Other targeted therapies
Everolimus ("Afinitor")
Research has shown that over time, tumours develop resistance to endocrine therapies such as Femara, Arimidex and Aromasin. This is one of the reasons why someone might "progress" on such a treatment - the cancer works out a way to resist the killing mechanisms of such drugs.
Everolimus is a signal transduction inhibitor which blocks the protein mTOR. The mTOR protein instructs other proteins to trigger cancer cells to reproduce. Everolimus blocks the mTOR pathway and therefore helps to stop tumours from growing.
In the pivotal study BOLERO-2, the women with hormone receptor positive, HER2 negative metastatic breast cancer who received Everolimus in combination with Exemestane took nearly twice as long (on average) to progress in comparison to the patients who received Exemestane alone (7.8 months vs 3.2 months).
As a result of this evidence, Everolimus is on the PBS for the treatment of metastatic breast cancer in women who are post-menopausal, in combination with the aromatase inhibitor Aromasin. It is taken once daily, at the same time everyday with a low, fat-free meal.
Everolimus has some very particular side effects associated with it, which my nurse will educate you on if you get prescribed this treatment. Jenny and I have treated many patients with this drug combination and Jenny is in fact regarded as a national expert on the management of the side effects associated with Afinitor. The side effects are all manageable with the right advice and a bit of stopping and starting and usually subside after the first couple of months. The most common side effects are listed below:
Information on the Afinitor / Aromasin combination can be found here.
Research has shown that over time, tumours develop resistance to endocrine therapies such as Femara, Arimidex and Aromasin. This is one of the reasons why someone might "progress" on such a treatment - the cancer works out a way to resist the killing mechanisms of such drugs.
Everolimus is a signal transduction inhibitor which blocks the protein mTOR. The mTOR protein instructs other proteins to trigger cancer cells to reproduce. Everolimus blocks the mTOR pathway and therefore helps to stop tumours from growing.
In the pivotal study BOLERO-2, the women with hormone receptor positive, HER2 negative metastatic breast cancer who received Everolimus in combination with Exemestane took nearly twice as long (on average) to progress in comparison to the patients who received Exemestane alone (7.8 months vs 3.2 months).
As a result of this evidence, Everolimus is on the PBS for the treatment of metastatic breast cancer in women who are post-menopausal, in combination with the aromatase inhibitor Aromasin. It is taken once daily, at the same time everyday with a low, fat-free meal.
Everolimus has some very particular side effects associated with it, which my nurse will educate you on if you get prescribed this treatment. Jenny and I have treated many patients with this drug combination and Jenny is in fact regarded as a national expert on the management of the side effects associated with Afinitor. The side effects are all manageable with the right advice and a bit of stopping and starting and usually subside after the first couple of months. The most common side effects are listed below:
- Stomatitis (mouth ulcers) - regular mouth washing is very important. Contact Jenny straight away if you get any mouth ulcers and she will instruct you on the next steps to take.
- Rash - a pimple like rash is common on the face, neck, upper torso and scalp.
- Pneumonitis - can occur months after the start of treatment. Let Jenny or myself know if you are experiencing any worsening shortness of breath or cough.
- Increases in your blood sugar and cholesterol levels
Information on the Afinitor / Aromasin combination can be found here.
Palbociclib (Ibrance), Ribociclib (Kisquali) and Abemaciclib (Verzenio) - the CDK inhibitors
Information to come....
Information to come....
Fulvestrant ("Faslodex")
Fulvestrant is a selective estrogen receptor modulator (SERM) which targets the oestrogen receptor on the surface of the breast cancer cell. Fulvestrant actually binds to the estrogen receptor on these cells and “down-regulates” it. This means that it reduces the amount of the receptor that is present and deprives the cell of an essential growth stimulant.
Unfortunately despite its common use in the UK and USA and multiple trials proving that Fulvestrant is an effective treatment for hormone receptor positive, HER2 negative metastatic breast cancer, it is not yet available on the PBS in Australia. It is however available via a patient access scheme where the drug company and patient share the cost of the drug. The total approximate cost of the program to you as the patient is approximately $2500.
Fulvestrant is a selective estrogen receptor modulator (SERM) which targets the oestrogen receptor on the surface of the breast cancer cell. Fulvestrant actually binds to the estrogen receptor on these cells and “down-regulates” it. This means that it reduces the amount of the receptor that is present and deprives the cell of an essential growth stimulant.
Unfortunately despite its common use in the UK and USA and multiple trials proving that Fulvestrant is an effective treatment for hormone receptor positive, HER2 negative metastatic breast cancer, it is not yet available on the PBS in Australia. It is however available via a patient access scheme where the drug company and patient share the cost of the drug. The total approximate cost of the program to you as the patient is approximately $2500.
Immunotherapies
Immunotherapies such as Pembrolizumab ('Keytruda") have been making their mark on the world in recent times following landmark results in patients with Melanoma. These agents have a complex mechanism of action, however I will try to explain as simply as possible how they work.
The immune system produces T-cells to find cancer cells (amongst other things) and kill them. T- cells contain on their surface a protein called programmed cell death 1 receptor (PD-1). This binds with the programmed death 1 receptor ligand (PDL-1) often found on the surface of a cancer cell, and this enables the cancer cells to hide from the immune system.
Pembrolizumab blocks PDL-1, therefore stopping the cancer cell from binding to PD-1 and hiding from it . This "presents" the cancer to the immune system, which as a result attacks it and kills it. This is probably better explained in the picture below:
Immunotherapies such as Pembrolizumab ('Keytruda") have been making their mark on the world in recent times following landmark results in patients with Melanoma. These agents have a complex mechanism of action, however I will try to explain as simply as possible how they work.
The immune system produces T-cells to find cancer cells (amongst other things) and kill them. T- cells contain on their surface a protein called programmed cell death 1 receptor (PD-1). This binds with the programmed death 1 receptor ligand (PDL-1) often found on the surface of a cancer cell, and this enables the cancer cells to hide from the immune system.
Pembrolizumab blocks PDL-1, therefore stopping the cancer cell from binding to PD-1 and hiding from it . This "presents" the cancer to the immune system, which as a result attacks it and kills it. This is probably better explained in the picture below:
Immunotherapies and breast cancer
Keytruda has been recently listed on the PBS for the treatment of metastatic melanoma. At this present time, there is no strong evidence to show that these drugs work as well in breast cancer as they do in melanoma.
There are several clinical trials in progress at present throughout the world looking to examine this. These trials are testing Pembrolizumab in both HER2 positive metastatic breast cancer patients as well as hormone receptor and HER2 negative ("Triple Negative") breast cancer patients.
We have access to some of these clinical trials at Macquarie University Hospital and will discuss them with you if you are potentially eligible to partake in a clinical trial.
More information on Clinical Trials can be found here.