The Margie Petersen Breast Center provides a variety of services from routine examination to oncologic treatment, starting with our breast clinic. Our multi-disciplinary team, including medical oncologists, surgeons, radiation oncologists, and genomics experts work together to devise the most effective treatment plan for each patient.
Systemic Therapies
Systemic therapies are treatments that are absorbed into the bloodstream and circulate throughout the body. These therapies include chemotherapy, biologic therapy, immunotherapy, and endocrine therapy. Medical oncologists are the specialist physicians who advise and guide these treatments. Some patients need systemic therapy after surgery to help reduce the risk of breast cancer recurring or spreading. This is called “adjuvant” treatment and is given to destroy any remaining cancer cells that might still be present after surgery. Sometimes systemic therapy is given before surgery to help shrink the cancer and make it easier to remove surgically. This is called “neoadjuvant therapy.” Systemic therapies are also used when patients have cancer that has returned or has spread to another part of the body.
Whether you need adjuvant or neoadjuvant systemic therapy, and which type will depend on several factors including:
- The type and stage of breast cancer
- The size of the cancer
- Whether the cancer cells have hormone receptors or overproduce certain proteins such as HER2-neu
- The presence or absence of cancer cells in the lymph nodes
- Histologic grade
- Results of special testing on the cancer cells such as OncotypeDx
Prior to receiving systemic therapies, our patients meet with a medical oncologist as part of our multidisciplinary treatment team. Once the treatment is determined, our patients also meet with an oncology nurse specialized in administering and caring for patients receiving systemic therapies to provide education about self-care during treatment.
Types of Systemic Therapies
Chemotherapy
Chemotherapy medications circulate throughout the body and kill cancer cells by interfering with their ability to reproduce. Typically, chemotherapy is given for approximately 3 to 6 months. The treatments are given by vein (IV) as an outpatient. Some treatments include daily pills as well as the IV treatments. Most treatments are given once every 2 or 3 weeks. Some treatments are given weekly. Many patients can function normally between treatments, including being able to go to work and care for their families.
Side effects of chemotherapy vary depending on the drug, the dose, the combination, and the schedule in which they are given. In general, these drugs can cause varying degrees of nausea, vomiting, low blood counts, tingling of the fingers and toes – known as neuropathy – and the weakening of heart muscle.
If chemotherapy treatments are recommended, other medications may also be prescribed to support the body as it responds to the chemotherapy and cancer cells are killed. Many kinds of drugs can be given to prevent or help minimize specific side effects. For example, if a chemotherapy drug is known to cause nausea and vomiting, anti-nausea drugs may be given. Patients may receive agents called colony-stimulating factors to increase the production of certain blood cells; and granulocyte colony-stimulating factor (G-CSF) which can stimulate the body to produce infection-fighting white blood cells.
Biologic Therapy Treatment
Biologic therapies target specific proteins or molecular pathways that breast cancer cells use to grow. Trastuzumab (Herceptin) is a monoclonal antibody that halts the growth of breast cancer cells by binding to the HER2-neu protein on cancer cells.
If the breast cancer is “HER2 positive,” this medication or other anti-HER2 medications may be offered to help prevent cancer recurrence. Trastuzumab is given intravenously. It works best when combined with standard chemotherapy for several months followed by a “maintenance” treatment of IV trastuzumab given every 3 weeks and continuing for one year of total therapy.
Patients who receive anti-HER2 therapy will often be monitored with an echocardiogram before starting the medication and periodically during the treatment period as there is a small risk that anti-HER2 therapy may damage the heart muscle. This is rare, and usually reversible.
Newer biologic agents that target HER2 include pertuzumab (Perjeta), lapatinib (Tykerb), and trastuzumab emtansine (T-DM1 or Kadcyla).
Immunotherapy
Drugs that stimulate a person’s own immune system to recognize and destroy breast cancer cells are known as immunotherapy. Also known as “checkpoint inhibitors,” these drugs interfere with protein signals that cancer cells use to grow and multiply. PDL-1 inhibitors are one category. Immunotherapy is usually given intravenously.
Endocrine Therapy Treatment
Anti-hormone therapy or endocrine therapy is often used to treat breast cancer. Breast cancer cells that have estrogen and progesterone receptors on the surface of the cells are known as estrogen and progesterone receptor-positive cancers.
Similar to chemotherapy, this form of therapy can be used to decrease the chance of cancer returning, to prevent a new breast cancer, as well as to treat cancer if it has spread. Endocrine therapy is absorbed and circulates throughout the entire body to destroy cancer cells that may be hidden, thereby preventing future cancer.
Tamoxifen
This medication was first approved by the FDA in 1977 for use in breast cancer patients. It stops estrogen from getting into cancer cells by blocking the estrogen receptor. It is useful for patients both before and after menopause. It is currently approved for use in women who are at risk for breast cancer, for those who have had ductal carcinoma in situ removed, for those who have had invasive breast cancer removed and for women who are being treated for metastatic breast cancer.
Aromatase inhibitors
There are three compounds used in the United States. They are anastrazole (Arimidex), letrozole (Femara), and exemestane (Aromasin). They were first approved by the FDA in 2000. They stop production of estrogen in fat tissue and adrenal glands but do not stop production of estrogen in the ovaries. They are used for women in menopause. They are NOT useful for patients who are pre-menopausal.
The two types of anti-estrogen medication have different side effects.
The medical oncologist will recommend which medication to use and the duration of treatment. There are ongoing research studies that are trying to determine the optimum length of time to take these medications.
Some premenopausal patients are candidates for ovary removal or chemical suppression of ovarian function.
New Developments in Breast Cancer Treatments
Targeted Therapy
Advancements continue to progress in targeted therapy, introducing new drugs that specifically target cancer cells while minimizing damage to healthy cells. One such drug is datopotamab deruxtecan (Dato-DXd), which targets the TROP2 protein found on cancer cells. This drug is currently in clinical trials for various types of breast cancer, including estrogen receptor-positive and triple-negative breast cancer
Another promising development is lasofoxifene, a hormone therapy targeting ESR1 mutations in breast cancer. This therapy is designed to stop the estrogen receptor even when it’s mutated, offering hope for patients whose cancer progresses despite initial treatment.
Advanced Imaging Techniques
Technological advances in imaging, such as 3-D mammography, are improving early detection of breast cancer. This method takes images from different angles around the breast and builds them into a 3-D-like image, potentially detecting cancer at a less advanced stage.
FDA Approvals
The FDA has recently approved new treatments for advanced breast cancer, providing more options for patients. These approvals include drugs that target specific cancer cell proteins and pathways, offering more personalized and effective treatment options.
We welcome your questions. Let us guide you through this process, whether a routine annual screening or more prolongued medical care. We are ready to support you.
Doctors who provide medial treatments
Contact the Margie Petersen Breast Center
The Margie Petersen Breast Center at Providence Saint John’s Health Center is widely renowned for its outstanding and compassionate patient care, expert surgical and medical team, and ability to evaluate any breast condition in one day fully.
Meet Our Breast Health Experts
The Breast Health Clinic can be reached at (310) 582-7209. If you have questions regarding a new symptom or want to make an appointment for evaluation please call and a staff member will assist with navigating you in the right direction.
