociclib brands are:
- PALBACE 125 mg
- PALBOXEN 125 mg
Dosage and duration of the drug should strictly be taken as per the oncology department’s prescription.
Potential Benefits of the medicine
The tablet may assist in preventing the progression of HR-positive, HER2-negative advanced or metastatic breast cancer by adding it to a suitable regimen based on endocrine therapy. Some of its possible benefits are:
- CDK4/6 inhibition.
- Delaying the cell cycle progress in cancer cells.
- Supplementing endocrine therapy.
- Offering an available targeted approach for advanced HR-positive, HER2-negative cancer.
Possible side effects caused by the medicine
Among the most notable side effects of the pill is neutropenia, a condition where the number of neutrophils decreases. This causes increased risk of infection. Other potential side effects include:
- Tiredness
- Anemia
- Low platelet count
- Nausea
- Sores in mouth
- Diarrhea
- Hair thinning
It is necessary for patients to undergo routine blood count tests during treatment periods. Based on results and adverse effects experienced, the treatment regimen can be adjusted accordingly.
3. Fulvestrant
The medicine is a hormonal-based medication that is utilized to treat specific types of breast cancers with positive hormone receptors. Fulvestrant falls under the category of drugs called selective estrogen receptor degraders (SERDs), which are administered via injections. However, the injection can be used on its own or in combination with other medications targeting different therapies.
Brands available
Some of the brand names of the Injection include:
It is given as an intramuscular injection, and the dose will depend on the oncologist prescribing the medication.
Potential Benefits of the medicine
It is an effective endocrine agent for selective patients who have HR positive advanced or metastatic breast cancer. Its capability of reducing the effects of estrogen receptor signaling makes it an effective agent that can be used in hormone therapies. Some of the possible advantages include:
- Targeting of estrogen receptors
- Reduction of estrogen signaling
- Achieving disease control in HR-positive breast cancer
- Partnering with select targeted drugs
Its applicability will depend on various considerations such as previous endocrine therapy and progression of the disease.
Possible Side effects caused by the medicine
The Injection is usually linked to reactions that may involve:
- Discomfort at the injection site
- Fatigue
- Nausea
- Weakness
- Musculoskeletal pain
- Hot flashes
Since this medication is given by way of intramuscular injections, temporary pain or discomfort in the area where the drug is injected may occur. The patient should discuss any bleeding problems or medications that increase the risk of bleeding with his/her doctor.
How Can These Medicines Be Used in Combination Therapy?
A combined treatment may prove useful in case of metastatic breast cancer since various drugs will work against different pathways that contribute to the development of tumor cells. Fulvestrant decreases the effects of estrogen receptors, whereas Palbociclib or Alpelisib targets other growth pathways. Whether this approach is going to yield positive results will depend on the biology of the tumor and prior treatment.
Conclusion
In current medicine, treatment of breast cancer is based on the underlying biological mechanisms of tumor development. The drugs Alpelisib, Palbociclib, and Fulvestrant affect distinct mechanisms in the development of HR-positive and HER2-negative breast cancer. Their use is decided depending on the biomarkers and other parameters. When used properly, these medications can help develop an individualized treatment regimen for breast cancer.
FAQs
1. Are these medicine appropriate for all patients suffering from breast cancer?
No, because it depends on several factors such as hormone receptors, HER2, PIK3CA mutation status, the state of the disease, previous medication and overall health of the patient.
2. Do pregnant women use these therapies?
Pregnant or breastfeeding women should discuss with their doctor before using these medications.
References
- Lukong, K. E. (2017). Understanding breast cancer–The long and winding road. BBA clinical, 7, 64-77. Https://www.sciencedirect.com/science/article/pii/S221464741630054X
- Koo, M. M., Von Wagner, C., Abel, G. A., McPhail, S., Rubin, G. P., & Lyratzopoulos, G. (2017). Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer epidemiology, 48, 140-146. Https://pubmed.ncbi.nlm.nih.gov/28549339/
- André, F., Ciruelos, E., Rubovszky, G., Campone, M., Loibl, S., Rugo, H. S., … & Juric, D. (2019). Alpelisib for PIK3CA-mutated, hormone receptor–positive advanced breast cancer. New England Journal of Medicine, 380(20), 1929-1940. Https://www.nejm.org/doi/full/10.1056/NEJMoa1813904
- Kim, E. S., & Scott, L. J. (2017). Palbociclib: a review in HR-positive, HER2-negative, advanced or metastatic breast cancer. Targeted oncology, 12(3), 373-383. Https://pubmed.ncbi.nlm.nih.gov/28488183/
- Roberston, J. F., Di Leo, A., Fazal, M., Lichfield, J., & Ellis, M. J. (2018). Fulvestrant for hormone receptor-positive advanced breast cancer in patients with visceral vs non-visceral metastases: findings from FALCON, FIRST, and CONFIRM. Cancer Res, 78(4 Suppl). https://www.researchgate.net/publication/387795712_Fulvestrant_Versus_Anastrozole_in_Endocrine_Therapy-Naive_Women_With_Hormone_Receptor-Positive_Advanced_Breast_Cancer_Final_Overall_Survival_in_the_Phase_III_FALCON_Trial
