Advances in Breast Cancer Research (Credit: NCI and Other Labs)
“Advances in Breast Cancer Research was originally published by the National Cancer Institute.”
Unlocking the mysteries of breast cancer is crucial to combating this disease. Thanks to the support of the National Cancer Institute (NCI), researchers are making significant strides in prevention, detection, and treatment. They are also addressing disparities and striving to improve the quality of life for survivors.
New clinical breakthroughs are being discovered that offer hope for better care and NCI-supported programs igniting progress in the field.
Breast cancer is one of the few cancers that can be effectively screened using mammography. While MRI and ultrasound are also used for detection, they are not typically employed for routine screening in individuals with average risk.
Ongoing studies are examining ways to enhance current screening options for breast cancer. Thanks to technological innovations in imaging, there are exciting opportunities to improve both screening and early detection.
One such advancement is 3-D mammography, or breast tomosynthesis. This cutting-edge procedure captures images from multiple angles, creating a 3-D-like image of the breast. While it is increasingly available, its superiority over standard 2-D mammography for detecting early-stage cancer remains uncertain.
NCI is investing in the Tomosynthesis Mammography Imaging Screening Trial (TMIST), a large-scale randomized study that will compare the detection of advanced cancers in women screened with 3-D mammography versus 2-D mammography over a 5-year period.
In breast cancer screening, two concerns arise, as with any cancer screening:
1. Over-diagnosis: the potential to detect tumors that would not have posed a threat to the individual’s life
2. False-positive results: the anxiety-inducing possibility of having to undergo additional tests or procedures
As cancer treatment becomes more personalized, researchers are focusing on tailoring breast cancer screening to each woman’s individual risk factors. They are exploring screening methods that are appropriate for different levels of risk, aiming to minimize over-diagnosis.
The Women Informed to Screen Depending on Measures of Risk (WISDOM) study exemplifies this personalized approach. By incorporating each woman’s genetic makeup, family history, and other risk factors, researchers aim to determine if risk-based screening—screening at intervals based on individual risk—is as safe, effective, and accepted as the standard annual screening.
The WISDOM study is also actively striving to increase the enrollment of Black women. Previous studies have predominantly included White women, leaving a dearth of data on how screening can benefit Black women. Researchers are actively taking steps to ensure the study’s diversity, inviting as many Black women as possible to participate and contribute to this vital research.
Please note that the above information is referencing factual representation from the NCI and other research reports and intended not to be plagiarizing but rather informational to promote Breast Cancer Awareness and Breast Cancer Awareness month – October.
Breast Cancer Treatment
(credit: NCI experts discussing challenges in Breast Cancer Research / Learn about the challenges associated with breast cancer research in this excerpt from a Facebook Live event featuring Dr. Stan Lipkowitz and Dr. Alexandra Zimmer from NCI’s Center for Cancer Research.)
As we gain more understanding about different subtypes of breast cancer and their behavior, we can utilize this knowledge to inform treatment decisions. One example includes the NCI-sponsored TAILORx clinical trial, which focused on patients with ER-positive, lymph node-negative breast cancer. The trial revealed that a gene expression test can predict which women can safely forgo chemotherapy.
Additionally, the RxPONDER trial demonstrated that the same gene expression test can be used to determine treatment options for women with more advanced breast cancer. The study found that certain postmenopausal women with HR positive, HER-2 negative breast cancer, who have spread to multiple lymph nodes and have a low risk of recurrence, do not benefit from the addition of chemotherapy to their hormone therapy.
Moreover, genomic analyses through The Cancer Genome Atlas (TCGA) have provided further insights into the molecular diversity of breast cancer, allowing for the identification of additional breast cancer subtypes. This knowledge may eventually contribute to the development of therapies that target the specific genetic alterations driving these cancer subtypes.
Please note that the above information is referencing factual representation from the NCI and other research reports and intended not to be plagiarizing but rather informational to promote Breast Cancer Awareness and Breast Cancer Awareness month – October.
HR-Positive Breast Cancer Treatment
Hormone therapies have long been a fundamental part of treating HR-positive cancer. However, there is now a growing emphasis on incorporating targeted therapies alongside hormone therapy for advanced or metastatic HR-positive cancers. These treatments have the potential to delay the need for chemotherapy and, ideally, improve overall survival rates. FDA-approved drugs for this purpose include:
Ribociclib (Kisqali), Palbociclib (Ibrance), and Everolimus (Afinitor) have all received FDA approval for use in combination with hormone therapy to treat advanced or metastatic breast cancer. Ribociclib has shown promising results in increasing the survival of patients with metastatic breast cancer and slowing the growth of metastatic cancer in younger women when used in combination with hormone therapy.
Abemaciclib (Verzenio) can be used in conjunction with or after hormone therapy to treat advanced or metastatic HR-positive, HER2-negative breast cancer. In October 2021, the FDA approved abemaciclib in combination with hormone therapy for individuals who have undergone surgery for early-stage HR-positive, HER2-negative breast cancer.
Alpelisib (Piqray) is approved for use alongside hormone therapy to treat advanced or metastatic HR-positive, HER2-negative breast cancers with a mutation in the PIK3CA gene.
These developments offer new possibilities in the ongoing battle against HR-positive breast cancer.
Please note that the above information is referencing factual representation from the NCI and other research reports and intended not to be plagiarizing but rather informational to promote Breast Cancer Awareness and Breast Cancer Awareness month – October.
Treatment for HER2-Positive Breast Cancer
Several targeted therapies have gained FDA approval for the treatment of HER2-positive breast cancer, including:
Trastuzumab (Herceptin): Approved for preventing relapse in early-stage HER2-positive breast cancer patients.
Pertuzumab (Perjeta): Used to treat metastatic HER2-positive breast cancer and as neoadjuvant and adjuvant therapy.
Trastuzumab and Pertuzumab Combination: Can be used with chemotherapy to prevent relapse in early-stage HER2-positive breast cancer patients, and delay disease progression in metastatic cases.
Trastuzumab Deruxtecan (Enhertu): Approved for advanced or metastatic HER2-positive breast cancer patients who previously received HER2-targeted treatment. Clinical trials have shown its effectiveness in prolonging progression-free survival and tumor shrinkage.
Tucatinib (Tukysa): Approved for HER2-positive breast cancer that is inoperable or metastatic. It is particularly useful in cases where the cancer has spread to the brain due to its ability to cross the blood-brain barrier.
Lapatinib (Tykerb): Approved for some patients with advanced or metastatic HER2-positive breast cancer, to be used in combination with capecitabine or letrozole.
Neratinib Maleate (Nerlynx): Used in early-stage HER2-positive breast cancer patients and in combination with capecitabine for advanced or metastatic disease.
Ado-Trastuzumab Emtansine (Kadcyla): Approved for metastatic HER2-positive breast cancer patients who have received prior trastuzumab and taxane treatment. Also used in some early-stage patients with residual disease after neoadjuvant therapy.
Please note that the above information is referencing factual representation from the NCI and other research reports and intended not to be plagiarizing but rather informational to promote Breast Cancer Awareness and Breast Cancer Awareness month – October.
HER2-Low Breast Cancer
A newly defined subtype, known as HER2-low, comprises over half of all cases of metastatic breast cancer. HER2-low tumors are characterized by lower levels of the HER2 protein on their cell surfaces. Historically classified as HER2-negative because they were unresponsive to HER2-targeted drugs, recent clinical trials have shown that patients with HER2-low breast cancer experienced improved survival when treated with trastuzumab deruxtecan (Enhertu) compared to chemotherapy. As a result, this drug has received accelerated approval for its usage in HER2-low breast cancer patients.
Pembrolizumab Factoid
Immunotherapy has demonstrated enhanced survival benefits in triple-negative breast cancer, particularly in cases where tumors exhibited high levels of PD-L1. Pembrolizumab, used in combination with chemotherapy, has proven effective in extending the lives of such patients.
Triple-Negative Breast Cancer Treatment
Triple-negative breast cancers (TNBC) present significant treatment challenges due to the absence of hormone receptors and HER2 overexpression. Consequently, therapies targeting these receptors are ineffective against TNBC. Currently, chemotherapy remains the primary treatment approach for TNBC. However, new treatments are emerging, including:
Sacituzumab govitecan-hziy (Trodelvy): Approved for treating TNBC that has spread to other parts of the body, this drug is prescribed after at least two prior therapies have been attempted.
Pembrolizumab (Keytruda): an immunotherapy drug approved for use in combination with chemotherapy to treat locally advanced or metastatic TNBC, regardless of PD-L1 status. It may also be used for patients with early-stage TNBC.
PARP inhibitors, such as olaparib (Lynparza) and talazoparib (Talzenna): Approved for treating metastatic HER2-negative or triple-negative breast cancers in patients with an inherited BRCA gene mutation. Olaparib is also approved for certain patients with early-stage HER2-negative or triple-negative breast cancer.
Androgen receptor-blocking or androgen production-inhibiting drugs are currently being studied for use in a subset of TNBC cases that express the androgen receptor.
Please note that the above information is referencing factual representation from the NCI and other research reports and intended not to be plagiarizing but rather informational to promote Breast Cancer Awareness and Breast Cancer Awareness month – October.
Triple-negative breast cancer (TNBC)
The treatment of triple-negative breast cancer (TNBC) can be challenging as it lacks hormonal receptors and HER2 over-expression, making it unresponsive to targeted therapies. Consequently, chemotherapy remains the primary treatment option. However, there are emerging treatment alternatives, including:
Sacituzumab govitecan-hziy (Trodelvy): Approved for TNBC that has metastasized after at least two previous therapies.
Pembrolizumab (Keytruda): An immunotherapy drug used in combination with chemotherapy for locally advanced or metastatic TNBC with the PD-L1 protein. It may also be employed for early-stage TNBC, regardless of PD-L1 status.
PARP inhibitors such as olaparib (Lynparza) and talazoparib (Talzenna) are approved for metastatic HER2-negative or triple-negative breast cancer patients with an inherited harmful BRCA gene mutation. Olaparib is also approved for certain patients with early-stage HER2-negative or triple-negative breast cancer.
Additionally, there are ongoing tests of drugs that target androgen receptors or impede androgen production specifically for TNBC subsets expressing the androgen receptor.
Please note that the above information is referencing factual representation from the NCI and other research reports and intended not to be plagiarizing but rather informational to promote Breast Cancer Awareness and Breast Cancer Awareness month – October.
NCI-Supported Breast Cancer Research Programs
Numerous researchers funded by NCI, both at the NIH campus and across the globe, are actively seeking more effective approaches to address breast cancer. This research encompasses a wide range of areas, from investigating the biological foundations of cancer to examining the social factors that influence cancer risk. Additionally, clinical studies aim to translate this fundamental knowledge into improved patient outcomes. Below are a few examples of the breast cancer research initiatives supported by NCI.
The Breast Specialized Programs of Research Excellence (Breast SPOREs) aim to expedite the translation of scientific discoveries into clinical applications. These programs support the development of new therapies and technologies, as well as studies investigating tumor resistance, diagnosis, prognosis, screening, prevention, and treatment of breast cancer.
The NCI Cancer Intervention and Surveillance Modeling Network (CISNET) employs modeling techniques to enhance our understanding of how breast cancer outcomes are affected by prevention, early detection, screening, and treatment.
The Confluence Project, led by NCI’s Division of Cancer Epidemiology and Genetics (DCEG), focuses on creating a research resource that includes data from diverse racial and ethnic backgrounds, compiling information from thousands of breast cancer patients and controls. The goal is to identify genes associated with breast cancer risk, prognosis, subtypes, treatment response, and second breast cancers. (DCEG conducts various other breast cancer research as well.)
The Black Women’s Health Study (BWHS) Breast Cancer Risk Calculator is a tool developed through NCI-funded efforts, allowing health professionals to estimate the risk of developing invasive breast cancer over the next 5 years in US Black women. The tool aims to assist in making more personalized decisions regarding breast cancer screening, particularly for younger Black women.
The Breast Cancer Surveillance Consortium (BCSC), launched in 1994 and funded by NCI, strives to advance our understanding of breast cancer screening practices in the United States and their impact on the stage at diagnosis, survival rates, and mortality rates of breast cancer.
The National Cancer Institute (NCI) runs various programs to support research on prevention and early detection of different cancers, including breast cancer. Notable examples are:
The Cancer Biomarkers Research Group focuses on cancer biomarker research and oversees the Early Detection Research Network (EDRN). The EDRN is a collaboration of NCI-funded institutions that aim to discover and validate early detection biomarkers. Within the EDRN, the Breast and Gynecologic Cancers Collaborative Group focuses on research related to breast and ovarian cancers.
NCI’s Division of Cancer Prevention houses the Breast and Gynecologic Cancer Research Group, which promotes and develops research on the prevention and early detection of breast and gynecologic cancers.
Please note that the above information is referencing factual representation from the NCI and other research reports and intended not to be plagiarizing but rather informational to promote Breast Cancer Awareness and Breast Cancer Awareness month – October.
Breast Cancer Survivorship Research
The Office of Cancer Survivorship at the National Cancer Institute (NCI), a division of the Division of Cancer Control and Population Sciences (DCCPS), supports research projects across the nation that investigate various aspects of breast cancer survivorship. These studies, which have received funding, examine the impact of cancer and its treatment on physical well-being, emotional health, cognitive function, sleep patterns, and cardiovascular health. Additionally, financial implications, effects on caregivers, care models for survivors, racial disparities, and communication issues are also explored.
Breast Cancer Clinical Trials
The NCI oversees and funds early- and late-phase clinical trials aiming to develop new treatments and enhance patient care for breast cancer. These trials encompass prevention, screening, and treatment of breast cancer.
Breast Cancer Research Results
Below are some recent articles covering breast cancer research and study updates:
View the full list of Breast Cancer Research Results and Study Updates.
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