Targeted therapies for secondary breast cancer
Targeted therapies (sometimes called biological therapies) are newer drugs that work differently from chemotherapy. There are different types that all work in slightly different ways. These drugs are usually given with or following chemotherapy or occasionally with hormonal therapy.
At the moment, Herceptin® is the only targeted therapy approved by the NICE and the SMC to treat secondary breast cancer.
Lapatinib (Tyverb®) and bevacizumab (Avastin®) are other targeted therapies, which may be used in certain circumstances, but aren’t widely available on the NHS.
These and other targeted therapy drugs are sometimes given in clinical trials.
In some situations a specialist may apply to a health board or trust for individual funding for certain drugs. If you live in England some drugs may be available through the Cancer Drugs Fund. Your specialist can discuss this with you and tell you if they think any of these drugs are suitable for you.
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Herceptin (trastuzumab) is a monoclonal antibody drug.
It’s the main targeted therapy used in women with HER2 positive breast cancer. Herceptin locks onto the HER2 protein and blocks the receptor stopping the cancer cells from dividing and growing.
You will usually have Herceptin every three weeks as a drip (infusion). It is given in combination with chemotherapy or following chemotherapy and occasionally with hormonal therapy. Your cancer specialist will explain the most appropriate way for you to have it.
The side effects are often mild but some women may have:
an allergic reaction.
In some women, Herceptin may cause damage to the heart. If this happens it may be stopped for a while. You will have tests to check your heart before and during treatment.
If secondary breast cancer continues to grow in areas outside the brain and spinal cord (central nervous system), Herceptin is usually stopped.
But if the cancer starts to grow in the central nervous system (CNS), treatment with Herceptin can continue. Although Herceptin doesn’t work for secondary cancer in the CNS it may carry on controlling secondary breast cancer in other parts of the body. Other treatments are used to control the cancer in the CNS.
Trastuzumab emtansine (T-DM1)
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This drug is a combination of trastuzumab and a chemotherapy drug called emtansine. Herceptin delivers the chemotherapy to the cancer cells. This drug may be given in a clinical trial.
Pertuzumab is a new monoclonal antibody drug that is being tried in trials in combination with Herceptin and chemotherapy drugs. Some results show that Herceptin and pertuzumab work better together.
Lapatinib can also be used in women with HER2 positive breast cancer. It is a type of drug called a tyrosine kinase inhibitors. Kinases are proteins in the body that are important in regulating how cells work and grow. Lapatinib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide.
Lapatinib is given as a tablet. It can be given in combination with the chemotherapy drug capecitabine (Xeloda®), or with an aromatase inhibitor in postmenopausal women.
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Bevacizumab is also a monoclonal antibody which works by stopping the cancer from developing new blood vessels.
This reduces the cancer’s supply of oxygen and nutrients, which may shrink the tumour or stop it growing.
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This drug can be prescribed in combination with exemestane in women with estrogen receptor positive breast cancer. It can only be used in certain situations or within clinical trials. The side effects are tiredness, sore mouth, skin rash and rarely inflammation of the lung.