Advances in chemical pharmacotherapy to manage advanced breast cancer

ABSTRACT

Introduction: Advanced breast cancer is still incurable. However, patients diagnosed with this fatal disease live longer. The selection of systemic therapy is mainly based on molecular subtype. The aim of management in these patients is to not only improve outcome, but also to maintain quality of life.

Areas covered: In this paper we focus on available treatments and drugs under late development in the three main subtypes of breast cancer: luminal (hormone receptor positive), HER2 positive and triple negative disease. Main advances during the last years have been made in the treatment of HER2 positive breast cancer with the approval of several new targeted agents. Luminal breast cancer is also a field of active clinical research. So far triple negative breast cancer remains the subtype with the worse prognosis, even though new discoveries have been made to better understand the huge heterogeneity of this type of breast cancer.

Expert opinion: Several new treatment options have recently been established in metastatic breast cancer. Side effects are sometimes cumbersome for the patient and are difficult to manage easily. Thus, identification of patients who derive the most benefit is needed. In addition, collaborative efforts should integrate the genotypic fragmentation in the management and future clinical research strategies of metastatic breast cancer patients.

KEYWORDS:

• Metastatic breast cancer
• targeted therapies
• new treatments

Article highlights

• The selection of treatment in MBC patients is based on limited molecular subtypes

• CDK 4/6 inhibitors (palbociclib and ribociclib) and m-TOR inhibitor everolimus prolong progression-free survival in association with endocrine therapy in HR positive MBC

• Overall survival benefit has been obtained with double HER2 blockage (trastuzumab and pertuzumab) and the antibody drug conjugate T-DM1 in HER2 positive MBC

• Triple negative breast cancer in a heterogeneous disease. Better molecular characterization could help to identify therapeutic targets in small patient populations

• Ongoing trials will establish the role of immune checkpoint inhibitors in MBC as single agent or on combination

• Collaborative efforts are needed to better characterize MBC and to address patients with low-frequency molecular alterations

This box summarizes key points contained in the article.

Declaration of interest

A Awada has served on the advisory boards for Roche, Pfizer and Bayer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded