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The novel therapeutic landscape in breast cancer
by Scarlett Zou Best Blog on Biochemical During the past 20 years, we assisted to a complete transformation of the standard of care in breast cancer. Systematic screening and early diagnosis, combined with an impressive arsenal of targeted therapies, have changed forever the prognosis of the majority of breast cancer patients.For HER2-positive breast cancers, diagnosed in approximately the 15% of the patients, we have now several targeted drugs that specifically hit cancer cells. Trastuzumab, an antibody against HER2, was the first of such agents that demonstrated significant activity first in metastatic setting, and then also in the adjuvant setting. After this success, other antibodies and kinase inhibitors against HER2 have been developed. Pertuzumab (another antibody), trastuzumab and chemotherapy are not the standard of care for HER2-positive breast cancer patients in most hospitals, but there are also other exciting compounds such as antibody-drug conjugates (T-DM1) and kinase inhibitors (lapatinib and neratinib). Several clinical trials are currently ongoing to test additional combinations of novel anti-HER2 molecules not only in breast but in other tumors that express the HER2 receptor (gastric cancer, lung cancer, etc).
For the triple negative subgroup of breast cancer, approximately a 10-15% of the cases, chemotherapy was the only therapeutic option until a few years ago. With the latest discoveries released in the past two years, we now know that immunotherapy is very effective in this disease, improving survival in the metastatic setting and improving pathological responses in the pre-operative setting. Moreover, a fraction of triple negative breast cancers is exquisitely susceptible to DNA damaging agents such as PARP inhibitors. These molecules are already changing the standard of care of ovarian cancer patients and they may be soon available for breast cancer patients with specific genetic defects.
For the rest of the patients, who are expressing hormonal receptors and whose tumors are dependent on hormones, there are also several options beyond chemotherapy. In addition to the “old” and “new” anti-hormonal molecules, inhibitors of enzymes called CDK4/6 are now given to the majority of the patients, with excellent results. Recently, PI3K inhibitors have also shown strong antitumor efficacy in about 40% of these patients, whose tumors carry specific mutations in a gene called PIK3CA. CDK4/6 and PI3K inhibitors are given in combination with anti-hormonal therapy (sometimes even without chemotherapy) because they work much better in combination.
Beyond these drugs, many other molecules and therapeutic options are being studied in clinical trials, some of which enroll patients based on their genetic characteristics.
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About Scarlett Zou 
Best Blog on Biochemical
13 connections, 0 recommendations, 65 honor points.Joined APSense since, October 17th, 2019, From Watertown, United States.
Created on Oct 21st 2019 03:04. Viewed 511 times.
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