Targeted therapy is one method of treatment of malignant breast disease. It uses synthetic or natural substances for the purpose of destruction, control, or influence the behavior of cancer cells. Targeted therapy in breast cancer is assigned:
- At high risk of tumor spread in combination with other drugs, hormonal therapy or cytostatics.
- In order to eliminate suppression (inhibition) of the bone marrow caused by chemotherapeutic treatment .
Individually selected drugs, the dose and receive modes.
Drugs against the protein HER2 targeted therapy in breast cancer
ERBB2 (HER2 or HER2 / neu) is a mutated gene which promotes the growth of malignant tumors. It is representative of the family of epidermal growth factor receptors. This gene controls the growth and stimulates protein located on the surface of breast cancer cells. Every healthy cell contains two copies of the HER2 gene. Sometimes it is part of an excess amount of the gene, so the body produces too much of the protein HER2. This is called overexpression of HER2.
Trastuzumab is designed specifically for HER2 binding of additional proteins and stop the growth of tumors in women with HER2-positive breast cancer. The drug also helps to stimulate the immune system works. It is administered intravenously or as a subcutaneous injection. Can be applied in the following cases:
- In combination with cytotoxic drugs as adjuvant treatment after surgery in women with high risk for metastatic tumor. It is given the same time as chemotherapy or after it. Treatment may be continued for one year after completion of chemotherapy.
- Used as monotherapy for metastatic tumors. Admission is carried out until the disease progresses.
Treatment with this drug target therapy in breast cancer is conducted on an outpatient basis, typically three times per week. The first injection takes 90 minutes, with subsequent doses of the order of 30. If this injection is from 2 to 5 minutes. Within 2 hours (at the first dose - 6) the patient is in the hospital.
If carried out treatment of primary cancer, trastuzumab is accepted throughout the year, if secondary, until then will keep the disease under control.
To the common side effects include diarrhea, nausea, flu-like symptoms, to less common - vomiting, shortness of breath, headache, dizziness, heart problems.
Pertuzumab (Perjeta ®)
Pertuzumab (Perjeta ®) - Another formulation aimed at HER2 proteins. It is used with trastuzumab and a taxane (docetaxel) in the treatment of metastatic HER2-positive breast cancer, as well as locally advanced, when the tumor has penetrated the tissue and the lymph nodes under the breast, around the chest and neck - unable to remove it surgically. It can appoint to patients who have not received prior to this therapy against the HER2 protein or cytostatic treatment. Acceptance of trastuzumab and pertuzumab can last as long as the disease is kept under control.
Administered intravenously, usually in the arm or leg. Treatment of this tool targeted therapy in breast cancer is done on an outpatient basis for 3 weeks. Usually, the process takes 30 to 60 minutes or longer, if given with other drugs.
Among the potential adverse effects receive pertuzumab noted loss of appetite, diarrhea, nausea, skin rash, inflammation of the mouth, fatigue, febrile neutropenia (neutrophils critical reduction), anemia, labored breathing, itching, dryness, or skin, thinning hair or hair loss.
Emtanzin Trastuzumab (Trastuzumab emtansine)
Trastuzumab emtanzin (Trastuzumab emtansine) consists of trastuzumab and emtanzina (DM1), recently developed anti-cancer drugs. The medicament is administered intravenously. The indication is a HER2-positive breast cancer metastases in the absence of prior treatment with trastuzumab or taxanes, alone or in combination.
Lapatinib (Tykerb) - one of the group of anticancer drugs called tyrosine kinase inhibitors, stopping cell growth and division. Lapatinib is known as a dual kinase inhibitor, because it is directed against HER2 and HER1 receptor. It works within cancer cells by blocking the signals for their growth.
The drug is given only to patients with high levels of HER2. According to statistics, breast cancer is HER2-positive status only occurs in 20% of patients with breast cancer.
It is taken orally one hour before meals or one hour after it. Lapatinib can be prescribed, in combination with the following drugs for the treatment of metastatic tumors with HER2-positive status:
- Capecitabine (Xeloda) after failure of trastuzumab or other types of cytostatics.
- Letrozole (Femara) - this scheme is assigned to patients with postmenopausal estrogen-positive tumors common with HER2-positive status. This drug is hormone therapy.
Since Lapatinib targets only cancer cells, side effects less than after chemotherapy. Their number increases if connected hormone therapy or treatment with cytostatics. Among the common adverse effects of treatment noted a loss of appetite, nausea, diarrhea, skin reactions, fatigue and weakness, sometimes there are problems with the heart or liver.
Everolimus (also known under the brand name Afinitor) belongs to a group of drugs called inhibitors of mTOR. It blocks the mTOR protein, helping to stop or slow the growth of Cancer. Research continues to study its use in the treatment of malignant breast disease.
Everolimus is given in pill form once a day with or without food. He also appointed with exemestane - an aromatase inhibitor.
everolimus treatment offered to patients with postmenopausal ER-positive (estrogen receptor positive), HER2-negative or secondary recurrent breast cancer, where the disease has progressed or returned after reception of hormonal preparations letrozole or anastrozole.
Potential everolimus common side effects include fatigue, weight loss, feeling of weakness, headaches, pneumonia, cough, hyperglycemia, nausea and vomiting, diarrhea, inflammation of the mouth, taste changes, rash, high cholesterol.
If the drug is carried out in combination with exemestane can be added unwanted effects of the drug.
Colony stimulating factors (CSFs)
Colony stimulating factors (CSFs) are used to relieve some of the side effects of cancer treatment, particularly bone marrow suppression. They contribute to its stimulation, increase the production of blood cells. This helps reduce the risk of infection, anemia and bleeding because of low blood indicators.
Due to these factors, there is the possibility of oncological treatment in a full dose, which in their absence would have been subjected to the delay due to the low levels of blood. In some cases, the CSF provides high doses of chemotherapy or radiation.
With malignant breast tumors colony stimulating factors are administered, to be able to continue treatment certain cytotoxic drugs. Usually they are applied in the form of injections.
Types of growth factors, which are used in the treatment of this disease:
Granulocyte growth factors stimulate the production of white blood cells and reduce the risk of infection: Filgrastim (Neupogen), pegfilgrastim (Neulasta).
CSF promote the synthesis of red blood cells and used for the treatment of anemia: epoetin (Eprex, erythropoietin) and the drug darbepoetin (Aranesp).
Side effects of targeted therapy
Possible negative effects of targeted therapies have varying degrees of symptoms in different patients, they are caused by a type of medicines, dose and the state of their health in breast cancer.
Consider the common side effects that are typical of most drugs of this type of therapy.
A number of factors increase the likelihood of this phenomenon, including the number and type of medications. A side effect of drug combinations amplifies reception.
This is one of the most common adverse effects of targeted therapy in breast cancer. Assuta Hospital experts recommend mild analgesics. With the ineffectiveness of drugs, or the appearance of vertigo with headache obligatory consultation with a doctor.
Vomiting and nausea
Individual formulations of targeted therapies for breast cancer, these phenomena cause a greater degree of their combination.
Rashes on the skin can provoke certain medications. Marked redness, dryness and itching.
Help get rid of the rash moisturizer recommended by the attending physician. It needs to protect the skin from UV rays. You will need to apply sunscreen, wear a hat, pants and long-sleeved shirts.
Fatigue and weakness
This is a common and temporary problem with the reception of certain means of targeted therapy in breast cancer is often caused dose. In most cases, accompanied by flu-like symptoms.
To these symptoms usually include fever, chills, loss of appetite, vomiting, moderate pain in some parts of the body, nausea. They appear immediately after therapy and decrease after a while, when the body gets used to the drug. The injection before bedtime and intake of other drugs, such as acetaminophen (Tylenol), can help reduce these side effects.
Are rare, may be a reaction to any drug targeted therapy in breast cancer. Celebrating shortness of breath and wheezing, skin rash, cough, in severe cases, anaphylaxis.
The emergence of constipation can affect the type of medication; medication relieves gastrointestinal disorders robots; reducing the amount of fluid per day. It occurs within three to seven days after initiation of treatment.
Pain in muscles and joints
These symptoms are often accompanied by flu-like symptoms, their development is influenced by the dose of the drug. Will assist analgesics and uncomplicated exercise.
loss of appetite
The reason for this undesirable effects of targeted therapies can be disorders of the digestive tract in breast cancer, weakness and fatigue, the accumulation of toxins due to the destruction of abnormal cells in the body. Some women stop eating and lose weight. It is important to maintain a healthy diet, as it will help to restore the body.
Inflammation in the mouth
Higher doses of drugs can provoke an inflammatory process in the mouth - stomatitis. There are likely to develop infections and painful ulcers, careful and constant care reduces it. Doctors are instructed about this, if necessary, to reduce pain prescribe rinses and medications.
Jumps in blood pressure
Receiving certain means of targeted therapies for breast cancer can lower or raise the blood pressure. It is rare. During the beginning of the reception it is important to control the pressure to rise slowly to avoid dizziness.
damage to heart
Trastuzumab (Herceptin), especially in conjunction with anthracycline drugs - lapatinib (Tykerb), can cause disruption to the heart muscle, including trigger the development of congestive heart failure and arrhythmias. Before you start treatment and then during the meeting carried out functional tests - radionuclide angiography, echocardiogram. Heart problems observed in only a small number of patients. If this happens, it may temporarily suspend the acceptance of trastuzumab and chemotherapy.
Damage to trastuzumab may be reversible, anthracycline drugs is generally constant.